Uloga otalgija u diferencijalnoj dijagnostici temporomandibularnih poremećaja

Otalgia (earache) is pain presented in the ear, which does not necessarily originate from the ear (primary otalgia). In the differential diagnostics of (secondary) otalgia cervicocephalic syndrome, temporomandibular disorders, odontogenic pathology, parotitis, tonsillitis, pharyngitis, epiglottis, oesophagitis and malignant tumours infiltrating trigeminal, vagal or auricular (cervical) nerves branches from oesophagus inferiorly and skull base cephalad, should be considered. Primary otalgia is usually confined to external otitis or acute otitis media, while it is rarely found as a symptom of chronic otitis media, except in exacerbations. In the chronic otitis media earache is usually a sign of complication and expansion of inflammation to the dura and cranial nerves. In the differential diagnostics of primary otalgia otoscopy and otomicroscopy are necessary, as well as radiologic work-out, where CT and MRI scans are replacing former conventional x-.ray Schuller and Stenvers views. If otalgia is associated with hearing or balance disorders without clinical manifestation of otitis, the etiology is most commonly viral neuritis of temporal bone nerves, and otoneurological diagnostic workout should be considered. If (secondary) otalgia is associated with dysphagia or odinophagia, the most common etiology would be tonsillopharyngitis, but quinsy, epiglottitis, tongue base abscess, parapharyngeal abscess, and tumours of pharynx, tonsill or tongue base or epiglottis should be considered. Eagle syndrom or elonged styloid process syndrom is also characterised by painful swallowing and referred otalgia. Earache can be caused by temporomandibular disorders, where otalgia is usually increased by mastication and joint palpation. The role of otorhinolaryngologist is to exclude otogenic and pharyngogenic otalgia, and the differential diagnostics should include workout considering cervicogenic otalgia (cervical spine x-ray or MRI), temporomandibular disorders (TMJ x-ray, dentist consultation), or odontogenic otalgia (dentist consultation). The diagnostic workout of otalgia should include radiologist, dentist, reumatologist, and neurologist.Otalgija je bol koja se prezentira u području uha, međutim to ne uključuje nužno otogenu etiologiju. U diferencijalnoj dijagnostici otalgije dolaze u obzir cervikocefalni sindrom, artralgija temporomandibularnog zgloba, odontogeni procesi, parotitis, tonzilitis, faringitis, epiglotitis, ezofagitis te maligni tumori s infiltracijom grana trigeminusa, vagusa i auricularis magnusa, koji se inferiorno šire do područja jednjaka, a kranijalno do lubanjske baze. Otogena bol najčešće se susreće u upalama vanjskog i srednjeg uha, dok je rijetka u kroničnim upalama, osim u fazama egzacerbacije. Kod kroničnih upala srednjeg uha, bol je znak komplikacije i širenja bolesti prema duri ili kranijskim živcima. Za diferencijalnu dijagnostiku otogene boli nužna je otoskopija, katkad mikrootoskopija, te radiološka dijagnostika, ranije konvencionalne snimke temporalne kosti po Schulleru i Stenversu, koje danas sve više zamjenjuje CT i MRI. Ako je bol povezana s ispadom sluha ili ravnoteže, što je najčešće rezultat virusnog neuritisa u temporalnoj kosti, a bez kliničke manifestacije otitisa, u obzir dolazi i audiovestibulološka dijagnostika. Ako je otalgija povezana s disfagijom ili odinofagijom, najčešće je riječ o tonzilofaringitisu, ali u obzir dolaze i peritonzilarni apsces, epiglotitis, apsces korijena jezika, parafaringealni apsces, tumor ždrijela, tonzile, korijena jezika ili epiglotitis. Eaglov sindrom, sindrom elongiranog stiloidnog nastavka, također uključuje bolno gutanje i refleksnu bol u uhu. Bolovi u uhu mogu biti uvjetovani temporomandibularnim poremećajima, s time da se otalgija pojačava žvakanjem ili palpacijom zgloba. Uloga otorinolaringologa jest isključiti otogenu ili faringolaringogenu otalgiju, a potom se diferencijalno dijagnostički uključuje obrada u smjeru cervikogene otalgije (radiološka obrada vratne kralježnice), artralgije temporomandibularnog zgloba (radiološka obrada zgloba, konzultacija stomatologa) ili odontogene otalgije (konzultacija stomatologa). U tome su smislu u obradu uključeni radiolog, stomatolog, reumatolog i neurolog

