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Graefe's archive for clinical and experimental ophthalmology 259(8), 2251-2257 (2021). doi:10.1007/s00417-021-05235-8, Published by Springer, Heidelberg

OBJECTIVES: Malignant (necrotizing) otitis externa (MOE) is an aggressive form of skin inflammation of the external ear with a tendency to spread infection to the temporal bone. The study aimed to evaluate a causal relationship between treatment responses and clinical features in patients with MOE. MATERIALS AND METHODS: In a retrospective, descriptive section study, the database was analyzed between January 2008 and December 2018 in our department, all patients with diagnosed MOE were identified. RESULTS: A total of 30 patients were evaluated, of which 27 men and 3 women. The youngest patient was 52 years old while he was eldest 88 years, (mean-71 years old). As the most common comorbidity, diabetes mellitus was found in 23 (76%) subjects. Median duration of symptoms was about 3 months. The most common isolated pathogen was Pseudomonas aeruginosa (47%). Patients with facial nerve palsy and erosion of temporal bone find on computerized tomography affect prolonged stationary treatment (Mean, SD 29.2±8.5 and 26,7±11.6 days), while 80% of patients with facial nerve palsy had recurrence of disease (p=0.005) with mean duration of clinical remission of 60±17.3 days. Overall length of treatment is also increased in the presence of comorbidities as well as in patients with cranial nerve involvement. CONCLUSION: Patients with cranial nerve involvement, erosion of temporal bone and presence of comorbidities affect prolonged treatment and adverse prognosis. Early diagnosis and initiation of aggressive therapy are essential for stopping the further spread of the disease and prevention of serious complications.

Introduction.Voice is the result of vocal cord vibrations and resonance effects of the vocal tract, therefore, the instrumental monitoring of the vibrations themselves is one of the essential aspects of objective instrumental assessment of voice. Inadequate height and volume, as well as increased nasality, represent the basic characteristics of voice in hearing-impaired persons. The aim of the study was to perform a detailed analysis of the acoustic structure of vowel /a/ in the hearing-impaired persons and in those with normal hearing and voice. Methods. The sample comprised 40 participants, aged 17 to 20 years (18.50 ±1.13), both sexes (50% males), divided into two groups. The first group consisted of 20 participants with moderately-severe hearing loss (56-70 dB), while the second group included 20 normal-hearing participants. Members of both groups were equal to each other in sex and age (± 3 months). The research was conducted in secondary schools, the Faculty of Medicine in Foča, as well as in Special School with a Student's Dormitory "Bubanj" in Niš during May 2018. Results. A statistically significant difference between hearing-impaired and normal-hearing speakers was found in 11 out of 14 tested acoustic parameters of vowel /a/: Standard Deviation of Fundamental Frequency (STD), Absolute Jitter (Jitta), Percentage of Jitter (Jitt), Relative Average Perturbation (RAP), Fundamental Frequency Variation (vFo), Shimmer (Shdb), Percentage of Shimmer (Shim), Amplitude Perturbation Quotient (APQ), Noise-to-Harmonic Ratio (NHR), Soft Phonation Index (SPI) and Frequency Tremor Intensity Index (FTRI) whereby the hearing-impaired participants showed higher values of the above-mentioned parameters. Conclusion: The obtained results show pathological changes in the voice of hearing-impaired persons, as well as the need for voice rehabilitation. Uvod. Glas je produkt vibratornog kretanja glasnica i rezonantnih efekata vokalnog trakta, stoga je instrumentalno praćenje samog vibratornog procesa jedan od bitnih aspekata objektivnog instrumentalnog ispitivanja glasa. Neodgovarajuća visina i neprimjerena glasnost, kao i pojačana nazalnost, predstavljaju osnovne karakteristike glasa kod osoba sa oštećenim sluhom. Cilj istraživanja je bio da se uradi detaljna analiza i poređenje akustičke strukture vokala A kod ispitanika sa oštećenim sluhom i ispitanika sa urednim sluhom i normalnim glasom. Metode. Ukupan uzorak je činilo 40 ispitanika, uzrasta od 17 do 20 godina (18,50 ± 1,13), oba pola (50% muškog), koji su podijeljeni u dvije grupe. Prvu grupu je činilo 20 ispitanika sa umjereno teškim oštećenjem sluha (56-70 dB), dok je druga grupa obuhvatila 20 ispitanika bez oštećenja sluha. Ispitanici obje grupe su međusobno ujednačeni po polu i uzrastu (± 3 mjeseca). Istraživanje je realizovano tokom maja 2018. godine u srednjim školama i Medicinskom fakultetu u Foči, i specijalnoj školi sa domom učenika ,,Bubanj" u Nišu. Rezultati. Statistički značajna razlika između ispitanika sa urednim i oštećenim sluhom utvrđena je za 11 od 14 ispitivanih akustičkih parametara vokala A: standardna devijacija osnovne frekvencije (STD), ukupan jitter (Jitta), jitter procenat (Jitt), relativna srednja vrijednost perturbacije (RAP), koeficijent varijacije osnovne frekvencije (vFo), shimmer (Shdb), shimmer procenat (Shim), koeficijent perturbacije amplitude (APQ), odnos šuma i harmonika (NHR), indeks prigušene fonacije (SPI) i indeks intenziteta osnovne frekvencije i tremora (FTRI), pri čemu ispitanici sa oštećenim sluhom ostvaruju veće vrijednosti navednih parametara. Zaključak. Prikazani rezultati ukazuju na patološke promjene u glasu kod ispitanika sa oštećenim sluhom i potrebu za rehabilitacijom glasa ovih ispitanika.

