Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60% of patients. It is unknown why 40% ...of patients do not respond to systemic steroid therapy. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation (HBO) therapy, with inconsistent results reported. This study aimed to compare the results of ITS and HBO therapy in patients with SSNHL that previously failed systemic steroid therapy.
This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBO therapy, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Pure-tone audiograms were performed before and after the salvage therapy in the IT and HBO groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with a cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery.
ITS and HBO therapy were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13.6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7.4 dB in HBO therapy in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBO therapy. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4.67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group.
ITS and HBO therapy show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy.
The most widely used laryngeal surgery technique for patients with vocal fold paralysis is medialization thyroplasty. Materials such as Gore-Tex, silastic, and hydroxyapatite are often used, and the ...most worrisome possible complication is extrusion of the implant. A 36-year-old female patient with a history of pediatric cardiac surgery was diagnosed with left vocal cord paralysis after an episode of upper respiratory infection with a working diagnosis of subclinical left vocal cord paralysis following cardiac surgery. She underwent medialization thyroplasty with a Gore-Tex implant under local anesthesia. On the 21st postoperative day, she presented with sudden-onset hoarseness and dysphagia due to Gore-Tex implant extrusion. The implant was removed and augmentation of the left vocal cord with adipose tissue was performed. Only 14 cases of Gore-Tex implant extrusion have been described in the literature so far. The aim of this case report was not only to show one possible complication when using a Gore-Tex implant but also to present fat augmentation as one of the solutions for revision medialization and salvage treatment, with sustained long-term results.
Purpose of Review
Novel integrative reviews that give detail information regarding various psychoactive substances (PS) with ability of inducing psychosis in adults are lacking. This review aims to ...scope the latest knowledge about substance-induced psychosis (SIP) through the comprehensive review of the most common misused PS inducing psychosis.
Recent Findings
Epidemiological data on the prevalence of SIP are insufficiently harmonized, so clear conclusions for most PS can not be drawn. Etiological mechanisms include three pathophysiological mechanisms: the modulation of GABA transmission, NMDA antagonism, and effects on the monoaminergic system. Beside positive symptoms, PS may induce negative and cognitive symptoms. There are no uniform therapeutic guidelines for specific SIP, but some antipsychotics appear to be more effective than others. It is likely that the conversion rate of SIP to schizophrenia may be higher in the future because novel PS with a higher psychotic potential are increasingly being consumed.
Summary
This review presents epidemiological data, etiological mechanisms, details of clinical pictures, and treatment options for psychoses induced by specific PS.
Severe dysphagia is a rare presenting symptom of primary hyperparathyroidism, whereas the most common hypercalcemia-related causes include gastrointestinal symptoms, such as anorexia, constipation, ...and pancreatitis. This case presentation aimed to describe swallowing difficulty as a leading symptom of hypercalcemia.
A 62-year-old man experienced vomiting, dysphagia bordering with aphagia, and 20-kg weight loss in a 2-month period. The parathyroid hormone and serum calcium levels were 102 pmol/L (reference range, 1.8-7.9 pmol/L) and 4.12 mmol/L (reference range, 2.14-2.53 mmol/L), respectively. Ultrasound-guided exploration of the neck revealed a large, rounded hypoechoic mass inferior to the left thyroid lobe, which contained parathyroid tissue on fine-needle aspiration cytology examination. Contrast-enhanced neck computed tomography revealed a mass measuring 3.6 × 2.6 × 2.5 cm behind the left thyroid lobe, alongside massive ventral spondylophytes of the cervical spine at the level of the postcricoid segment of the hypopharynx. Magnetic resonance imaging confirmed ventral tissue displacement due to spondylophyte size and location. Surgical exploration of the left side of the neck was performed, and the left lower parathyroid gland weighing 9.07 g was excised. Pathohistologic findings verified a parathyroid gland adenoma. The postoperative values showed parathyroid hormone and serum calcium levels at 4.54 pmol/L and 2.25 mmol/L, respectively.
The pathophysiology of dysphagia in hypercalcemia is not fully elucidated. In this case, the patient’s improvement after surgery implies a plausible connection between hypercalcemia and dysphagia, suggesting a causal relationship.
Although aphagia is not a typical presenting symptom of parathyroid adenoma, it should be noted in the differential diagnosis.
The COVID-19 pandemic significantly affected our society and healthcare system. This study aims to evaluate the effects of COVID-19 on the number of hospitalized patients with dermatological diseases ...in Croatia, as well as the number of these patients treated surgically and conservatively, before (2017-2019) and during the pandemic (2020-2021).
This is a retrospective, comparative study of the hospital admission rate for patients with skin, subcutaneous tissue, and breast disorders both before and during the pandemic. This study used data from the Croatian Institute of Public Health (CIPH) and the Croatian Health Insurance Fund (CHIF). Inpatient data for the CHIF data collection were categorized using the Australian Refined Diagnosis Related Groups (AR-DRGs). All hospital admissions for dermatology patients at all non-specialized hospitals in Croatia were tracked during two periods, before (2017-2019) and during the pandemic (2020-2021).
