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Introduction/Objective. Aesthetically, the nose adds special signature to a person?s look. This results in many nasal pyramid surgeries, either functional or aesthetic. The problem arises in aesthetic surgeries. Patients often tend to present their dissatisfaction with the appearance of the nose as a breathing difficulty, as they often lack the support of the environment in the decision to undergo cosmetic surgery. The objective of the paper was to examine, using subjective assessment and objective measurements, the change in the nasal respiratory function in patients who undergo aesthetic nose surgeries, despite having a straight nasal septum before the surgery. Methods. The study was conducted as a prospective, cross-sectional one, and involved 32 patients of both genders. Before and at six months after surgery all patients underwent subjective nasal breathing assessment using visual analog scale (grade 0?10) as well as objective nasal respiratory function assessment using rhinomanometry and acoustic rhinometry after anemization. Results. There were seven male and 25 female patients, age ranging 18?27 years. Objective measurements after surgery showed that the nasal cavity volume, minimum cross-sectional area, as well as the airflow through the nose reduced, while resistance to the nasal airflow increased, but with no statistical significance. The subjective assessment of nasal breathing statistically significantly improved after the surgery. Conclusion. The subjective assessment of nasal breathing postoperatively is not a relevant indicator of the objective state of the nasal respiratory function in patients after aesthetic rhinoplasty.

Background/Aim. Chronic rhinosinusitis (CRS) is one of the most common chronic conditions that is diagnosed on the basis of the condition symptoms, nasal endoscopy and computed tomograhpy (CT) of the nose and paranasal sinuses. There are two forms of CRS: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). The aim of this paper was to determine if there is a correlation between the symptoms, nasal endoscopy and CT in patients with CRSsNP. Methods. The study included 110 patients with CRSsNP. The intensity of the symptoms assessed on the visual analogue scale (VAS) and the condition of nasal mucosa and the presence of nasal secretion was estimated by endoscopic examination of the nose while CT was used to determine the Lund-Mackay (LM) score values. Pearson?s coefficient of correlation was used for statistic data processing. Results. The severity of the disease as a whole (r = 0.509) and nasal discharge (r = 0.562) moderately correlated with CT. Nasal congestion (r = 0.354) and the reduction of loss of smell (r = 0.324) mildly correlated with CT, while facial pain/pressure (r = 0.218) had a very weak correlation with CT. The severity of the disease as a whole (r = 0.717) and nasal discharge (r = 0.821) strongly correlated with nasal endoscopy. Nasal congestion (r = 0.525) had a moderate correlation with nasal endoscopy while facial pain/pressure (r = 0.345) and the reduction of the loss of smell (r= 0.394) had a mild correlation with nasal endoscopy. A moderate correlation was found between nasal endoscopy and CT (r = 0.630). Conclusion. The severity of the disease as a whole and nasal discharge have more significant correlations both with nasal endoscopy and CT in relation to the correlations between other symptoms and nasal endoscopy, as well as CT. More significant correlations between the symptoms and nasal endoscopy in relation to the correlations between the symptoms and CT and the existence of a moderate correlation between nasal endoscopy and CT, enable a lesser use of CT diagnostics and only in precisely defined situatiations.

Introduction/Objective Fungal rhinosinusitis comprises of a wide range of immune-pathological responses, including invasive, chronic, granulomatous, and allergic diseases. Aim of this study was to determine total number of patients, their characteristics, frequency of symptoms, the manner of disease manifestation and the success of therapy. Methods Study included 21 patients with diagnosis FRS made according to the 2012 EPOS guidelines. Results Based on VAS(visual analogue scale), feeling of localized pressure, ie. facial pain was dominant in 9.57 ? 0.98, than the secretion from the nose is 8.14 ? 1.62, problem of the breathing on the nose in 6.67 ? 3.25, while reduction the sense of smell was in 2.14 ? 3.00. T-test showed there is a statistically significant difference between mucosal changes on the diseased and healthy sides of the patient's face (p

Introduction: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. Objective: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. Methods: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. Results: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients’ assessment (p

Backgound/Aim. Allergic rhinitis is the most frequent type of rhinitis affecting more than 600 million people worldwide. As incidence increases, it is important to know about the characteristics, the allergens that exacerbate it as well as effects of allergic rhinitis on population. The aim of this study was to determine among patients with chronic rhinitis the number of patients positive to standard inhaled allergens, their distribution by sex, age and to determine the type and frequency of allergic sensitization to specific inhalatory allergens. Methods. Data was collected from 514 patients tested for standard inhalatory allergens via the skin prick test from 01.01.2016 to 31.12. 2016. Age, sex and concomitant diseases as well an analysis of type and frequency of hypersensitivity to different allergens were assessed and recorded. Results. Of 514 patients, 307 patients, with an average age of 29.6 ? 8.88 years had a positive skin prick test. The sex ratio was 1.2 : 1 in favor of the females. Outdoor allergens affected 81.2% of all patients while indoor allergens 66.4% of them. Weed pollen (71%), grass pollen (61%) and Dermatophagoides pteronyssinus (46%) were the most common allergens. Most patients were sensitized to 1 (22%) or 2 (22%) allergens, while 20% of patients were simultaneously sensitized to 3 allergens. Conclusion. Most patients with the symptoms of chronic rhinitis had a positive allergic reaction. Those in their third decade of life were the most commonly affected. Outdoor allergens were the most prevalent allergen group, and weed pollen was the most frequent type of allergen.