Background Providing care for someone with a disease or chronic condition can have a negative psychological, physical, social, and economic impact upon informal caregivers. Despite the socio-economic relevance and more than three decades of caregiver intervention research only very few translational efforts of successful interventions are reported. Still less of these interventions have been implemented into routine services. The aim of the ReDiCare study (German acronym BerTA) is to evaluate the effectiveness of a stepped counselling approach for burdened caregivers delivered by care counsellors of two long-term care insurances and registered psychotherapists. Methods/ design A pragmatic randomised controlled trial with 572 caregivers of older adults (≥ 60 years) receiving benefits of one of the two participating long-term care insurances. Participants are assigned (t0) to either the ReDiCare intervention or a control group receiving routine care and counselling. Data are collected at baseline (-t1), 3-month (t1), 9-month (t2) and 15-month (t3). The 9-month post-intervention assessment (t2) is the primary endpoint to evaluate the results on the primary and secondary outcomes, measured by self-reported questionnaires. Depressive symptoms measured with the CES-D are the primary outcome. The main secondary outcomes are physical complaints, utilization of psychosocial resources, caregiver self-efficacy and burden, positive aspects of caregiving and perceived care quality. A process evaluation, including audio tapes, self-report questionnaires and documentation will be conducted to examine internal and external validity of the intervention. Data on direct and indirect costs are collected for the (health) economic evaluation, using a health care perspective and a societal perspective. Discussion While comparable previous caregiver interventions have been developed and evaluated for specific caregiver groups (e.g. dementia caregivers, stroke caregivers), the ReDiCare study will indicate whether a stepped approach will be effective also in a broader group of caregivers. The intervention is one of the very few translational studies in caregiver intervention research and will provide valuable insights into relevant factors for training, intervention protocol adherence, effectiveness, and costs for future implementation steps. Trial registration Deutsches Register Klinischer Studien (German Clinical Trials Register), DRKS00014593 (www.drks.de, registered 14 May 2018) and International Clinical Trials Registry Platform, DRKS00014593 (https://apps.who.int/trialsearch/).

Purpose To test if an encircling band improves outcomes in vitrectomy for pseudophakic retinal detachment (PRD) with inferior or with multiple (4 or more) breaks. Methods Subgroup analysis of a prospective randomized controlled multicenter trial in patients with uncomplicated PRD assigned either to 20 G vitrectomy plus encircling band (group E1), or 20 G vitrectomy without any buckle (group C), or 23/25 G vitrectomy without any buckle (group E2). The primary endpoint was defined as no indication for any retina reattaching procedure during the review period of 6 months. One hundred out of 257 patients were identified with inferior breaks and 63 patients had 4 or more breaks. Results In patients with retinal breaks between 5:00 and 7:00, treatment was successful in 77.4% (24/31, treatment arm E1) versus 57.1% (16/28, treatment arm C) (p = 0.301, odds ratio (OR) 1.83, 95% confidence interval (CI) 0.48 to 7.17). In patients with multiple breaks, success rates were 68.2% (15/22, E1) versus. 72.4% (21/29, C, p = 0.46, OR 0.52, CI 0.08–3.65). Conclusion Combining an encircling band with vitrectomy in patients with pseudophakic retinal detachment and inferior or multiple breaks does not significantly improve primary anatomical success in comparison to treatment with 20 G or 23/25 G vitrectomy alone.

Background: Finding reliable information on one of more than 7,000 rare diseases is a major challenge for those affected. Since rare diseases are defined only by the prevalence criterion, a multitude of heterogeneous diseases are included. Common to all, however, are difficulties regarding information access. Even though various quantitative studies have analyzed the use of different information sources about rare diseases, still little is known about how users rate these sources and how their importance changes over time. Methods: Fifty-five patients with a variety of rare diseases and 13 close relatives participated in qualitative interviews. For these interviews, a semi-structured guideline was developed, piloted, and revised. Evaluation followed qualitative content analysis developed by Philipp Mayring. Results: The internet is the most important and widespread information source, especially for early information. Although patients have difficulty dealing with information obtained online, they consider online searching a quick and practical option to gather information. During the course of the disease, personal contact partners, especially self-help associations and specialized doctors, become more important. This is also because information provided online is sometimes insufficiently detailed to answer their information needs, which can be complemented by information from doctors and self-help. Conclusions: People rarely use just one type of source, but rather refer to different sources and informants. The source used depends on the type of information sought as well as other person-related factors such as preexisting knowledge and the disease stage. To improve people’s information searching and connect them with specialists in rare diseases, a central information portal on rare diseases is a suitable access point to provide free and quality assured information for patients, caregivers, and physicians. This would allow not only patients but also doctors to find quality assured information on symptoms and therapies as well as patient associations and specialized doctors.

Background It is unclear whether or not an additional encircling band improves outcome in vitrectomy for pseudophakic retinal detachment (PRD). Also unclear is whether small gauge transconjunctival trocar-guided vitrectomy is as successful as conventional 20 gauge (G) vitrectomy. Methods 257 adult patients with uncomplicated PRD were enrolled in 14 vitreoretinal centres across Germany. Contingent on availability of qualified surgeons, eligible patients were randomly assigned either (i) with ratio 1:1 to 20 G vitrectomy plus encircling band (group E1) or 20 G vitrectomy without any buckle (group C) or (ii) with ratios 1:1:1 to group E1, C or 23/25 G vitrectomy without any buckle (group E2). Treatment success was defined as no indication for any retina reattaching procedure during the follow-up of 6 months. Results Success was reached in 79.0% (=79/100, group E1) versus 73.5% (=72/98, group C) (p=0.558, OR 1.32, 95% CI 0.65 to 2.65. In group E2 87.7% (=50/57) of patients reached success compared with 78.7% (=48/61) in group C, demonstrating non-inferiority of E2 to C regarding the prespecified margin of 0.8 (OR scale; p=0.05, OR 2.17, 95% CI 0.80 to 5.89). Best corrected visual acuity significantly increased after surgery independent of technique, that is, on average −0.7 (from 1.0 to 0.3) logMAR. Patients suffered from a shift in spherical refraction of −1.0 D in group E1 compared with −0.1 D in group C. Similarly, intraoperative complications (15.2% vs 8.8% of patients) and serious adverse events (30.3% vs 22.5% of patients) were more frequent in group E1. Conclusions Vitrectomy with gas is an efficient and safe treatment for uncomplicated PRD. An additional encircling band does not significantly reduce the risk for any second procedure necessary to reattach the retina in 20 G vitrectomy. Small gauge transconjunctival vitrectomy is not inferior to the conventional 20 G technique. Trial registration number DKRS 00003158, Results.