The average number of dermatology patients in all hospitals fell by 29% during the pandemic. The overall number of dermatological patients admitted to hospitals fell by 32% in 2020 and by 26% in 2021 when compared to the number of patients admitted each year on average over the preceding 3 years. Additionally, there was an average 22% fall in surgical procedures performed during the pandemic. The only exception for surgical procedures is Major Breast Reconstruction for which is noted an increase, as also for Malignant Breast Disorders, Minor Complexity and Major Skin Disorders, Minor Complexity in a group of non-surgically treated patients.
Examining the all consequences of the Croatian dermatological patient care interruption will require more investigation. Reduced access to medical care during the pandemic is anticipated to lead to later illness diagnosis, a later start to treatment, a poorer disease prognosis, as well as higher medical expenditures.
The pandemic of COVID-19 had a profound impact on our community and healthcare system. This study aims to assess the impact of COVID-19 on psychiatric care in Croatia by comparing the number of acute ...psychiatric cases before coronavirus disease (2017-2019) and during the pandemic (2020-2022).
The paper is a retrospective, comparative analyzes of the hospital admission rate in Diagnosis Related Group (DRG) classes related to mental diseases, and organic mental disorders caused by alcohol and drug use. This study used DRG data from all acute hospitals in Croatia accredited to provide mental health care services and relevant publicly available data from the Croatian Institute of Public Health (CIPH) and the Croatian Health Insurance Fund (CHIF). All hospital admissions for acute psychiatric patients in Croatia were tracked during both periods under study.
During the pandemic, the average number of all such cases decreased by 28% in secondary and tertiary hospitals, and by 11% in specialist psychiatric hospitals. It was also found that during COVID-19, there was a decrease in case numbers in DRG classes related to major affective disorders and anxiety, alcohol, and drug intoxication (31, 48, 34 and 45%, respectively). However, the same period saw an increase in hospital activity for eating disorders and for involuntary admissions related to schizophrenia and paranoia (30, 34 and 39% respectively). There were no changes in the admission rate for cases related to opioid use.
The COVID-19 pandemic resulted in both a steep decrease in the overall number of psychiatric cases inpatient treatment at mental health facilities and their DRG casemix. Increasing our understanding of how pandemics and isolation affect demand for psychiatric care will help us better plan for future crises and provide more targeted care to this vulnerable group.
Cilj istraživanja: Pandemija koronavirusa ima značajan utjecaj na društvo i zdravstveni sustav. Cilj ovoga rada je usporediti podatke o broju i strukturi dijagnoza i obavljenih pregleda iz područja ...otorinolaringologije i kirurgije glave i vrata na razini primarne (PZZ) i tercijarne zdravstvene zaštite, u razdoblju od godinu dana prije i godinu dana nakon proglašenja pandemije koronavirusa. Bolesnici i metode: Podaci su prikupljani retrospektivno, za razdoblja od 20.3.2019. do 19.3.2020. i od 20.3.2020. do 20.3.2021. Uzorak je prigodan, prikupljen iz jedne ustanove na razini primarne i jedne ustanove na razini tercijarne zdravstvene zaštite. Iz dobivenih podataka isključene su one dijagnoze koje se ne odnose na stanja i bolesti iz otorinolaringologije i kirurgije glave i vrata. Rezultati: Tijekom promatranog razdoblja 20.3.2020.-20.3.2021. došlo je do značajnog pada broja pregleda u objema ustanovama u odnosu na razdoblje 20.3.2019.-19.3.2020. Na razini PZZ bilo je ukupno 533 pregleda, što predstavlja 50,5% pregleda obavljenih u istom razdoblju 2019.godine, dok je na razini specijalističko-konzilijarne zdravstvene zaštite (SKZZ) obavljeno 1672 pregleda, odnosno 56,4% pregleda obavljenih 2019. godine. Do najvećeg pada broja pregleda na razini PZZ došlo je među dijagnozama: zloćudni melanom kože, gripa, akutni bronhitis i bronhiolitis, akutne infekcije gornjeg dišnog sustava i bronhitis, emfizem, astma i druge kronične opstruktivne bolesti. Analizirajući preglede obavljene u SKZZ, najveći pad broja pregleda zabilježen je za dijagnoze: pneumonija, bronhitis, emfizem, astma i druge kronične opstruktivne bolesti, oštećenje sluha, zloćudni melanom kože i ostale bolesti dišnog sustava. Zaključci: Smanjeni broj pregleda i hospitalizacija u odnosu na vrijeme prije početka pandemije kao posljedicu mogu imati povećani broj bolesnika s novim dijagnozama, među kojima i karcinoma otkrivenih u kasnijim stadijima bolesti, što će u konačnici rezultirati kasnijim početkom liječenja i lošijim ishodom bolesti, ali i povećanim opterećenjem zdravstvenog sustava i povećanim troškovima liječenja.
