Slobodan Savovic

Comparison between auditory steady-state responses and pure-tone audiometry.

BACKGROUND/AIM A more recent method, the auditory steady-state 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.

Endonasal endoscopy and computerized tomography in diagnosis of the middle nasal meatus pathology

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 apporach--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, kappa > 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.

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.

[Nasal hump--five year analysis].

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.

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.