Background/Aim. Cochlear implantation (CI) is a therapeutic modality that provides a sense of sound to children and adults with profound sensorineural hearing loss or deafness. The aim of this work was to evaluate the lateral semicircular canal function using a high frequency video head impulse test in children after CI. Methods. A prospective descriptive study included 28 children (6?17 years old) with profound sensorineural hearing loss and unilateral CI. The control group included 20 healthy children with normal hearing. The measurement of vestibular function of the lateral semicircular canal was performed using video head impulse test. After cochlear implantation, the children underwent the vestibular testing. Values vestibulo-ocular reflex of lateral semicircular canal were measured using the video head impulse test in the children with cochlear implant and the control group. The values of vestibulo-ocular reflex were compared between the group. Also, in the children with CI values of vestibulo-ocular reflex were compared between the non-implanted ear and the ear with the embedded CI. Results. All 28 children with sensorineural hearing loss underwent the placement of CI through cochleostomy at the average age of 4.8 ? 2.92 years. Children with the cochlear implant had a significantly lower vestibulo-ocular reflex gain of the lateral semicircular canal measured by a high frequency video head impulse test compared to the control group of children with normal hearing (T test: t = 3.714; p = 0.001). However in these children there was no statistically significant difference of vestibulo-ocular reflex gain in the lateral semicircular canal measured in ears with embedded CI and non-implanted ears (T test: t = 0.419; p = 0.677). Conclusion. The values of vestibulo-ocular reflex gain in the lateral semicircular canal evaluated by the video head impulse test are significantly lower in the children with a profound sensorineural hearing loss compared to the children with normal hearing. The CI did not appear to have a negative impact on the lateral semicircular canal.

Introduction/Objective. Chronic rhinosinusitis is one of the most frequent chronic disorders which significantly influences the patients? quality of life. The objectiv? of this paper was to examine which are the most frequent and intensive symptoms in patients with chronic rhinosinusitis, and also to determine whether there is a correlation between a subjective assessment of the disease as a whole and individual symptoms. Methods. The study encircled 90 patients with clinical diagnosis of chronic rhinosinusitis that was endoscopically proven and computer tomography of the nose and paranasal sinuses. Every possible symptom was recorded in every patient (nasal congestion, nasal discharge, facial pain/pressure, reduction or loss of smell, headache, fatigue, cough, halitosis and ear pain/fullness), the intensity of every possible symptom as well as the disorder as a whole. The patients assessed the intensity of their symptoms on the visual analogue scale. Results. Nose congestion is the most frequent symptom. It occured in 82 patients (91.1%), followed by nasal discharge in 81 patients (90%) and there was no difference in frequency of these two symptoms. Nasal discharge has been recorded as the most intensive symptom (x? = 5.4) and it is significantly more intensive in comparison to nasal congestion which was the second on the intesity list (x? = 4.1, p = 0.002). All other symptoms were significantly less frequently and less intensive. The average intensity value of the disease as a whole is the same as the average intensity value of the nasal discharge (x? = 5.4) while the average intensity values of all other symptoms are statistically significantly lower than the average intensity value of the disease as a whole; in all comparisons p < 0.001. Conclusion. Nasal congestion and nasal discharge are the most common symptoms in the patients with chronic rhinosinusitis. Nasal discharge is the most intensive symptom in patients with chronic rhinosinusitis while its intensity determines the sensation of the intesity of the disorder as a whole.

Despite the fact that laryngeal cancer causes symptoms early, the patients often present with advanced disease. The aim of this paper was to determine how much time had been lost from the beginning of the symptoms to establishing the diagnosis, and what was the clinical stage of the laryngeal cancer at the time of diagnosis in two examination years (2001 and 2016).The research involved 108 patients of both genders, 54 during each examination year, with whom the diagnosis of laryngeal carcinoma was established. The charts of the patients were reviewed, and the data were analyzed and compared.The median lost time from the time when the symptoms started to the time of diagnosis was 8.22 months during 2001 versus 8.77 months during 2016, with no statistically significant difference (p=0.774). Early clinical T stage of the disease in 2001 was present in 57.4% of the cases and 70.4% in 2016, with no statistically significant difference (p=0.161). Early clinical TNM stage in 2001 was in 48.1%, and 64.8% in 2016, with no statistically significant difference (p=0.081). Tracheotomy at the time of establishing the diagnosis was necessary in statistically significantly greater number of patients in 2001 compared to 2016 (59.3% versus 31.5% ;p=0.004).The diagnosis of laryngeal carcinoma is established late, with a long lost time. Favourable is the statistically significant decrease in the number of patients who require tracheotomy at the time of establishing the diagnosis with a 15-year-long interval.