Uloga otalgija u diferencijalnoj dijagnostici temporomandibularnih poremećaja

Otalgia (earache) is pain presented in the ear, which does not necessarily originate from the ear (primary otalgia). In the differential diagnostics of (secondary) otalgia cervicocephalic syndrome, temporomandibular disorders, odontogenic pathology, parotitis, tonsillitis, pharyngitis, epiglottis, oesophagitis and malignant tumours infiltrating trigeminal, vagal or auricular (cervical) nerves branches from oesophagus inferiorly and skull base cephalad, should be considered. Primary otalgia is usually confined to external otitis or acute otitis media, while it is rarely found as a symptom of chronic otitis media, except in exacerbations. In the chronic otitis media earache is usually a sign of complication and expansion of inflammation to the dura and cranial nerves. In the differential diagnostics of primary otalgia otoscopy and otomicroscopy are necessary, as well as radiologic work-out, where CT and MRI scans are replacing former conventional x-.ray Schuller and Stenvers views. If otalgia is associated with hearing or balance disorders without clinical manifestation of otitis, the etiology is most commonly viral neuritis of temporal bone nerves, and otoneurological diagnostic workout should be considered. If (secondary) otalgia is associated with dysphagia or odinophagia, the most common etiology would be tonsillopharyngitis, but quinsy, epiglottitis, tongue base abscess, parapharyngeal abscess, and tumours of pharynx, tonsill or tongue base or epiglottis should be considered. Eagle syndrom or elonged styloid process syndrom is also characterised by painful swallowing and referred otalgia. Earache can be caused by temporomandibular disorders, where otalgia is usually increased by mastication and joint palpation. The role of otorhinolaryngologist is to exclude otogenic and pharyngogenic otalgia, and the differential diagnostics should include workout considering cervicogenic otalgia (cervical spine x-ray or MRI), temporomandibular disorders (TMJ x-ray, dentist consultation), or odontogenic otalgia (dentist consultation). The diagnostic workout of otalgia should include radiologist, dentist, reumatologist, and neurologist.Otalgija je bol koja se prezentira u području uha, međutim to ne uključuje nužno otogenu etiologiju. U diferencijalnoj dijagnostici otalgije dolaze u obzir cervikocefalni sindrom, artralgija temporomandibularnog zgloba, odontogeni procesi, parotitis, tonzilitis, faringitis, epiglotitis, ezofagitis te maligni tumori s infiltracijom grana trigeminusa, vagusa i auricularis magnusa, koji se inferiorno šire do područja jednjaka, a kranijalno do lubanjske baze. Otogena bol najčešće se susreće u upalama vanjskog i srednjeg uha, dok je rijetka u kroničnim upalama, osim u fazama egzacerbacije. Kod kroničnih upala srednjeg uha, bol je znak komplikacije i širenja bolesti prema duri ili kranijskim živcima. Za diferencijalnu dijagnostiku otogene boli nužna je otoskopija, katkad mikrootoskopija, te radiološka dijagnostika, ranije konvencionalne snimke temporalne kosti po Schulleru i Stenversu, koje danas sve više zamjenjuje CT i MRI. Ako je bol povezana s ispadom sluha ili ravnoteže, što je najčešće rezultat virusnog neuritisa u temporalnoj kosti, a bez kliničke manifestacije otitisa, u obzir dolazi i audiovestibulološka dijagnostika. Ako je otalgija povezana s disfagijom ili odinofagijom, najčešće je riječ o tonzilofaringitisu, ali u obzir dolaze i peritonzilarni apsces, epiglotitis, apsces korijena jezika, parafaringealni apsces, tumor ždrijela, tonzile, korijena jezika ili epiglotitis. Eaglov sindrom, sindrom elongiranog stiloidnog nastavka, također uključuje bolno gutanje i refleksnu bol u uhu. Bolovi u uhu mogu biti uvjetovani temporomandibularnim poremećajima, s time da se otalgija pojačava žvakanjem ili palpacijom zgloba. Uloga otorinolaringologa jest isključiti otogenu ili faringolaringogenu otalgiju, a potom se diferencijalno dijagnostički uključuje obrada u smjeru cervikogene otalgije (radiološka obrada vratne kralježnice), artralgije temporomandibularnog zgloba (radiološka obrada zgloba, konzultacija stomatologa) ili odontogene otalgije (konzultacija stomatologa). U tome su smislu u obradu uključeni radiolog, stomatolog, reumatolog i neurolog

