Dubravko Manestar

Gastroesophageal reflux and sequelae of chronic tubotympanal disorders in children

Objective—To compare sequelae of chronic tubotympanal disorders in children with and without gastroesophageal reflux (GER). Material and Methods—In 32 patients with chronic tubotympanal disorders GER was studied by means of 24-h continuous esophageal pH monitoring. After a period of 2–6 years (mean 4 years) sequelae of the tubotympanal disorders were examined, together with the clinical status of the ears and hearing status. The criteria for classification into mild, moderate and severe sequelae were based on the clinical status of the ear. Hearing was determined using tonal audiograms. Conductive hearing loss was classified as either slight (≤ 35 dB hearing loss in speech frequencies) or severe (>35 dB hearing loss in speech frequencies). Results—In the group of 16 patients (mean age 6.1 years) with GER, sequelae were observed in 29 ears (mild, n=11; moderate, n=5; severe, n=13). Hearing impairment was determined in 20 ears (mild, n=8; severe, n=12). In the group of 16 patients (mean age 7.1 years) without GER, sequelae were observed in 17 ears (mild, n=11; moderate, n=1; severe, n=5). Hearing impairment was determined in 10 ears (mild, n=6; severe, n=4). Conclusion—The total number of ears with sequelae and the total number of ears with conductive hearing impairment were significantly higher in patients with GER.

Amount of airflow required for olfactory perception in laryngectomees: a prospective interventional study.

Clin. Otolaryngol. 2012, 37, 28–34

The clinical status of the eardrum: An inclusion criterion for the treatment of chronic secretory otitis media in children

OBJECTIVE To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion. METHODS 161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum. RESULTS The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes (z=1.565; p=0.0587). There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz (t=2.173; p=0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower. Sequelae: scars of the eardrum (chi-square=28.107; ss=1; p<0.001) and attic retractions (chi-square=4.592; ss=1; p=0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on. CONCLUSION A criterion that could influence the approach to the therapy of CSOM in children.

Auricular epithesis: Auricular Epithesis

INTRODUCTION Tumors of the ear are relatively common and usually affect older people. If the tumor is small, a cure can be achieved by total excision and primary closure of the defect. Larger tumors require partial or full amputation of the ear, which negatively affects the aesthetics of the face. For older patients with additional comorbidities, we prefer reconstruction with an epithesis to plastic surgery. We manufacture the epithesis by means of threedimensional (3D) additive manufacturing (AM) technology. The advantages of this approach are a substantially shorter project cycle, with decreased time required to manufacture the epithesis, and excellent results with respect to comfort, aesthetics, and ease of use.