Radiotherapy-Induced Hearing Loss in Patients with Laryngeal and Hypopharyngeal Carcinomas

The purpose of this study was to investigate a hypothesized correlation of development of a sensorineural hearing loss and radiotherapy in patients with laryngeal and hypopharyngeal carcinoma. This prospective study included a total of 50 patients, which after strict exclusion critera (audiologic problems before RT, primary tumors of the auditory system, spread of the primary tumor to any part of the auditory system) resulted in 23 analyzed patients, ranging between 50 and 76 years of age, with a mean age of 60. Audiometry measuring frequency-specific thresholds was performed in three time points: one month before radiotherapy, one and six months after radiotherapy. A significant statistical difference in hearing tresholds after radiotherapy was found in 6 out of 23 patients. An obvious tendency towards hearing loss without statistical significance at 250 and 4000 Hz was found for a whole tested population (p≤0.3 with Bonferroni correction). Observed tendency towards hearing loss after radiotherapy of laryngeal carcinoma was related to side of the tumor and less severe when chemotherapy was not added as adjuvant therapy. These results should help to decrease a rate of hearing loss by careful planing of ear protection, by using observed frequencies as relevant markers of hearing loss and by reconsidering adjuvant chemoterapy during radiotherapy of laryngeal carcinoma

Subkonjunktivna fragmentacija XEN gel stenta nakon prethodno uspješne implantacije i posljedičnog formiranja filtracijskog jastučića: prikaz slučaja

The XEN gel stent is one of the available minimally invasive glaucoma surgery devices, a new generation implant, which is designed to reduce intraocular pressure in patients with primary open angle glaucoma if past medical treatments have failed. This report presents a case of subconjunctival fragmentation of the XEN gel stent after a three-month follow-up of successful XEN gel implantation. A 70-year-old male patient was treated for primary open angle glaucoma. He underwent successful phacoemulsification and intraocular lens implantation two years before. Due to medical therapy failure in controlling glaucoma, XEN gel stent implantation was suggested to the patient. The implant was successfully placed in both eyes, and extended bleb and drainage aqueous humor from the anterior chamber to the subconjunctival space was obtained. Three months after the surgery, at a regular follow-up visit, three fragments of the subconjunctival part of the XEN gel implant were found in his left eye. Neither serious complications nor intraocular pressure increase were detected. A new potential complication of the XEN gel implant is described.XEN gel stent je implantat nove generacije koji se rabi u minimalno invazivnoj kirurgiji glaukoma, namijenjen za snižavanje intraokularnog tlaka u bolesnika s glaukomom primarno otvorenog kuta kada prethodno liječenje nije dovelo do željenog rezultata. Prikazan je slučaj bolesnika kod kojega je nakon tri mjeseca praćenja uspješno implantiranog XEN gel stenta došlo do njegove subkonjunktivne fragmentacije. Muškarac u dobi od 70 godina liječen je zbog glaukoma otvorenog kuta. Dvije godine ranije imao je uspješnu operaciju katarakte s ugradnjom intraokularne leće. Zbog neuspješne kontrole glaukoma medikamentnom terapijom bolesniku je predložena implantacija XEN gel stenta. Implantat je uspješno implantiran u oba oka te je omogućen protok očne vodice iz prednje očne sobice u subkonjunktivni prostor uz formiranje filtracijskog jastučića. Tri mjeseca nakon operacije lijevoga oka, na redovnoj kontroli vizualizirana su tri fragmenta subkonjunktivnog dijela XEN gel stenta, bez da je prethodno bilo ozbiljnijih komplikacija ili porasta intraokularnoga tlaka. Opisana je nova moguća komplikacija XEN gela implantata

Utjecaj nošenja slušnog pomagala na kognitivne sposobnosti i subjektivni status tinitusa u bolesnika sa zamjedbenom nagluhošću: pilot studija