Šum u uhu - sadašnje 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.Šum u uhu je pojava nenormalne buke u uhu. Otprilike 6% populacije pati od tzv. jakog šuma u uhu. Šum se može pojaviti i nestati, ali može biti i trajan. Može zvučati poput duboke tutnjave ili zvonjave visokih tonova. Može nastati u oba uha ili samo u jednom. Uzroci šuma mogu biti različiti, npr. oštećenje unutarnjeg uha, ozljeda osmog moždanog živca ili moždanog debla, ili pak rjeđe ozljeda mozga. Ekstrakranijski uzroci šuma također su brojni. Nakon postavljanja dijagnoze osjet buke u uhu može se ublažiti upotrebom lijekova, iako uzrok šuma jo. nije utvrđen. U suvremenom načinu liječenja šuma, tzv. liječenju metodom privikavanja (tinnitus retraining therapy), najprije treba utvrditi što je zapravo prouzročilo nastanak šuma. Taj se proces zove "privikavanje na nastalu situaciju". Šum se tako može ublažiti na dulje vrijeme, a na kraju može i sasvim nestati ili se stopiti sa zvučnom pozadinom (habituacija percepcije). Promjene u unutarnjem uhu u nekim slučajevima mogu potaknuti naglu pojavu šuma u uhu (npr. Meniereova bolest ili akutna akustička trauma), ali valja naglasiti da liječenje metodom privikavanja daje dobre rezultate bez obzira na to što je u osnovi nastanka šuma. Unatoč važnosti gubitka sluha najnovija ispitivanja u bolesnika sa šumom pokazuju da nema značajnih razlika u sluhu između bolesnika sa šumom i skupine zdravih ispitanika

Šum u uhu - sadašnje 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.Šum u uhu je pojava nenormalne buke u uhu. Otprilike 6% populacije pati od tzv. jakog šuma u uhu. Šum se može pojaviti i nestati, ali može biti i trajan. Može zvučati poput duboke tutnjave ili zvonjave visokih tonova. Može nastati u oba uha ili samo u jednom. Uzroci šuma mogu biti različiti, npr. oštećenje unutarnjeg uha, ozljeda osmog moždanog živca ili moždanog debla, ili pak rjeđe ozljeda mozga. Ekstrakranijski uzroci šuma također su brojni. Nakon postavljanja dijagnoze osjet buke u uhu može se ublažiti upotrebom lijekova, iako uzrok šuma jo. nije utvrđen. U suvremenom načinu liječenja šuma, tzv. liječenju metodom privikavanja (tinnitus retraining therapy), najprije treba utvrditi što je zapravo prouzročilo nastanak šuma. Taj se proces zove "privikavanje na nastalu situaciju". Šum se tako može ublažiti na dulje vrijeme, a na kraju može i sasvim nestati ili se stopiti sa zvučnom pozadinom (habituacija percepcije). Promjene u unutarnjem uhu u nekim slučajevima mogu potaknuti naglu pojavu šuma u uhu (npr. Meniereova bolest ili akutna akustička trauma), ali valja naglasiti da liječenje metodom privikavanja daje dobre rezultate bez obzira na to što je u osnovi nastanka šuma. Unatoč važnosti gubitka sluha najnovija ispitivanja u bolesnika sa šumom pokazuju da nema značajnih razlika u sluhu između bolesnika sa šumom 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

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