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Introduction: Rhinosinusitis is an inflammatory process in the mucous membranes of nasal cavity and one or more paranasal sinuses. Diagnosis of this illness involves implementation of various procedures, some of which do not match. Objective: The aim of this paper is to determine if there is correspondence between clinical and radiological findings in patients with chronic rhinosinusitis with or without sinonasal polyposis. Method: 60 patients with nasal mucus condition, nasal secretion, a certain degree of nasal septum deformity and the CT Lund-Mackay score underwent the research. Results: Results of the study indicate that there is no correlation between clinical and radiological findings in patients with chronic rhinosinusitis, regardless of presence of sinus polyposis (p>0.05). Correlation between clinical findings in these groups of patients is statistically significant (p

Introduction. Vestibular evoked myogenic potentials are neurophysiological method for examining of saccular function, the bottom of the vestibular nerve that in nervates the sacculus and central vestibular pathways. Those are inhibitory potentials of the sternocleido mastoid musclein response to ipsilateral acoustic stimulation of the sacculus. Parameters of vestibular evoked myogenic potential testing include threshold, latencies of p1 and n1 wave and interamplitude p13-n23, interaural difference of p13 and n23 latency and interaural amplitude difference ratio. The aim of this study was to compire parameters standardization of vestibular evoked myogenic potentials responses, latency p13 and n23 of waves, the amplitude of responses and interaural differences in the amplitude andto determinewhether there is a difference in values between the sexes. Material and methods. This research was meant to be a prospective study which included 30 normal audiovestibular volunteers of both sexes. The group consisted of 53.3% women and 46.7% men. The saccular function testing by vestibular evoked myogenic potentials was performed monoaurally using air-conductive 500 Hz tone burst auditory stimulation. Results. The average value of the p13 wave latency in healthy subjects of this study was 15.18 ms (±1.24) while the mean latency of n23 waves in the same subjects was 25.00 ms (±2.23). The average value of the amplitude of the p13-n23 waves was 80.28 (34. ±04) microvolts. Conclusion. The difference in the values of the basic parameters of vestibular evoked myogenic potential responses between men and women does not exist. No differences between the right and the left ear in the values of latency and amplitude were observed.

Introduction. The aim of this paper is to determine the influence of nasal septum deformity degree on the subjective nasal breathing assessment as well as the existence of correlation between one side of the nose with nasal septum deformity and the subjective feeling of difficulty in breathing on that side in the subjects with different degrees of nasal septum deviation. Material and Methods. The research included 90 randomly chosen patients, who claimed to have nasal breathing difficulties. Every patient assessed subjectively which side of the nose made breathing difficult and scored the breathing on that side from 0 to 10 cm on the visual analogue scale. Results. The patients from the third group described their breathing as the most difficult, while the subjects from the first group claimed that their nasal breathing problems were the least difficult. The subjective feeling of heavy nasal breathing on the deformed nasal septum side was significantly different in all groups (H= 38.466, p= 0.000). In the second and the third group of patients there was a significant correlation between the deformed side of the nose and the subjective heavy breathing on that side (p< 0.05), whereas this correlation was not found in the first group (p> 0.05). Conclusion. The subjective feeling of difficulty in breathing on the deformed side of the nose is intensified with the degree of the nasal septum deformity, thus this feeling was reported only by the subjects with a higher degree of the nasal septum deformity.

Introduction. Silent sinus syndrome is a rare condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and downward displacement of the orbital floor. Patients with this syndrome present with ophthalmological complaints, without any nasal or sinus symptoms. Silent sinus syndrome has a painless course and slow development. It seems to be a consequence of maxillary sinus hypoventilation due to obstruction of the ostiomeatal unit. The CT scan findings are typical and definitely confirm the diagnosis of silent sinus syndrome. Case report. We present the case of a 35-year-old woman, with no history of orbital trauma or surgery. She had slight righthemifacial pressure with no sinonasal symptoms. The patient had no double vision nor other ophthalmological symptoms. The diagnosis of silent sinus syndrome was based on the gradual onset of enophthalmos and hypoglobus, in the absence of orbital trauma (including surgery) or prior symptoms of sinus disease. On paranasal CT scans there was a complete opacification and atelectasis of the right maxillary sinus with downward bowing of the orbital floor. The patient was treated with functional endoscopic sinus surgery, with no orbital repair. Conclusion. Silent sinus syndrome presents with orbithopaties but is in fact a rhinologic disease, so all ophthalmologists, rhinologists and radiologists should know about it. The treatment of choice for silent sinus syndrome is functional endoscopic sinus surgery, which should be performed with extra care, by an experienced rhinosurgeon.