Background: Cochlear dysfunction can arise not only from various factors such as ear diseases but also from systemic disorders of the body. The occurrence of otologic symptoms such as hearing loss, dizziness, and tinnitus can be due to cardiovascular disorders. Therefore, current understandings in the field of the diagnosis and therapy of cardiovascular diseases (CVDs) should include, among others, evidence of otologic disorders. Objective: The aim of this study is to determine the association between risk factors for CVD and cochlear dysfunction. Methods: The cross-sectional study included 128 participants with major CVD risk factors who underwent auditory function examination (pure tone audiometry). Results: There were 52 women (40.6%) and 76 men (59.4%) in total. The mean age of the participants was 58 years (a range of 28-83 years). The mean age among participants with hearing loss was 60 (+/- 10.88), whereas the mean age among participants that had normal hearing thresholds was 54 (+/- 12.18). Sensorineural hearing loss (SNHL) was measured in 59% of participants, of most frequent mild degree hearing loss. The prevalence of SNHL was higher in participants with arterial hypertension (P lt 0.001, OR = 5.881, 95% CI 2.694-12.837) and the most common among them was moderate degree hearing impairment (38%). There is also a statistically significant association of SNHL with dyslipidemia and elevated body mass index (P lt 0.001, [OR]: 4.118, 95% [CI]: 1.873-9.053 and P lt 0.001, [OR]: 1.517, 95% [CI]: 1.237-1.859 ) with moderate and profound hearing loss. Conclusion: Based on the data obtained, it seems that the presence of major cardiovascular risk factors was a significant predictor for cochlear dysfunction.

British journal of ophthalmology : BJO 100(3), 405-410 (2016). doi:10.1136/bjophthalmol-2015-306732, Published by BMJ Publ. Group, London

Blue–yellow visual-evoked potentials (BY-VEPs) may be used for diagnostics of functional ganglion cell damage in glaucoma and other ocular diseases. In this study we investigated the impact of lenticular opacities on BY- and standard pattern reversal VEPs by examining patients before and after cataract surgery. Eighteen patients with moderate cataract were included in a prospective study. Transient on/off isoluminant blue–yellow 2° checks were used for short-wavelength stimulation (BY-VEP), transient large 1° (M1) and small 0.25° (M2) black-white checks for standard pattern reversal VEPs. VEPs were acquired before (24 ± 30 days) and after cataract surgery (14 ± 16 days). The contralateral eye was used as a control. Amplitude and latency of M1 and M2 peaks did not change significantly from before to after surgery. The amplitude of the BY-VEPs did not change significantly after cataract surgery (pre-surgery, −7.42 ± 3.43 μV, post-surgery, −7.93 ± 3.65 μV, p = 0.42), yet the latency of the main negative peak showed a significant decrease (pre-surgery, 143.9 ± 12.9 ms, post-surgery, 133.2 ± 7.7 ms, p = 0.0006). The BCVA improvement was significant from before to after cataract surgery (pre-surgery, 0.344 ± 0.125 LogMAR, post-surgery, 0.224 ± 0.179 LogMAR, p = 0.013) yet not correlated to the absolute decrease in latency of the BY-VEP after surgery (r = 0.309, p = 0.22). No significant changes were found in the contralateral eye. The BY-VEP is sensitive to lenticular opacities of the human lens, presumably due to the increased short-wavelength absorption in the aging eye. This fact should be considered when applying BY-VEPs for diagnostics.

Biomed research international 2014, 706809 (2014). doi:10.1155/2014/706809, Published by Hindawi, New York

The aim of our study was to assess the outcome of treatment of horizontal canal benign paroxysmal positional vertigo and to analyze the influence of the different prognostic factors on treatment failure. Fifty-nine patients with horizontal canal benign paroxysmal positional vertigo were included in the study. They were divided into two groups according to the treatment protocol, randomly. The first group, after treatment with the barbecue maneuver or inverted Gufoni, depending on the nystagmus form, was instructed to sleep on the side with weaker nystagmus, and the second group did not. In the first group, 88.9% of patients were cured and 91.3% in the second one. There was no significant difference between the two groups. Migraine and the apogeotropic form of nystagmus had a significant effect on treatment outcome, while other variables had no effect.

Phonation is a fundamental feature of human communication. Control of phonation in the context of speech-language disturbances has traditionally been considered a characteristic of lesions to subcortical structures and pathways. Evidence suggests however, that cortical lesions may also implicate phonation. We carried out acoustic and perceptual analyses of the phonation of /a/ in 60 males with aphasia (20 Wernicke’s, 20 Broca’s, 20 subcortical aphasia) and 20 males matched in age with no neurological or speech-language disturbances. All groups with aphasia were significantly more impaired on the majority of acoustic and perceptual measures as compared with the control speakers. Within the subjects with aphasia, subjects with subcortical aphasia were more impaired on most measures compared to subjects with Broca’s aphasia, and they, in turn, more impaired than those with Wernicke’s aphasia. Lesions in regions involved in sound production–perception result in dysfunction of the entire neurocognitive system of articulation–phonological language processing.