There is an increased number of people with hearing impairment and decreased cognitive abilities among the elderly population. Due to the fact that the auditory system and central nervous system are connected, pathological changes associated with aging occur on both levels. With the development of hearing aid technology, the quality of life of these patients can be improved. The aim of this study was to determine whether wearing a hearing aid has an impact on cognitive abilities and tinnitus. Current research does not show a clear connection between these factors. This study involved 44 subjects with sensorineural hearing loss. They were divided into two groups of 22 people, depending on whether they had previously used a hearing aid or not. Assessment of cognitive abilities was performed via the MoCA questionnaire, and assessment of the impact of tinnitus on daily activities was evaluated using the Tinnitus Handicap Inventory (THI) and the Iowa Tinnitus Handicap Questionnaire (ITHQ). Hearing aid status was classified as a primary outcome, while cognitive assessment and tinnitus intensity were associated variables. Our study showed an association between longer hearing aid use and poorer naming ability (p = 0.030, OR 4.734), poorer delayed recall (p = 0.033, OR 4.537), and spatial orientation (p = 0.016, OR 5.773) when compared with patients who had not used hearing aids, while tinnitus did not correlate with cognitive impairment. Based on the results, we can emphasize the importance of the auditory system as an input source for the central nervous system. The data direct us to improve the rehabilitation strategies for hearing and cognitive abilities in patients. Such an approach results higher quality of life in patients and prevents further cognitive decline.Među starijom populacijom nalazimo povećan broj osoba s oštećenim sluhom i smanjenim kognitivnim sposobnostima. Zbog povezanosti slušnog sustava sa središnjim živčanim sustavom, dolazi do patoloških promjena na obje razine. Razvoj tehnologije u području slušnih pomagala poboljšao je kvalitetu života takvih bolesnika. Cilj istraživanja je utvrditi postoji li utjecaj nošenja slušnog pomagala na kognitivne sposobnosti i šum u uhu. Trenutna istraživanja ne pokazuju striktno povezanost ta dva entiteta. U provedenoj studiji sudjelovalo je 44 ispitanika sa zamjedbenim oštećenjem sluha. Podijeljeni su u dvije skupine po 22 osobe, ovisno o tome koriste li slušno pomagalo. Procjena kognitivnih sposobnosti vršila se putem Montrealske ljestvice kognitivne procjene (MoCA), a procjena utjecaja šuma u uhu na svakodnevne aktivnosti putem upitnika Tinnitus Handicap Inventory (THI) i Iowa Tinnitus Handicap Questionnaire (ITHQ). Analizirana je povezanost nošenja slušnog pomagala s rezultatima navedenih upitnika. U našem istraživanju pokazana je povezanost duljeg nošenja slušnog pomagala i lošije sposobnosti imenovanja (p=0,030, OR 4,734), slabijeg odgođenog prisjećanja (p=0,033, OR 4,537) i prostorne orijentacije (p=0,016, OR 5,773). Tinitus nije pokazao povezanost s kognitivnim oštećenjem. Rezultati govore o specifičnim vezama između slušnog sustava i funkcije središnjeg živčanog sustava. Ovi nas podaci usmjeravaju na poboljšanje strategije rehabilitacije sluha i kognitivnih sposobnosti u bolesnika. Takvim se pristupom omogućava veća kvaliteta života i prevencija daljeg kognitivnog oštećenja

Istraživanje svjesnosti roditelja opasnosti udahnuća stranog tijela u djece

Background: The presence of a foreign body in the airways is a life-threatening condition and thus a medical emergency that requires timely diagnosis and treatment. If not recognized, it can lead to a number of serious complications. It is of the utmost importance to raise public awareness and educate parents and other caregivers on all aspects of this topic. Methods: This observational cross-sectional study aimed to investigate parental awareness of the dangers of foreign body aspiration. To determine the current level of knowledge of the parents, a 14- question questionnaire was designed and filled out by parents of children under 5 years of age referred for their regular check- ups. Results: The results show that majority of parents know that inhaling a foreign body is a potentially life-threatening condition and recognize which objects have a potential to cause foreign body aspiration. 36.9% of respondents said they knew what the symptoms of foreign body aspiration were, however only 15.6% offered a complete answer. 59.6% of the respondents could not specify the right course of action in case FBA occurred. 2 % responded accurately. No statistically significant correlation was found between the number of children in the family nor the age and the sex of the parents and the level of knowledge about the aspiration of foreign bodies. Conclusion: This study indicates that parents are insufficiently informed on recognizing foreign body aspiration symtoms as well as providing first aid. Media-assisted campaigns and the internet are potential sources of easily accessible educational material.Prisutnost stranog tijela u dišnim putevima predstavlja hitno i po život opasno stanje te samim time zahtijeva pravovremenu dijagnozu i liječenje. Strano tijelo, ukoliko ostane neprepoznato, može dovesti do brojnih ozbiljnih komplikacija. Od iznimne je važnosti podizanje svijesti javnosti te edukacija roditelja i drugih skrbnika. Cilj ovog opservacijskog presječnog istraživanja bio je ispitati svijest roditelja o opasnostima aspiracije stranog tijela. Kako bi se utvrdila njihova trenutna razina znanja, izrađen je upitnik od 14 pitanja koji su ispunili roditelji djece mlađe od 5 godina upućene na redovite preglede. Rezultati pokazuju da većina roditelja zna da je inhalacija stranog tijela potencijalno po život opasno stanje i prepoznaju koji su predmeti najčešćim uzrokom aspiracije. 36,9% ispitanika navodi da zna koji su simptomi aspiracije stranog tijela, no odgovor njih 15,6% evaluiran je kao točan. 59,6% ispitanika ne zna kako postupiti u slučaju aspiracije stranog tijela, dok je samo 2 % adekvatno odgovorilo. Nije utvrđena statistički značajna korelacija između broja djece u obitelji niti dobi i spola roditelja te razine znanja o aspiraciji stranih tijela. Ovo istraživanje pokazuje da su roditelji nedovoljno informirani o prepoznavanju simptoma aspiracije stranog tijela kao i pružanju prve pomoći. Kampanje potpomognute medijima i internet potencijalni su izvori lako dostupnog obrazovnog materijala