The nose is the most prominent feature of the human face and in terms of esthetics, it has a significant impact on the overall facial appearance, its expression and beauty. In addition, it has other functions, which are much more important, above all breathing, protection, the sense of smell and the sound of the voice. The nasofrontal angle is the angle between the forehead and the dorsum of the nose. It determines the prominence of the nasal pyramid. A more acute nasofrontal angle is associated with a more prominent nasal pyramid. The nasofrontal angle in the Greek nose is 180°. Although authors have different opinions, the nasofrontal angle in Caucasian population should be between 127° and 150°. This prospective, cross-sectional study included 80 patients of both sexes who had undergone rhinoseptoplasty at the Department of Ear, Nose and Throat Diseases of the Clinical Center of Vojvodina. Of 80 patients, 22 were males. As for their age, 61% of patients were between 18 and 25 years old. Analysis of the nasofrontal angle before and after surgery, with a correlation coefficient of 0.4866, indicates that preoperative parameters of the nasofrontal angle have a moderate impact on the postoperative outcome. The impact analysis of the nasofrontal angle on the airway resistance in the preoperative and postoperative period showed distinct differences. Both functions can be best described by linear regression equations. The rhinoseptoplasty procedure reduces the nasofrontal angle to standard dimensions, consequently leading to reduction of the nasal airway resistance.

Background/Aim. Nasal obstruction is one of the most frequent disorders because of which patients see their Ear, Nose and Throath (ENT) doctors. Impaired nose breathing is a subjective symptom and it often does not coincide with clinical nose findings and functional tests of breathing function. Therefore, the aim of this study was to establish if there is an accordance between a subjective nose breathing assessment and objective methods (rhinomanometry and acoustic rhinometry) in assessing nose breathing function in patients with diverse nasal septum deformity degrees, as well as to establish an accordance between these two objective methods. Methods. This study involved the total of 90 examinees divided into three groups. The group I consisted of examinees with nasal septum deformities less than 10o. The group II consisted of examinees with nasal septum deformities ranged from 10o to 15o. The group III involved examinees with nasal septum deformities over 15o. Each examinee had subjectively graded his/her nasal breathing on the side of the nose septum deformity from 0 to 10, and afterwards the whole noses. Rhinomanometry and acoustic rhinometry were done on the side of the nasal septum deformities and after that on the other side of the nose using the Interacoustics SRE 2000 device. Results. In the groups II and III there was a positive correlation between a subjective nose breathing assessment and rhinomanometric values both on the side of the nasal septum deformities and the nose as a whole, (p < 0.05), and no correlation between these traits in the group I (p > 0.05). In none of the examined groups correlation was found between a subjective nose breathing assessment and rhinometric values, both minimum cross-sectional area (MCA) and volume (VOL), both on the side of the nasal septum deformities and the nose as a whole (p > 0.05). There was no correlation found between rhinomanometric and rhinometric MCA and VOL values in either on the sides of nasal septum deformities or the nose as a whole in any of the examined groups (p > 0.05). Conclusion. Rhinomanometry significantly correlates with the subjective nose breathing assessment and it can be used as a reliable and objective indicator of nose breathing in everyday clinical practice. Acoustic rhinometry, on the other hand, which does not correlate with a subjective nose breathing assessment could have a greater significance in a scientific sense than in clinical applying.

Introduction. Orofacial pain occurs in various disorders of the orofacial region. Objective. The aim of this study was to examine applicability of the visual-analogue scale (VAS) in patients with orofacial pain (model of acute and chronic pain). Methods. The study involved 60 patients, aged 18-70 years. The first group consisted of patients with dentin hypersensitivity, and the second group of patients with chronic rhinosinusitis. All patients were asked to fill-in a pain questionnaire and to rate pain intensity on the modified visual analogue scale (VAS; 0-10). Air indexing method was performed in the patients with dentin hypersensitivity in order to provoke pain, while the patients with chronic rhinosinusitis underwent CT imaging of paranasal sinuses. Wilcoxon?s test and Pearson?s correlation coefficient were used for statistical analysis. Results. In patients with dentin hypersensitivity provocation increased subjective feeling of pain, but without statistical significance (t=164.5; p>0.05). In patients with chronic rhinosinusitis a significant statistical correlation (r=0.53; p