Citation information: Roessler GF, Dietlein TS, Plange N, Roepke A-K, Dinslage S, Walter P, Mazinani BAE. Accuracy of intraocular lens power calculation using partial coherence interferometry in patients with high myopia. Ophthalmic Physiol Opt 2012, 32, 228–233. doi: 10.1111/j.1475-1313.2012.00903.x Abstract Purpose: Ultrasound-A-scan-biometry intraocular lens power calculation for cataract surgery sometimes shows lack of accuracy in patients with high myopia. The purpose of this retrospective study was to assess the accuracy of lens power calculation with optical biometry using the Zeiss IOLMaster across a large range of myopia levels. Methods: We included 37 consecutive, myopic eyes with an axial length >26.5 mm (31 patients, 62 ± 13 years old, average preoperative refraction of –14.46 ± 6.61 D, range −3.5 to −32.0 D), which underwent phacoemulsification and implantation of an intraocular lens following biometry using the IOLMaster. For lens power calculation, the Haigis formula was used in all cases. For comparison, refraction was back-calculated using the SRK/T and Holladay I formulae. Results: The preoperative mean axial length was 29.37 ± 2.44 mm with a range of 26.50–35.52 mm. Thirty eyes (81.1%) showed a postoperative spherical equivalent which differed 1.00 D or less from the predicted value, in 20 cases (54.1%) the postoperative refractive error was within ± 0.50 D. The mean absolute error (MAE) was 0.70 ± 0.59 D (Holladay I, 0.85 ± 0.68; SRK/T, 1.01 ± 0.61 D). Conclusions: Optical biometry for intraocular lens power calculation seems to deliver reliable results for cataract surgery in patients with high myopia, although our data describe an increasing lack of accuracy beyond an axial length of 30 mm. The Haigis formula provided the best predictability of postoperative refractive outcome for myopic eyes in general.

Background?Aim. A school teacher's occupation is one of the most vocal demanding professions. Vocal tiredness affects acoustic characteristics of voice, leads to the change in acoustic quality during vocal production. The aim of this study was to examine the influence of vocal tiredness on voice acoustic characteristics of school teachers. Methods. The study included 36 school teachers (16 male and 20 female) of 27-58 years of age. Vocal tiredness was evaluated by analyzing acoustic parameters of voice, using computerized laboratory ?Kay Elemetrics?. The voices were recorded before the first class on the beginning of a working week and after the last class at the end of a working week. Signal, noise and tremor parameters were processed. In their analysis the methods of descriptive statistics, as well as the analytical statistics (Student's t-test for paired samples, ?2 test, Mann Whitney U-test and Pearson?s correlation coefficient) were applied. Results. The obtained results showed statistically significant differences in average values of parameters as a consequence of the vocal tiredness (p < 0.01), while gender, age and being smoker or not, did not have a significant effect on voice acoustic characteristics in this group of examinees (p > 0.05). Conclusion. The results of the study suggest a casual relationship between vocal tiredness and voice quality in vocal professionals.

Introduction. The hearing apparatus is one of the most important factors related to the development of oral communication. Thus, hearing disorders and deafness lead to severe handicap. Hearing impairment in adults cause verbal communication disorders that influence psychical, emotional and social functioning. Nowadays, there is a noticeable world tendency towards improving hard of hearing person?s quality of life. Objective. Objective was to assess the association between hearing impairment and health-related quality of life. Methods. A hundred adults with billateral hearing impairment underwent hearing examination and answered the Hering Handicap Inventory for the Elderly-Screening (HHIE-S, Ventry and Weinstein), specific for hearing impairment. Results. Almost half of all participants (44%) had a moderate hearing loss, and 36% had a mild loss. Infrequently, participants had a severe degree of hearing loss (13%) and deafness (7%). Self reported hearing handicap revealed significant emotional, social and situational dysfunctions (?2=40.960; df=1; p

Introduction. There are subjective and objective ways to examine the effects of vocal therapy in voice disorders. The most precise and objective check-up is the use of computer voice analysis. Objective. The aim of the research was to perform a detailed analysis of acoustic structure of the vowel A before and after voice treatment in patients with vocal fold nodules in order to obtain objective verification of the vocal rehabilitation success. Methods. We examined 30 female patients, aged 34.6?6.69 years, with vocal fold nodules. Acoustic parameters of voice were compared with the control group consisting of 21 subjects without voice pathology. In all persons the vowel A was recorded and analyzed before and after a month of vocal therapy. The success of the vocal therapy was tracked using computer analysis of vocal structure. Signal, noise and tremor parameters were processed. Results. Of the analyzed vowel A parameters: STD, PER, JITA, JITT, RAP, vFO, ShdB, SHIM, APQ, VTI, SPI, F0, NHR, FTRI, eleven improved (p0.05). Conclusion. Based on the obtained results it was concluded that vocal therapy gave satisfactory results, but that it should be continually applied until full stabilization of the voice.

Introduction: Prevalence of sensorineural hearing loss is 1-3 per 1,000 newborns. Transient evoked otoacoustic emission (TEOAE) and automated auditory brain stem responses (AABR) are most frequently used methods in newborn hearing screening programmes. Objective. The aim of this study was to examine hearing function in newborns with and without risk factors for hearing loss. We investigated accuracy and feasibility of two automated technologies: transient otoacoustic emissions (TEOAE) and auditory brain stem response (AABR) in early detection of hearing loss. Method. In prospective study, 907 newborns were tested on both ears with transient evoked otoacoustic emissions (TEOAE). If results were "refer", we performed automated brain stem response (AABR). Two stage screening protocols were used with two screening technologies (TEOAE, AABR). Results. Results showed screening pass of 86.3% of the newborns in the first protocol and 99.3% in the second. Six (0.7%) newborns had positive screening results for hearing loss. They were referred for additional audolologic tests (otoacoustic emissions, tympanometry, and auditory brain stem response) to confirm or exclude hearing loss. Audiologic examination was performed up to the third month of life. We confirmed unilateral sensorineural hearing loss in two babies. Average test time per ear was 21.3?19.4 s for TEOAE and 135.3?67.9 s for AABR. Conclusion TEOAE, AABR tests are confidential, noninvasive and feasible methods and can help to detect hearing impairment.

