Ljiljana Vlaski

Phage-antibiotic synergism: a possible approach to combatting Pseudomonas aeruginosa.

Pseudomonas aeruginosa is a highly resistant opportunistic pathogen and an important etiological agent of various types of infections. During the last decade, P. aeruginosa phages have been extensively examined as alternative antimicrobial agents. The aim of the study was to determine antimicrobial effectiveness of combining subinhibitory concentrations of gentamicin, ceftriaxone, ciprofloxacin or polymyxin B with P. aeruginosa-specific bacteriophages belonging to families Podoviridae and Siphoviridae. The time-kill curve method showed that a combination of bacteriophages and subinhibitory concentrations of ceftriaxone generally reduced bacterial growth, and synergism was proven for a Siphoviridae phage σ-1 after 300 min of incubation. The detected alteration in morphology after ceftriaxone application, resulting in cell elongation, along with its specific mode of action, seemed to be a necessary but was not a sufficient reason for phage-antibiotic synergism. The phenomenon offers an opportunity for future development of treatment strategies for potentially lethal infections caused by P. aeruginosa.

Transient evoked otoacoustic emissions in young children with otitis media with effusion before and after surgery

OBJECTIVE Otitis media with effusion (OME) is one of the commonest causes of acquired hearing loss in children with increasing incidence. In young children the diagnosis is restricted to clinical trials and tympanometry whereas evaluation of the auditory function is impossible due to noncompliance during pure tone audiometry. For this purpose, measurement of otoacoustic emissions, especially transient evoked ones (TEOAE), can be applied. The aim of this study is to evaluate the parameters of TEOAE in young children with OME prior and after surgery. METHODS Prospective study included 50 children with OME, both sexes, aged 2-5 years. Preoperatively tympanometric examination was performed and TEOAE were recorded. Surgery was performed under general anesthesia and included myringotomy with/without ventilation tube insertion. Measurements of TEOAEs (correlation percentage, signal to noise ratio and amplitude) were repeated on the first and six day postoperatively as well as 6 weeks and 6 months postoperatively. RESULTS The preoperative TEOAEs were not recorded in 93.5%, with values of all TEOAE parameters being the most affected on highest frequencies. Significant changes of all TEOAE parameters were found 6 weeks postoperatively with further improvement 6 months postoperatively. Statistically highly significant difference of TEOAE between examinees with and without inserted ventilation tubes was established only in regard to preoperative results. CONCLUSION In small children with OME, application of TEOAEs in follow-up of surgical effects is a method of choice for hearing screening due to its objectivity, simplicity and ease of use even after insertion of ventilation tubes. Follow-ups of TEOAE correlation percentage and signal to noise ratio reflect the condition earlier than follow-ups of TEOAE amplitude.

Endoscopic repair of cerebrospinal fluid rhinorrhea

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.

Rhinoplasty: Open Techniques

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.

Audiologic diagnostics of vestibular schwannoma

INTRODUCTION Vestibular schwannoma (acoustic neuroma) is a rare, but important cause of sensorineural hearing loss. Patients with asymmetric hearing loss, or unilateral tinnitus should be evaluated expeditiously, to prevent further neurological damage. AUDIOLOGIC DIAGNOSTICS Audiologic diagnostics represents the basic diagnosis for early detection of vestibular schwannoma. Patients with vestibular schwannomas may present with a variety of clinical features, including retrocochlear pattern of sensorineural hearing loss. Supraliminary audiometry, tympanometry, stapedius reflex and otoacoustic emissions as well as vestibular response to caloric testing are methods for selection of patients with suspicion of this tumor. CONCLUSION The golden standard for audiologic diagnostics of vestibular schwannoma is BAEP (Brainstem Auditory Evoked Potentials). Patients with pathological findings of BAEP should undergo MRI of the posterior fossa. Gadolinium-enhanced magnetic resonance imaging is the best and final tool for making a diagnosis of vestibular schwannoma.

Unilateral tinnitus as a single symptom of unusually large vestibular schwannoma

Introduction. Vestibular schwannomas are relatively rare tumors whose symptoms are based on its location and as the tumor grows, the symptoms usually advance. Case Report. An 18-year old patient was examined by an otolaryngologist due to buzzing in her right ear that had lasted for about 1 month. Her pure-tone audiometry findings showed slight asymmetry; a slight ascendant type sensorineural hearing loss was found in the right ear (25 dB HL at 125 Hz, 20 dB HL at 250 Hz, and 10 dB HL at other frequencies), while the threshold in the left ear was 15 dBHL at 125 Hz and 10 dB HL at other frequencies. Electronystagmography, otoacoustic emissions and auditory brain-stem responses suggested retrocochlear etiology of tinnitus. Magnetic resonance imaging examination revealed a large right cerebellopontine angle tumor, measuring 5 x 3 x 3 cm, which had shifted the brain stem laterally. Conclusion. Every case of unilateral tinnitus, asymmetric sensorineural hearing loss, or hypotonia of labyrinth not strictly accompanied by vertigo, needs to be further evaluated using a battery of audiologic tests whose findings may be normal. Audiologic tests should be repeated in cases of persistent symptoms and accompanied by cranial magnetic resonance imaging, which is today considered the gold standard for diagnosis of vestibular schwannoma.