Introduction: Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. Objective: The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. Methods: This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. Results: Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. Conclusion: Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate. Resumo Introdução: A liquorreia nasal indica uma fístula liquórica (FL), uma comunicação aberta entre o líquido cerebrospinal intracraniano e a cavidade nasal. Pode ser traumática e espontânea. Objetivo: Avaliar o desfecho do reparo endoscópico da fístula liquórica nasal com o uso de fluoresceína. Método: Este estudo retrospectivo incluiu 30 pacientes de ambos os sexos, com idade média de 48,7 anos, tratados de 2007 a 2015. Todos os pacientes foram submetidos à administração lombar de solução de fluoresceína de sódio a 5% no pré-operatório. A fístula foi fechada com enxerto de três camadas e cola de fibrina. Resultados: As fístulas de líquido cerebrospinal foram comumente localizadas no seio etmoidal (37%) e esfenoidal (33%). A maioria dos pacientes apresentou fístulas liquóricas traumáticas (2/3). A taxa de sucesso relatada para a primeira tentativa de reparo foi de 97%. Complicações ocorreram em três pacientes: um apresentou hidrocefalia aguda; um, síndrome reversível de encefalopatia no quinto dia de pós-operatório com perda bilateral da visão; e um foi diagnosticado com hidrocefalia dois anos após o reparo de fístula liquórica. Conclusão: O diagnóstico endoscópico e o reparo de fístulas liquóricas nasais com uso de fluoresceína intratecal têm alta taxa de sucesso e baixo índice de complicações.

Background/Aim. A more recent method, the auditory steadystate response (ASSR), has become more and more important test method due to difference that was found in previous investigations between hearing thresholds determined by the ASSR and the pure-tone audiometry (PTA). The aim of this study was to evaluate the reliability of the ASSR in determining the frequency specific hearing thresholds by establishing a correlation between the thresholds determined by PTA, as well as to evaluate the reliability of ASSR in determining the hearing threshold with respect to the level of hearing loss and the configuration of the PTA findings. Methods. The prospective study included 46 subjects (92 ears) which were assigned to groups based on their level of hearing loss and audiometric configuration. All the subjects underwent determination of hearing thresholds by PTA and ASSR without insight into their previously obtained PTA results. Results. The overall sample differences between the ASSR and PTA thresholds were 4.1, 2.5, 4.4, and 4.2 dB at 0.5, 1, 2, and 4 kHz, respectively. A high level of correlation was achieved in groups with different configurations of PTA findings. The correlation coefficients between the hearing thresholds determined by ASSR and PTA were significant in subjects with all levels of hearing loss. The differences between hearing thresholds determined by ASSR and PTA were less than 10 dB in 85% of subjects (ranging from 4 dB for moderately severe hearing loss to 7.2 dB for normal hearing). Conclusion. The ASSR is an excellent complementary method for the determination of hearing thresholds at the 4 carrier frequencies, as well as determination of the level of hearing loss and the audiometric configuration.

Most standard textbooks of hand surgery report on the rate of palmaris longus muscle absence of 15%. The aim of the study was to determine the absence of palmaris longus and to correlate it with age, sex and body side.The study included 800 subjects (400 male and 400 female). They were initially asked to do the standard test for the assessment of the palmaris longus tendon. If the tendon was not visualized or palpable, four additional tests were done to confirm its absence.Unilateral absence of the palmaris longus was recorded in 173 (21.6%) and bilateral in 127 (15.9%) study subjects. According to body side, right-sided absence of palmaris longus was found in 69 (8.6%) and left-sided in 104 (13%) subjects, yielding a statistically significant difference. Bilateral absence was slightly more common in men. The prevalence of palmaris longus absence on the right and left side was similar in men, whereas in women it was significantly more common on the left side. Differences between the three age groups (young, middle-aged and old) were not significant; however, the middle-aged and young groups showed a lower rate of palmaris longus presence as compared to old-age group.It has been suggested that this tendon is rapidly disappearing in humans. The results of our study show a relatively high incidence of tendon absence and pointed to more pronounced loss of the muscle on the left side.