Blue–yellow short wavelength testing (BY-VEPs) has proven diagnostic relevance in detecting early ganglion cell damage, e.g., in glaucoma. To date testing has generally been conducted using individual protocols without consideration of the lens status. In this study, we compared changes in BY-VEPs and standard pattern VEPs in phakic and pseudophakic glaucoma patients and controls. The eyes of 57 healthy controls (18 pseudophakic and 39 phakic) and 67 glaucoma patients (29 pseudophakic and 38 phakic) were included in a prospective study. Phakic eyes were arranged in three groups according to the Lens Opacities Classification System III. Transient on/off isoluminant blue–yellow 2° checks were used for BY-VEPs, transient large 1° (M1) and small 0.25° (M2) black–white checks for standard pattern reversal VEPs, according to the ISCEV standards. Latencies and amplitudes of M1 and M2 did not differ significantly between groups or lens status. ANOVA analysis revealed significantly longer BY-VEP latencies in glaucoma compared to controls (p = 0.002), independently of the lens status. The amplitudes showed no such pattern (p = 0.93). Mean defect (MD) was significantly negatively correlated to BY-VEP latency (r = −0.54, p = 0.003) only in pseudophakic glaucoma patients. Different stages of cataract did not show a significant effect on the BY-VEP latencies. Glaucoma led to a significant increase of BY-VEPs latencies, while standard pattern VEPs were not influenced. The correlation of MD and BY-VEP latency only in pseudophakic glaucoma patients indicates a substantial confounding effect of lens opacifications on the diagnostic value of BY-VEPs in glaucoma.

Chronic inflammation of the middle ear is the most frequent cause of otogenic complications. Meningitis is the most frequent otogenic intracranial complication, followed by otogenic brain abscesses, while other complications are significantly less frequent. The study is aimed at presenting clinical casuistry of otogenic brain abscesses consequential to chronic suppurative otitis in order to evaluate modern diagnostic and therapeutic possibilities. The study was retrospective and included the patients treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Centre of Serbia diagnosed with otogenic brain abscess during a five-year period (1996-2000). A total of 9 patients (male to female ratio 8:1), aged 16-68 years, were assessed. The following parameters were analyzed: sex, age groups, place of living, occupation number of hospitalizations, diagnostic procedures, symptoms and clinical signs of otogenic complications, other otogenic complications associated with brain abscess, endocranial localization of otogenic abscess therapeutic procedures (oto-surgical treatment) and intraoperative otological findings. In our group of patients, otogenic brain abscesses were significantly more frequent in male patients in their forties, with median age of 33.5 years. As for the place of living, the patients from the provinces were more frequent, while with respect to their level of education, those with elementary or high school degrees were predominant. The inflammatory process most frequently spread into the endocranium through direct destruction of the bone walls of the middle ear. Diagnostic procedures included history, clinical otorhinolaryngological examination audiological and vestibulological assessment, neurological ophthalmolog-ic and radiographie examinations (CT, MRI). CT is the most reliable diagnostic tool enabling localization of the change, timing of surgical treatment and monitoring of surgical success. Presence of other otogenic complications associated with brain abscess was evidenced in six of our patients. Cerebral localization of abscess was more frequent (7). Four patients underwent previous oto-surgical treatment. The treatment included primary neurosurgical approach (radical extirpation or abscess drainage), followed by radical oto-surgical treatment after improvement of the patient's general condition.

Rabdomiosarkomi nazoparanazalne pegije spadaju među retke maligne bolesti Međutim, oni predstavljaju znacajan dijagnosticki i terapijski problem. Cilj rada je da prikažemo klinicku kazuistiku rabdomiosarkoma nazoparanazalne regije kod odraslih osoba i dece radi procene mogucnosti savremene dijagnostike i lecenja. Istraživanje je bilo retrospektivno i obuhvatilo je bolesnike s utvrđenim i patohistoloski verifikovanim rabdomiosarkomima nazoparanazalne regije, koji su dijagnostikovani i leceni u Institutu za otorinolaringologiju i maksilofacijalnu hirurgiju Klinickog centra Srbije, u periodu od 1988. do 2001. godine, a lecenje nastavili u Institutu za onkologiju i radiologiju Srbije u Beogradu. Ukupno je ispitano devet bolesnika, starosti 3-50 godina (medijana 15). Od toga, pet muskaraca i cetiri žene. Sedam bolesnika je prethodno bilo hospitalizovano u drugim zdravstvenim ustanovama. Analizovani su sledeci parametri: pol, dobne grupe broj hospitalizacija, simptomi i znaci bolesti, lokalno, regionalno, i udaljeno sirenje tumora, prethodna dijagnostika, dijagnosticki postupci histopatoloski tipovi tumora, nacin lecenja i ishod bolesti. Kod sedam bolesnika tumor je bio prosiren izvan nazoparanazalne regije: kod sest u orbitu, kod pet u epifarinks, kod tri u kranijum, a kod po jednog u pterigopalatinsku jamu i parafarinksni prostor. Samo kod jednog bolesnika bili su zahvaceni regionalni limfonodusi, a kod jednog su bile udaljene metastaze u kostima. Kod sedmoro nasih bolesnika tip tumora bio je embrioni a kod dvoje alveolni tip rabdomiosarkoma. Srednje vreme preživljavanja kod obolele dece bilo je znatno duže (76,3 meseca) nego kod odraslih osoba (11,5 meseci). Terapijski postupak podrazumeva kombinovanu primenu protokola hemioterapije (koji odgovaraju dobnim grupama i stadijumu bolesti) i radioterapije. Radikalno operaciono lecenje primenjuje se samo kada je tumor u svom najpocetnijem stadijumu, a može i u slucajevima zaostalog ili recidivisuceg tumora posle sprovedene hemioterapije odnosno radioterapije.