Introduction: The SARS-CoV-2 pandemic has a profound impact on our society and health system.This paper aims to report the impact of the COVID-19 pandemic on patients referred to tertiary health care,as well as primary health care practice settings.Patients and methods: The number of patient referrals to a University Hospital CenterOtorhinolaryngology and Head and Neck Surgery department and a primary care office requiring patientconsultations regarding otorhinolaryngologic conditions between March 20th, 2019 and March 19th, 2020,and March 20th, 2020 and March 20th, 2021, was retrospectively collected. Diagnoses that do not relate toconditions related to otorhinolaryngology and head and neck surgery, or those that were not found in bothhealth care settings, were excluded.Results: A significant reduction in the total number of consultations during the pandemic was observed,at both levels of health care. In primary care, 533 consultations were performed (50.5% of the total numberin 2019), and at the tertiary level, 1672 consultations were performed (56.4% consultations performed in2019). When analyzing the conditions treated in primary care, the most relevant reduction regarded skinmelanoma, influenza, acute bronchitis and bronchiolitis, acute upper respiratory infections, bronchitis,emphysema, asthma, and other chronic obstructive pulmonary diseases. When analyzing the conditionstreated at the ENT department, the most relevant reduction regarded pneumonia, bronchitis, emphysema,asthma, other chronic obstructive pulmonary diseases, hearing impairment, skin melanoma, and otherrespiratory tract diseases.Conclusions: A reduced number of consultations and hospitalizations compared to pre-pandemic timemay result in an increased number of patients with new diagnoses, including cancer detected in later stagesof the disease, which will lead to later treatment and worse disease outcome, and also higher burden oftreatment costs.
Tinnitus is a frequent condition that indicates the sensation of sound in the absence of a corresponding external stimulus and can significantly impair the quality of life. The main risk factor for ...developing tinnitus is hearing loss. The diagnosis of tinnitus is based on history, assessment of tinnitus severity, clinical examination, and audiological tests. The main purpose of this research was to examine the relationship between the presence and level of hearing loss and the characteristics of tinnitus in patients with bilateral subjective tinnitus.
Total number of 50 participants, 20 men, and 30 women were included in the research. Demographic data, data on hearing impairment obtained by tone audiometry, and data on difficulties caused by tinnitus obtained in two questionnaires - Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI) were used.
Age above 30 years is significantly associated with tinnitus with hearing loss. Hearing impairment is also significantly more often associated with an auditory TFI index >6.7, a total THI index >20, and an emotional THI index >3. Hearing loss was noted in 76% of patients.
Tinnitus represents a significant burden for patients, therefore it is important to assess the impact of tinnitus on daily activities and quality of life.
Introduction: Sinonasal-type papilloma is a very rare tumor, most commonly connected with the sinonasal space, and very rarely with the middle ear. Primary tumors of the temporal bone are extremely ...rare and only 28 cases have been described in literature, with additional 29 cases of tumor spreading from the sinonasal tract to the temporal bone. Case presentation: We discuss the case of a 49-year-old woman who had a primary right-sided exophytic form of the sinonasal papilloma of the middle ear, which led to right-sided hearing loss, aural fullness, and otorrhea. During postoperative CT and MRI follow-up one year after surgery, a sinonasal oncocytic-type papilloma was discovered in the sphenoid sinus. To our knowledge, this is the first described case of histologically two different primary sinonasal-types of papilloma in a patient. Common presenting symptoms associated with sinonasal papilloma of the middle ear can be easily misdiagnosed with chronic otitis media or Eustachian tube dysfunction. Although primarily benign, sinonasal papillomas are locally aggressive and pose a risk of recurrence and malignant transformation. Therefore, surgery remains the treatment of choice with necessary long-term follow-up, to detect relapse or even a completely new tumor in that area.
Uvod: Sinonazalni tip papiloma vrlo je rijedak tumor, najčešće vezan uz sinonazalni prostor, a vrlorijetko za srednje uho. Primarni tumori temporalne kosti izuzetno su rijetki, a u literaturi je opisano samo28 slučajeva, uz dodatnih 29 slučajeva širenja tumora iz sinonazalnog trakta u temporalnu kost.Prikaz bolesnice: Prikazana je 49-godišnja žena koja je imala primarni desnostrani egzofitični obliksinonazalnog papiloma srednjeg uha, koji je doveo do desnostranog gubitka sluha, osjećaja punoće u uhu iotoreje. Tijekom postoperativnog CT i MRI praćenja godinu dana nakon operacije, sinonazalni onkocitnitip papiloma otkriven je u sfenoidalnom sinusu. Prema našim saznanjima ovo je prvi opisani slučaj dvajuhistološki različitih primarnih sinonazalnih tipova papiloma u jednog bolesnika. Uobičajeni simptomipovezani sa sinonazalnim papilomom srednjeg uha mogu se lako zamijeniti s kroničnom upalom srednjeguha ili disfunkcijom Eustahijeve cijevi. Iako primarno benigni, sinonazalni papilomi su lokalno agresivni ipredstavljaju opasnost od recidiva i maligne transformacije. Stoga operacija ostaje liječenje izbora, uzpotrebno dugotrajno praćenje, kako bi se otkrio recidiv ili čak potpuno novi tumor na tom području