Introduction The most common anatomic variations of the structures of the middle nasal meatus are variations of agger nasi cells, variations of the middle turbinate, variations of uncinate process, variations of the ethmoidal bulla, deviations and deformations of nasal septum in the region of the middle nasal meatus, Haller's cell (orbitoethmoidal) and Onodi's cell(sphenoethmoidal cell). In 1997, the Otorhinolaryngology-Head Neck Surgery, Tasc Force on Chronic Rhinosinusitis defined chronic sinusitis and nasal disease initially by including sinusitis and rhinitis with one term-chronic rhinosinusitis. This was done because it was apparent to many that nasal disoders often affected the sinuses, and vice versa. Also they established baseline parameters, major and minor signs and symptoms, for definition of rhinosinusitis. Two major factors or one major factor and two minor factors constitute a strong history for rhinosinusitis. Material and methods The following methods were used in the study: 1. Anamnestic data processing about: disease symptoms that were recognired by American Academy for ENT as major and minor criteria in diagnosing nosinusitis; the duration of symptoms; the kind of sinonasal disorder and the secondary disorders. 2. Data processing obtained by anterior/posterior rhinoscopy. 3. Data processing obtained by endoscopic examination. 4. Data processing obtained by CT of paranasal cavities and the nose. The data about anatomic variations were statistically processed by Eives's correlation coefficient that indicates the degree of correlation between sinonasal disorders and anatomic variation. Results By analyzing the obtained data in the examined patients with sinonasal disorders, anatomic variations were present in over 50% of the patients and are defined by percentage. I. The deviation of nasal septum in 83.33% patients. 2. The variations of the form of the middle nasal chonha in 58.92% patients. 3. The presence of agger nasi cells in 50% patients. 4. Variations of the form of ethomoidal bulla in 50% patients. Eives's correlation coefficient i.e. the degree of correlation between sinonasal disorders and the presence of anatomic variation statistically significantly correlate at r >/= ft 05 of anatomic variation of the middle nasal chonha (r =0.23) and the presence of deviation/deformation of nasal septum (r = 0.6) with sinonasal disorders. Discussion and conclusion Anatomic variations of the structures of the middle nasal meatus can additionally complicate the anatomy of the lateral nasal wall and the conditions of the ostiomeatal unit. Therefore we must view these variations as factors predisposing to more rapid and frequent appearance and persistence of chronic inflammations. Also, familiary with the variations in sinonasal anatomy is a prerequisite to safe and effective surgical treatment of sinonasal disease. Recognition of this anatomic variation should minimize catastrophic violation of vital structures such as orbit or skull base.

Introduction A rhinolith is a rock which forms in the nose. It occurs from the solidification of mucus and nasal debris: by mineral salts, calcium, magnesium phosphate and carbonate, and it leads to unilateral obstruction of the nasal airway followed by inflammatory changes of the nasal mucus membrane and paranasal cavities. This inflammatory process may lead to a purulent form with complications, intracranial propagation and dacryocystitis. Case report This is a case report of a patient with rhinolithiasis, 30 years of age, complaining of breathing difficulties for 10 years, with nasal secretion, reduced olfactory function and headaches. She underwent the following procedures: frontal rhinoscopy, epipharyngoscopy, nasal mucus analysis (fungi and bacteria), x- ray check-up as well as pathohistological analysis of the removed rhinolith. Discussion and conclusion The significance of computer tomography of paranasal cavities was confirmed in coronal lines, as the most valid radiological analysis which provides adequate diagnosis, differential diagnosis and helps in making the decision on surgical treatment. Surgery is obligatory and in most cases it is endonasal endoscopy. Bigger nasal stones (rhinoliths), progressing into the surrounding anatomic structures, are treated using rhinotomy and trepanation (Caldweell-Luc). In cases of greater rhynolits with propagation into neighboring anatomic areas, cases of surgical treatment by lateral rhynotomy and trepancy of the sinuses (Caldwel-Luc) were shown.

The sense of smell is the least examined of all senses. The significance of the organs of smell is in their influence on the mental state as well as on the vegetative, visceral and sexual functions. The objective of this experiment was to define the influence of sex on the olfactory function. It was performed on 120 subjects (60 females and 60 males) divided into three age groups (20 - 30; 31 - 40; 41 - 50 years of age). The experiment was carried out by the Fortunato-Niccolini olfactometric method using six odorous experimental substances: A - anethol, PH - phenyl-ethyl-alcohol, C citral, M - menthol, V- vanillin and P - pyridine, the thresholds of perception (TP) and identification (TI) being defined for each odorous substance. The examined females had slightly lower thresholds of perception (TP) and identification (TI) in relation to the males of the same age group. However, the differences were not statistically significant except for the group of subjects between 41 and 50 years of age where the females, being in the pre-menopause, had significantly better olfactory functions. The results can be explained by the weakening of the olfactory power as a result of ageing in both sexes, however, the females still experienced the protective role of sex hormones.

Introduction A need for research of the olfactory function exists in everyday clinical work. The aim of this study was to determine standards for perception and identification thresholds regarding olfactory substances in healthy subjects in regard to their age. Material and methods The research included 120 healthy examinees (60 women and 60 men) classified according to age into three age groups (20-30, 31-40, 41-50 years of age). This examination was done using Fortunato-Niccolini's method. Results and discussion The results of this work show that olfactory function becomes significantly weaker after the age of forty. Thresholds of perception in correlation with thresholds of identification for examined olfactory substances are significantly lower in older age groups. Conclusion A gradual loss of olfactory capability with age can be explained by gradual destruction of olfactory cells and fibres of olfactory nerves during life.

On the basis of incisions that are made in order to lift soft nasal tissue and showing the skeleton of the nasal pyramid as well as the septum, all surgical techniques can be divided into open and close ones. In close techniques, incisions are inside the nasal cavity and are not visible whereas in the open ones the first incision on columella skin. The authors discuss surgical indications, incisions, the surgical procedure, problems with the nasal tip, nasal valve problems, and graft materials.