Juvenile nasopharyngeal angiofibroma is an infrequent epi-pharyngeal tumor necessitating particular diagnostic and therapeutic procedures in comparison to other benign epipharyngeal tumors due to its expansive growth tendency. Our retrospective study is aimed at presenting clinical casuistry of the tumor in order to evaluate modern diagnostic and therapeutic possibilities. The study included 13 male patients, aged 13-24 years, who were hospitalized, diagnostically assessed and surgically treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia over the period 1990 - June 2001. The following parameters were analyzed: sex, age groups, preoperative symptoms of the disease, diagnostic methods, embolization, local tumor spreading, number and time of tumor relapses and surgical approach.

Introduction. Over the last two decades the intratympanic perfusion of corticosteroids has been used as a minimally invasive surgical therapy of Meniere’s disease. According to experimental studies the antiinflammatory, immunoprotective, antioxidant and neuroprotective role of the locally perfused corticosteroids was noticed in the inner ear structures. The recovery of action potentials in the cells of the Corti organ was confirmed as well as a decreased expression of aquaporine-1, a glycoprotein responsible for labyrinth hydrops and N and K ions derangement. Objective. The study showed results of intratympanic perfusion therapy with dexamethasone in patients with retractable Meniere’s disease who are resistant to conservative treatment. Methods. Single doses of 4 mg/ml dexamethasone were given intratympanically in 19 patients with retractable Meniere’s disease. Six single successive doses of dexamethasone were administered in the posteroinferior quadrant of the tympanic membrane. Follow-up of the patients was conducted by using a clinical questionnaire a month after completed perfusion series as well as on every third month up to one year. Results. One month after completed first course of perfusions, in 78% of patients, vertigo problems completely ceased or were markedly reduced. The recovery of hearing function was recorded in 68% and marked tinnitus reduction in 84% of patients. After a year of follow-up, in 63% of patients the reduction of vertigo persisted, while hearing function was satisfactory in 52%. Tinitus reduction was present in 73% of patients. Conclusion. Intratympanic perfusion of dexamethasone in patients with Meniere’s disease is a minimally invasive therapeutic method that contributes to the reduction of the intensity of vertigo recurrent attacks, decrease of the intensity of tinnitus and improvement of the average hearing threshold. Patients with chronic diseases and Meniere’s disease who are contraindicted for systemic administration of cortocosteroids (hypertension, diabetes, glaucoma, peptic ulcer, etc.) have an additional therapeutic option by dexamethasone intratympanic perfusion.

Objective: To investigate the potential risk factors associated to the treatment failure and recurrence of benign paroxysmal positional vertigo (BPPV). Study Design: Prospective cohort study. Setting: Tertiary referral center. Patients: Four hundred patients with benign paroxysmal positional vertigo, 119 men and 281 women, aged 27 to 88 years. Intervention: Patients were treated once a week, with only one, appropriate, depending on the affected canal, repositioning maneuver (modified Epley, Semont, barbecue/inverted Gufoni, Kim). The control Dix-Hallpike test and the roll test were performed on 7 days. Main Outcome Measures: The treatment outcome and recurrence were evaluated with regard to sex, age, duration of symptoms, etiologic factors, migraines, osteoporosis, vascular risk factors, endocrine diseases, localization of otoconia, and simultaneous involvement of multiple canals. Results: The results indicate that treatment was negatively affected by patients' age, osteoporosis, and head trauma, without them causing recurrent symptoms. The highest number of uncured patients was observed in the 73- to 88-year-old age group (14.8%). The application of more than one maneuver was necessary in 27.5% of cases with primary BPPV and 88.9% with secondary BPPV. The highest treatment success was achieved in the group with BPPV of the posterior semicircular canal (F = 3.668, p = 0.026). The recurrence rate was 15.5%. Conclusion: Potential risk factors associated to the treatment failure were as follows: the age older than 50, secondary BPPV, head trauma, the occurrence of osteoporosis, and localization of otoconia in the anterior semicircular canal. The analyzed factors did not have impact on the recurrence.

To characterize the effects of intravitreal injections of iodoacetic acid (IAA) in comparison to its systemic application as a measure to induce unilateral photoreceptor degeneration.Seven-week-old C57BL/6 J mice received either intravitreal injections of IAA or systemic treatment (intraperitoneal vs intravenous) and were observed in the following 5 weeks using ERG, OCT, and histology.Systemic treatment with IAA induced high toxic effects and a high mortality in contrast to the intravitreal injection. Intraperitoneal application had no effect on the retina. Intravenous application of 2 × 30 mg/kg BW IAA (time between injections 3.5 h) resulted in an extinction of the ERG and a thinning of the retina, in particular of the outer nuclear layer (ONL) indicating photoreceptor degeneration. Animals receiving intravitreal injections developed cataracts already at low concentrations (up to 100% at 0.25 mg/kg BW). Higher intravitreal IAA doses led to extinguished ERGs. In histology, a thinning of the entire retina was observed that was most prominent in the inner part of the retina.In contrast to intraperitoneal administration, intravenous application of IAA led to a selective photoreceptor degeneration. After intravitreal injection, dense cataracts were already observed at concentrations lower than those needed to induce changes in the ERG. ERG results must be interpreted carefully. A thinning of all retinal layers rather than a specific outer retinal degeneration was observed upon intravitreal injection. IAA is not a useful model to induce outer retinal degeneration in mice.