Tracheobronchial foreign body aspiration: A 13-year retrospective analysis

Introduction. Foreign body aspiration into the respiratory tract remains a diagnostic and therapeutic challenge in clinical practice, especially in young children, who are the most frequently affected age group. The aim of this study was to present the results of treating the patients with foreign body aspiration in all age groups. Material and Methods. The medical and radiological records of 64 patients with confirmed foreign body out of 146 patients with suspected foreign body aspiration were retrospectively analyzed during the period of 13 years (from 2001 to 2013). Results. A foreign body was found in 64 (44%) of the 146 patients of all age groups with suspected foreign body aspiration. The patients’ age ranged between 11 months and 80 years. There were 84% children and 16% adults, and 63% of patients were male. Time between the moment of aspiration and admission to the Department ranged between 0.5 hours and 14 days, with majority of patients (70%) being admitted during the first 24 hour. History of respiratory drama was present in 92% of patients. Physical and radiological findings were positive in 66% and 47% of patients, rescpectively. Organic vegetable foreign bodies accounted for 75% of all cases, and they were most frequently found in the right main bronchus (63%). All foreign bodies were successfully extracted by rigid bronchoscopy, without serious complications and fatal outcomes. Conclusion. Bronchoscopy should be performed in any case of suspected foreign body aspiration, even if clinical and radiological findings are normal, in order to avoid serious and possible life-threatening complications. More should be done to raise awareness of this potentially preventable condition.

Mastoiditis in children: A retrospective analysis of clinical characteristics

Introduction. Acute mastoiditis is the most common otogenic complication among infants and young children and is always considered a serious complication. In addition to determining the age at which mastoiditis usually occurred in children, the time of onset of clinical signs in relation to the onset of symptoms of middle ear inflammation, as well as the most common clinical signs of mastoiditis, the study has been aimed at finding out whether mastoiditis is of seasonal character. Material and Methods. A retrospective study of children surgically treated for mastoiditis was conducted at the Department of Ear, Nose and Throat Disease of the Clinical Center of Vojvodina in Novi Sad in the period January 1, 2002 - December 31, 2011. The sample included 56 children (30 boys - 53.57%, and 26 girls - 46.42%), up to 17 years of age. The obtained results were statistically analyzed and presented using Microfsot EXCEL for statistical analysis. Results. Mastoiditis is most common in children up to 2 years of age, 39/56 (69.82%). It has a seasonal character, with the peak season in the autumn-winter period, with a statistically significant difference compared to the spring-summer period (p = 0.0449, i.e. p<0.05). In 25 children (44.64%), the middle ear symptoms lasted up to three weeks before operation. Otomicroscopic findings showed that the tympanic membrane was thickened and stiff in 41 children (73.21%) and 9 children (16.07%) presented with thickened tympanic membrane and lowering of the posterior wall of the external auditory canal. Conclusion. Mastoiditis in children is most common among children up to 24 months of age. It has a seasonal tendency. In nearly half of the cases, clinical manifestations of mastoiditis appear 3 weeks after the onset of the first symptoms of middle ear inflammation, whereas the key otomicroscopic finding is stiffness and thickening of the tympanic membrane.

Prolonged peripheral facial nerve paralysis in a child — think of temporal bone rhabdomyosarcoma: case report

Rhabdomyosarcoma is the most common type of soft tissue sarcoma in childhood. When localized in the middle ear and temporal bone, they are highly aggressive, whereas the outcome directly depends on an accurate and timely diagnosis, stage of the disease, and adequate multimodal therapy. Early clinical diagnosis of the temporal bone rhabdomyosarcoma is often difficult since clinical signs are not specific for this disease. We present a case of an embryonal rhabdomyosarcoma, botryoid subtype, of the middle ear in a girl aged 4 years and 4 months, diagnosed 34 days after the first symptoms — right ear pain with peripheral facial nerve palsy on the same side. The overall symptoms were poor, in no way suggesting such a serious condition. After the treatment, control follow-ups for more than 3 years showed no recurrence of the disease, while signs of the right peripheral facial palsy persist.ConclusionIn cases of prolonged peripheral facial nerve palsy in children, not responding to conservative treatment, a temporal bone rhabdomyosarcoma should be considered in a differential diagnosis.

The Tubular Technique in Otoplasty

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.