Protruding ears are diagnosed if the auriculocephalic angle, determined by the line from the root of the helix to its most lateral edge and the mastoid plane, is over 25°. The most common causes of ear protrusion are underdeveloped or poorly developed antihelix. The authors discuss preoperative preparation, postoperative care, and complications. The tubular technique is described in a step-by-step fashion. When using this surgical procedure, complications are extremely rare. The basic advantage of this procedure is that the anterior auricular surface is spared of damage.

Introduction In the course of bone tissue development some genetic disorders such as exostoses and enostoses, may occur. Exostoses and enostoses represent bone tissue hyperplasia that can develop at any part of skeleton. Neurotrauma can cause fatal biological consequences, which is directly associated with skull development abnormalities. Case report This is a case report of a male cadaver 36 years of age. The autopsy revealed massive hemorrhage on the left side of the neck and the right side of the lower jaw. A major fissure of the arterial wall was found on the basilar artery. A bony, wart-like excrescence was found on the clivus of the occipital bone. Discussion Coinciding ruptures and consequential bleeding from basilar artery with presence of development abnormalities in the clivus region, suggest that one has to clearly distinguish the result of the injury from anomalies already existing in the skull. The position of the attacker can be determined by concise and objective investigation. Conclusion This is a case report of an anomaly in bone development: a bony, wart-like excrescence on the right side of the clivus. Due to neurotrauma and consequential sliding of brain structures, the damage of basilar artery and of the bony excrescence occurred, which led to bleeding and fatal outcome.

Background. Expression of immersion syndrome implies sudden and unexpected death of swimmer in water. A drowned swimmer is still a riddle for the forensic and clinical doctors. Pathophysiological mechanisms which cause immersion syndrome may be divided into vegetatively regulating and mechanical ones. Case report. We presented heterotopic intracranial ossification with the anomaly of the skull base bones development in a young man, a swimmer, drowned after entering water and where the circumstances required expertise in forensic medicine. Conclusion. Intracranial heterotopic ossification with or without a disorder in the development of skull bones may be one of the causes of immersion syndrome.

Introduction The nose has a prominent central position in the face and therefore it considerably contributes to the esthetic appearance and facial harmony. On the anterior view, the face is dominated by the nasal length and width, as well as medial location. On the lateral view, the nasal dorsum is most important; although it is the dimension we cannot see ourselves, it is the most common cause of surgery. Material and methods This five-year retrospective study included 216 patients of both sexes; their average age was 22 years, and they underwent surgery at the Ear, Throat and Nose Clinic in Novi Sad in the period from 2001 to 2006. There were 89 male, and 127 female patients. Results Most patients were aged 18 - 22 years (57%). A nasal pyramid deformity with septal deviation was present in 81.1% of patients, whereas 18.9% (41 patients) presented only with a nasal pyramid deformity. Out of the total number of patients, 24 patients had both nasal kyphosis and scoliosis. All patients underwent closed rhinoplasty with obligatory correction of the tip of the nose. The nasal hump removal with lateral osteotomy was also performed in all patients. Two patients underwent reoperation, due to small dorsal humps within the cartilage, while one patient had a postoperative septal perforation. One patient presented with a postoperative abscess of the nasal dorsum, which was conservatively managed. Conclusion Nasal hump is the most common nasal pyramid deformity, often without a nasal septum deviation. It is quite easily treated by surgery. Two patients have already undergone reoperation with good results, and two patients had postoperative complications. Postoperative complications were recorded in 1,85% of patients.

Introduction Nose injuries are of great importance in ENT and medico-legal practice. The importance lies in the frequency of injuries, diverse approaches to diagnosis, treatment and qualification of injuries used in legal proceedings in court. Objective assessment of health impairments due to an injury, requires knowledge about morphofunctional nasal characteristic, therapeutic procedures and medico-legal expertise. Nose injures: etiology and diagnosis Nasal fractures are the most common types of facial fractures which occur in different situations. They are often combined with soft tissue injuries. The diagnosis of nasal injuries involves clinical examination, radiography and nasal endoscopy. Classification and therapy of nose injuries There are several classifications of nasal injuries depending on pathological findings. The most acceptable one is the modified categorization after Harrison. The treatment of nasal injuries depends on the type of injury and possible complications. Qualification of nose injuries Nasal soft tissue injuries, nasal fractures, dislocations and partial dislocations should be assessed at the time of diagnosis. Conclusion Medical assessment of injuries is of utmost importance for legal purposes and regarding medico-legal aspects. .