Background/Aim. Benign paroxysmal positional vertigo is one of the most frequent peripheral vestibular system disorders. The aim of this study was to examine the efficacy of the Epley maneuver in treating benign paroxysmal positional vertigo of the posterior semicircular canal (p- BPPV) and to discover possible causes of failure. Methods. This prospective study included 75 patients. In all the cases medical history showed and the positioning Dix-Hallpike test confirmed the diagnosis of p-BPPV. We also performed clinical ENT examination, searching for spontaneous nystagmus, vestibulospinal tests, caloric test, and audiometry. All the patients were treated by the modified Epley canalith repositioning maneuver. The patients were followed up at the intervals of seven and, fourteen days, and one, tree, and six months and one year. The maneuver was repeated if vertigo and nystagmus on control positioning test persisted. The transition from positive into negative Dix Hallpike test after one or two Epley maneuver was considered as success in treatment. Results. After the initial Epley maneuver the recovery rate was 90.7%, and after the second 96%. In three (4%) patients with secondary p-BPPV, symptoms did not cease even after the second repositioning maneuver. The etiology of p-BPPV had a significant effect on the maneuver’s success rate (p < 0.01), whereas duration of symptoms, age and gender had no effect (p > 0.05). After a successful treatment 11 (14.66%) patients had recurrent attack of BPPV during the first year. Conclusion. The Epley maneuver is very successful repositioning procedure in treating p- BPPV. The patients with idiopathic form p-BPPV showed higher success rate with Epley maneuver than those with secondary p-BPPV.

Background The Prague C & M criteria, developed for the endoscopic grading of Barrett's esophagus (BE), (C = circumferential length, M=maximal length) were previously validated among a panel of 29 expert endoscopists with a special interest in BE. Its performance among gastroenterology trainees is unknown. Objective To test interobserver agreement among gastroenterology trainees for the Prague C & M criteria, identification of the gastroesophageal junction (GEJ) and the diaphragmatic hiatus. Design A prospective study. Setting Two tertiary referral centers. Patients and Interventions Standardized endoscopic videos were used. Main Outcome Measurements Interobserver agreement. Results Eighteen high-quality videos (normal esophagus, short and long lengths of BE, equally distributed) were independently evaluated by 18 gastroenterology trainees (year 1, n=5; year 2, n=6; year 3, n=7) after administration of a formal teaching module by an expert endoscopist. Overall intraclass correlation coefficients for assessment of the C and M extent of the endoscopic BE segment above the GEJ were 0.94 (95% CI, 0.89-0.98) and 0.96 (95% CI, 0.94-0.98), respectively. The overall intraclass correlation coefficients for GEJ and diaphragmatic hiatus location recognition were 0.92 (0.86-0.96) and 0.90 (0.82-0.95), respectively. The year of training did not affect interobserver agreement. Limitations The use of videos for endoscopic evaluation. Conclusion After standardized teaching, the Prague C & M criteria have high overall validity among gastroenterology trainees irrespective of the level of training for endoscopic evaluation of visualized BE lengths as well as key endoscopic landmarks.

PURPOSE To examine the relationship between surgeon experience and success rates in retinal detachment surgery. METHODS Success rates during a follow-up of 11 months of 8 surgeons who performed in total 375 retinal detachment procedures ranging from 14 to 115 cases between December 1997 and January 2002 were correlated to the total number of vitreoretinal procedures ranging between 176 and 2,587. All patients received either scleral buckling or vitrectomy, and complicated cases were excluded. RESULTS Mean primary anatomical success rates were 0.69 ± 0.14 for scleral buckling and 0.9 ± 0.05 for primary vitrectomy (P < 0.05). The primary anatomical success rates did not correlate to the number of vitreoretinal procedures. Seven of the eight surgeons showed an intraindividual learning effect with better success rates in the second versus the first half of the observed procedures. The learning effect was correlated to the total number of procedures with a higher effect in inexperienced surgeons. CONCLUSION An intraindividual learning effect that was higher in inexperienced surgeons could be demonstrated. The learning effect was reduced by half after 500 vitreoretinal procedures while the primary anatomical success rates were not correlated to the number of vitreoretinal procedures.

The fixation of polyimide stimulator foils as the basic substrate of epiretinal prostheses by using retinal tacks may cause retinal or choroidal alterations such as retinal proliferations or choroidal neovascularizations. During the prospective trial for the semichronical testing of a wireless intraocular retinal implant (EPIRET3) we investigated alterations in angiographic findings during implantation and after explantation of the device, to detect potential vascular pathologies at the fixation site or elsewhere. As the final step of the implantation surgery in six blind patients, the stimulator was placed on the retinal surface using retinal tacks. For the detection of possible morphological or vascular alterations committed by the implant fluorescein angiography (FA) was performed 1 day before and 4 weeks after implantation surgery, as well as at the final visit 5 months after explantation. Following implantation surgery funduscopy and FA did not reveal any evidence of either vascular pathologies or choroidal neovascularisations (CNV), in addition, no cystoid macular edema (CME) occurred after 4 weeks. At the 6-month follow-up visit, we found a mild epiretinal gliosis formation in four patients. In one patient a retinal break occurred during explantation, requiring a temporary silicone-oil endotamponade. At the final visit, we observed a focal proliferative vitreoretinopathy (PVR) reaction without activity, while there was no evidence for a CNV formation in that area. The FA findings confirm our previous results on the safety of the EPIRET3 system, which was tolerated in all patients but revealed a certain risk profile in regard to the stimulator fixation. While there was no evidence for newly occurred CME or CNV during the follow-up visits, nevertheless gliosis or even PVR reaction at the tack’s fixation site suggests the need to develop alternative fixation procedures of epiretinal stimulators.