Connexins Expression in Adenocarcinoma of Nasal Cavity and Paranasal Sinuses

Aim: To investigate the immunohistochemical expression of connexins (Cxn) 30, 32, 37, 43 in patients with adenocarcinoma of the nasal cavity and paranasal sinuses. Methods: This was a retrospecitve study which included patients with adenocarcinoma of the nose and paranasal sinuses operated at the ENT Department of University Hospital Center Sisters of Mercy in an 11-year period (from 2007-2018). Immunohistochemical analysis was performed on a single representative block from 20 cases. We used primary antibodies for Cxn 30, 32, 37 and 43 (Abcam). Material was routinely processed and analyzed under the light microscope. Each section was analyzed in the whole mount two times. The first time under low power (x40) and the second time under high power magnification (x400). Results: All cases showed negative reaction for Cxn 43, moderately positive reaction for Cxn 32 and extremly strong positive reaction for Cxn 30 and 37. Conclusion: The preliminary data of our study showed the absence of the reaction for Cxn 43 and positive reaction of Cxn 30, 32 and 37 in patients with adenocarcinoma of nasal cavity and paranasal sinuses. These findings are in concordance with the results of studies performed on adenocarcinomas of the ovary, prostate, lung and stomach. Further studies are needed to explore the potential prognostic role of Cxn expression in these patients

Istraživanje učinkovitosti ispiranja nosa izotoničnom i hipertoničnom otopinom nakon endoskopske sinusne kirurgije nosne polipoze

Cilj ove studije bio je istražiti učinkovitost izotonične otopine (Sterimar) i hipertonične otopine (Sinomarin plus algae) u poslijeoperacijskom tijeku cijeljenja sinonazalne sluznice nakon operacije nosne polipoze metodom endoskopske sinusne kirurgije. Ovim istraživanjem htjeli smo pokazati postoji li razlika u sinonazalnim simptomima, simptomima vezanim uz kvalitetu života, te brzini i kvaliteti poslijeoperacijskog cijeljenja sluznice nosa i paranazalnih šupljina tretirane izotoničnom i hipertoničnom otopinom. U tu svrhu provedeno je randomizirana kohortna prospektivna studija. Ispitanici su ispunili upitnik vizualno analogne skale s ocjenama nosnih simptoma (VAS (od 0 do 10) TNSS – total nasal symptom score) deset simptoma povezanih s njihovom bolešću i endoskopski će biti pregledani, te je njihov lokalni status ocijenjen prema Lund Kennedy ocjenjivanju pri uobičajenom endoskopskom pregledu nosa. Ocjenjivala se polipoza, edem, sekrecija, ožiljci i kraste ocjenama od 0 do 2. Ocjenjivanje simptoma i lokalnog nalaza vršilo se prvi puta po primitku u bolnicu prije operacije, te dva puta po otpustu iz bolnice, nakon operacije. Nakon operacije 15 ispitanika je koristilo izotoničnu otopinu (Sterimar), a njih 15 hipertoničnu otopinu (Sinomarin plus Algae) tri puta dnevno. Prva kontrola bila je sedam dana od operacije, a druga nakon 14 dana, te su pri oba posjeta bolesnici ispunili VAS TNSS upitnik, a operater je učinio ocjenu lokalnog nalaza prema Lund Kennedy (LK) ocjenjivanju. Dobiveni podaci će se statistički obraditi. U studiji je sudjelovao podjednak broj muških i ženskih ispitanika, prosječne dobi 50 godina. Preliminarni rezultati pokazuju da je većina bolesnika preoperativno imala više ocjene nosnih simptoma nego nakon operacije, kao i LK zbroj. Nakon operacije zabilježene su niže ocjene nosnih simptoma, kao i niži LK zbroj u skupini bolesnika koji su ispirali nos hipertoničnom otopinom obogaćenom ekstraktima algi. U konačnici ova studija je pokazala kako postoji razlika u poslijeoperacijskom cijeljenju i sinonazalnim simptomima u bolesnika koji ispiru nos izotoničnom otopinom i hipertoničnom otopinom obogaćenom ekstraktima nekih algi