Introduction. Diagnostic nasal endoscopy enables clear visualization of all structures of the middle nasal meatus and of the ostiomeatal complex. It is a primary means for diagnosis of all anatomic variations and other pathogenic factors of the lateral nasal wall, which cannot be diagnosed by using anterior/posterior rhinoscopy. Furthermore, the effects of therapy can be endoscopically controlled and, if necessary, a surgical procedure may be performed. Computed tomography has become the imaging study of choice in the diagnosis and management of sinonasal diseases. It provides detailed information and an unparalleled view of the sinuses, especially the bony anatomy. Material and methods. The following methods were used in the study: endoscopic examination and CT of the nose and paranasal cavities. Data processing and comparison of diagnostic methods tomography was done using a biostatistical approach - kappa. Results. The correlation between computerized tomography and endoscopy of the nose and sixty nasal cavities of examined patients is significantly high, with mean kappa coefficient of k=0.89 i.e. k>0.8. Discussion and conclusion. The diagnosis of rhinosinusitis is generally based on clinical grounds. In 1997, the Task Force of Rhinosinusitis developed the major and minor criteria for diagnosing rhinosinusitis. The presence of two major or one major and two minor symptoms is generally sufficient to make a clinical diagnosis of rhinosinusitis. In order to make a specific diagnosis and provide specific treatment, ednonasal endoscopy is the method of choice. In cases with refractory rhinosinusitis, acute rhinosinusitis with complications, or atypical cases requiring confirmation of sinusitis, use of coronal and axial CT is necessary. This article confirms that diagnostic endoscopy of the nose and paranasal cavities with computer tomography of paranasal cavities represent an ideal combination and a widely recognized standard for diagnosis and treatment of nasal and paranasal cavity disorders in many countries. .

Introduction Neck metastases of unknown origin are metastatic solid tumors with primary undetactable by physical examination, chest x-ray, rutine blood and urine studies and histologic evaluation. Material and methods This study included 77 patients of both sexes, average age 57 years, undergoing a diagnostic procedure at ENT clinic, Clinical Center Novi Sad, in the period from 1992 to 2001. Results The primary tumor was detected in 51% of all cases by panendoscopy and bilateral tonsillectomy. In 14 of 26 patients (54%), in whom the site of the primary tumor was not detected, after telecobalt therapy and radical neck dissection, no relapses occurred. Pathohistological examination revealed planocellular carcinoma in 50 (65%) cases, transitional cell carcinoma in 9 (11.7%) cases and lymphoma in 7 (9.1%) cases. Conclusion Cervical metastases with unknown primary tumor are the first sign of head and neck malignant disease. Panendoscopy with bilateral tonsillectomy and multiple mucosal biopsies are necessary procedures in detecting the primary tumor site. .

Introduction Sense of smell is susceptible to various changes, both in physiological and in numerous pathological conditions. Of quantitative disorders of smell, hyposmia and anosmia are quite common, whereas of qualitative disorders parosmia is most frequent. The aim of this paper was to examine impact of bilateral nasal polyposis on olfactory function. Material and methods The research was carried out at the Nose, Ear and Throat Clinic in Novi Sad. It included 80 examinees, 40 (20 male, 20 female) with bilateral nasal polyposis, while 40 examinees belonged to the control group (20 male, 20 female) without symptoms of nasal polyposes. Fortunato-Niccolini olfactometer was used for this examination. Results and discussion In patients with bilateral nasal polyposis the average perception threshold values for examined odors were 15.50 ccm of odorous air, while in the control group they were 10,20 ccm of odorous air. The average identification threshold values for examined odors in patients with bilateral nasal polyposis were 18.80 ccm of odorous air, while in the control group they were 13.55 ccm of scented air. T-test showed that values of both tresholds were statistically significantly higher (p< 0,01) in patients with bilateral nasal polyposis in relation to the control group. Conclusion Olfactory deficit in patients with bilateral nasal polyposis is explained by difficult or impossible passage of odors into the olfactory region.

Introduction Olfaction is considered to be the ability to: perceive, conduct and recognize scents and odors. With its numerous connections to the limbic system and reticular formation, the olfactory system affects regulation of numerous vegetative functions, visceral functions and sexual behavior. Since estrogen and progesterone protect the olfactory function, changes in their levels in particular physiological states in women (in pregnancy and postmenopause) exert an influence on the ability to feel and recognize smells. It has its role in creating emotions and adjustment of visceral and vegetative response to particular emotional states. Also, it represents the connection between higher cortical functions and the endocrine system. Material and methods Our investigation was performed at the Ear, Nose and Throat Clinic in Novi Sad. The research included 80 healthy women classified into 4 groups; 20 women aged between 20 and 30; 20 women in the first trimester of pregnancy aged between 20 and 30; 20 premenopausal women aged between 41 and 50; and 20 women at least 3 years in postmenopause, aged between 41 and 50. For our research we used an olfactometer and the Fortunato-Niccolini method. Results and discussion In pregnancy the thresholds of perception (TP) and identification (TI) of examined substances were slightly lower in comparison to nonpregnant women of the same ages, but without any statistical significance (p>0.05). In climacteric-postmenopausal women there was a significant decrease of olfactory ability in comparison to nonmenopausal women of the same ages (p