Background/Aim. Prevention of the consequences of hearing loss can be accomplished by early hearing screening of the cochlear function in newborus, but also with continuous hearing screening in the early childhood. The aim of this study was to investigate the reliability and feasibility of otoacoustic emissions (OAE) in hearing screening in children, evaluate the frequency and type of hearing loss and determine etiological factors of these losses. Methods. In the study, 133 children, aged 2 to 7.5 years, were tested on both ears with transient evoked otoacoustic emissions (TEOAE) and distortionproduct otoacoustic emissions (DPOAE). Before screening tests all children had undergone otoscopic examination. If children had not passed either or both hearing screening tests and/or abnormal otoscopic findings in at least one ear, audiological evaluation was scheduled to confirm or exclude hearing loss. Results. Eighty-five percent of children passed the hearing and otoscopic screening bilaterally. For additional audiologic tests 15% of children were referred. Agreement between otoscopic examination and screening tests was very good (agreement for TEOAE 95%, for DPOAE 93%). The results showed that normal tympanograms were very likely to be associated with normal screening tests. Sensitivity of TEOAE test was 94.12%, specificity 78.95%, while DPOAE sensitivity was 87.50% and specificity 75%. Hearing loss was found in 6.76% of the cases, conductive in 6.01% and sensorineural in 0.75%. Conductive hearing loss was a consequence of chronic otitis media with effusion in 25% of the cases, and a consequence of adhesive process in the middle ear in 8.33% of cases. Sensorineural hearing loss was a consequence of using ototoxic medications. Conclusion. TEOAE and/or DPOAE tests are reliable, noninvasive, and feasible methods for hearing screening in childhood.

Over the last several decades, cochlear implantation has been fully proven as the treatment for profound hearing losses. The direct electrical stimulation of the spiral ganglion hair cells through the electrode inserted in the cochlear scala tympani is the essence of the cochlear implant (CI) functioning. Modern technological development has introduced unexpected technical quality possibilities of the device itself, as well as coding strategies, which further enable improved patients' rehabilitation results. Nevertheless, in spite of cochlear implantation becoming a routine surgical procedure, which has been changing lives of thousands of profoundly deaf adults and children, it has possible complications. Though rare, these complications could lead to severe, even fatal consequences. Bacterial meningitis represents one of the most severe postoperative complications. In this article, our five-year experience with cochlear implantation is shown, compared to other, much bigger, experiences. Despite severity and a potentially fatal outcome of meningitis, it has rarely been seen, and the precise connection between surgical procedure and this complication is not yet clear. Do cochlear implants increase the risk of bacterial meningitis? Are deafness-associated factors predisposing the bacterial meningitis occurrence, independently from the implant? These are the questions that the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the CI surgeons have been facing, as well as manufacturers and patients with their families.

Objectives. The aim of the investigation was to obtain acoustic correlates of the vocal quality of patients with vocal polyps, before and after the endolaryngeal phonomicrosurgery (EPM). Methods. Acoustic voice tests were carried out on 46 female patients with vocal fold polyp, before the EPM intervention and 3 weeks after its completion. Acoustic voice parameters were compared with the control group without voice pathology. The results of the investigation were analyzed acoustically. Results. The results showed that jitter (%), shimmer (%), fundamental frequency variation (vF(0)), voice turbulence index (VTI), pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and NHR values significantly differentiate the patients with vocal fold polyps from a control group without any pathological changes in the larynx. All of the analyzed parameters improved significantly (P lt 0.05) after the phonomicrosurgical intervention and tended to reach normal values. Conclusions. The acoustic voice analysis may be used for presurgical and postsurgical voice-status evaluation.

Objectives: The aim of this study is to present observation concerning clinical features, diagnosis and menagement of labyrinthine fistulae secondary to chronic suppurative otitis media. Methods: The authors studied 160 surgically treated patients with labyrinthine fistulae due to chronic otitis media with cholesteatoma. The material does not include erosion or incomplete fistula presenting itself as a bluish line on the labyrinth, but with a layer of bone is still intact. Results: In 136 (85.5%) of operated ears, the labyrinthine fistulae were found at the first surgery and in 24 (14.5%) at a reoperation. In a number of patients other complications were associated with the fistula such as peripheral facial paralysis, meningitis, and brain abscess. Total deafness and sensorineural hearing loss are commonly occurred with labyrinthine fistulae (63.1%). Preoperative fistula test was negative in 42% patients. The multiple fistulae were found in 14% patients. The fistulae were most commonly localized on the lateral semicircular canal (l 7%) and much less frequently involved only the oval window area (7%) and promontory (4%). The closed technique was used, while the open technique was adopted only when the ear was deaf preoperatively, in cases of multiple fistulae and associated intracranial complications. Conclusion: The cholesteatoma matrix should not be removed from fistulae of the oval window area, the promontory, multiple fistulae and large fistulae of the lateral semicircular canal if the matrix has already penetrated into the labyrinth. After removal of the matrix over fistulae of the lateral semicircular canal, a temporalis fascia graft should be used for cover.

PURPOSE. Visual sensations in patients with blindness and retinal degenerations may be restored by electrical stimulation of retinal neurons with implantable microelectrode arrays. A prospective trial was initiated to evaluate the safety and efficacy of a wireless intraocular retinal implant (EPIRET3) in six volunteers with blindness and RP. METHODS. The implant is a remotely controlled, fully intraocular wireless device consisting of a receiver and a stimulator module. The stimulator is placed on the retinal surface. Data and energy are transmitted via an inductive link from outside the eye to the implant. Surgery included removal of the lens, vitrectomy, and implantation of the EPIRET3 device through a corneal incision. The clinical outcome after implantation and explantation of the device was determined. The implant was removed after 4 weeks, according to the study protocol. RESULTS. Implantation was successful in all six patients. While the anterior part was fixed with transscleral sutures, the stimulating foil was placed onto the posterior pole and fixed with retinal tacks. The implant was well tolerated, causing temporary moderate postoperative inflammation, whereas the position of the implant remained stable until surgical removal. In all cases explantation of the device was performed successfully. Adverse events were a sterile hypopyon effectively treated with steroids and antibiotics in one case and a retinal break in a second case during explantation requiring silicone oil surgery. CONCLUSIONS. The EPIRET3 system can be successfully implanted and explanted in patients with blindness and RP. The surgical steps are feasible, and the postoperative follow-up disclosed an acceptable range of adverse events.