<p><strong>Introduction. </strong>The aim of this article was to present a case of a foreign body in the external auditory canal described as a pseudotumor of the middle ear, as well as to point out diagnostic and therapeutic aspects of this problem.</p> <p><strong>Case report. </strong>An 8-year-old girl was hospitalized several times in our department due to the surgery of left-sided chronic otitis media. Mastoidectomy and posterior atticotomy were performed during initial hospitalization. Six months later, she was admitted for the second act of the left-sided tympanoplasty. However, two months prior hospitalization, symptoms regarding the right ear appeared: sense of fullness, gradual hearing loss and occasional pain. An otoscopic finding on the right indicated the presence of &ldquo;tumefaction&rdquo; in the external auditory canal with a surface that was markedly hyperemic. This pseudotumor was finally interpreted as the foreign body in the external auditory canal.</p> <p><strong>Conclusion. </strong>Foreign bodies in the external auditory canal (EAC) are relatively common in pediatric population. The medical history sometimes is not reliable, and the clinical and radiological interpretation of pseudotumor in the external auditory canal or middle ear must include this possibility in the differential diagnosis as well. Surgical exploration and pathohistological diagnosis are necessary to make a definitive diagnosis and to avoid potential complications.</p>

<p>The participation of deaf and hard of hearing people in sports activities contributes to the improvement of the quality of life in all its domains, and compared to people with some other types of disabilities, deaf and hard of hearing people achieve higher scores in sports activities. Practicing sports activities improves physical health, mental state, degree of independence and social relationships. Sports activities have a positive effect on building and strengthening the self-esteem of individuals. Subjective experience and individual perception have a great influence on the quality of an individual&rsquo;s life, therefore, self-esteem is a very important factor that contributes to this. The aim of this paper is to review the literature from the period 2000&ndash;2021 on the impact of sports activities on the psychophysical health of deaf and hard of hearing people. The subject of interest was: to determine the role of sports activities in the quality of life of deaf and hard of hearing people, as well as how they affect their level of self-esteem. The following search engines were used for the literature search: Ebscohost, ScienceDirect, Wiley Inter Science and SpringerLink, KoBSON, Google Scholar. The results of the literature review showed that sports activities contributed to the preservation and development of the overall psychophysical health of deaf and hard of hearing people. Participation in sports activities, whether recreational or professional in nature, has proven to be a significant factor in raising the level of self-esteem, alleviating symptoms of anxiety and stress. Participation in sports activities leads to better social functioning among peers and building an inclusive society.</p>

Introduction. Tinnitus is a perception of a sound in the ears in the absence of acoustic stimulation whose pathophysiological mechanisms have not been evaluated yet. Approximately, 1-2% of people report distress which can negatively affect their daily performance. Our study aimed to assess the incidence of anxiety in patients with tinnitus. Methods. The study was designed as a cross-sectional study. The participants were divided into two groups: a group of 73 patients with tinnitus (with two subgroups in relation to the duration of tinnitus-less than one year and more than one year) and a control group of 43 patients without tinnitus. We examined the presence of anxiety in all patients using the Burns Anxiety Inventory (BAI). The quality of life of all patients was estimated by Tinnitus Handicap Inventory (THI). Results. In the group of patients with tinnitus, 56.2% of them had mild and 24.7% moderate hearing loss, while 27.7% of respondents from control group had mild and 8.5% moderate levels of hearing impairment. THI results showed that patients with tinnitus less than 1 year had a significantly (p= 0.002) higher level of disorders in daily life, compared with the group who had tinnitus for more than 1 year. The 30.8% of respondents had minimal anxiety, 26.7% borderline anxiety, 17.5% mild anxiety, the same percentage of respondents moderate, 5% severe, while 2.5% had extreme anxiety based on BAI. Conclusion. Anxiety can be considered as potentially significant modulators of changes in brain structures observed in people with tinnitus.

Introduction. Chronic rhinosinusitis with sinonasal polyposis is a chronic inflammatory process of the mucous membranes of the nasal and paranasal sinuses, clinically manifested by the appearance of polyps in the nasal cavity. The presence of polyps in the nose and sinuses is the cause of the characteristic symptoms that affect the quality of life of the patient. The study investigates the correlation between endoscopic, microbiological and radiological findings and symptom severity in patients with chronic rhinosinusitis and sinonasal polyposis. Methods. The research included 45 patients with chronic rhinosinusitis and sinonasal polyps, for whom surgery treatment was indicated after the failure of conservative therapy, and 25 healthy subjects. Intensity of symptoms in subjects was assessed by A Visual Analogue Scale. The bacteriological examination of secretion of the medial nasal corridor was carried out. Clinical and radiological assessment of the severity of the condition was done by the endoscopy and computerized tomography score (CT score). Results. A statistically significant difference was found in symptom severity between the experimental and control groups. There was a statistically significant correlation between endoscopy score and the symptom severity (r = 0.315; p = 0.035), CT-score (r = 0.720; p < 0.001) and the presence of asthma (r = 0.335; p = 0.025). Furthermore, there was a statistically significant correlation between CT score and the presence of asthma (r = 0.419; p =0.004). By binary logistic regression, a statistically significant correlation between the endoscopy score and symptom severity (OR = 1.513; p = 0.044) was found. Conclusion. In comparison with the objective clinical parameters, the severity of symptoms in patients with sinonasal polyposis is in a statistically significant correlation with the endoscopy score.

Uvod. Akutni rinosinuzitisi (ARS) predstavljaju hetoregenu grupu zapaljenskihoboljenja sluzokože nosa i pneumatskih supljina u kostima lica ilobanje. Rinosinuzitis je najcesca bolest u Sjedinjenim Americkim Državama.Procenjeno je da preko 30 miliona stanovnika godisnje ambulantnoposeti lekara zbog ovog stanja, kao i da prosecno svaka sesta odrasla osobaoboli od ARS. Među svim komplikacijama ARS, preko 91% su orbitalnekomplikacije (engl. orbital complications-OC) sa prosecnom prevalencom6% i vecom incidencom kod dece u odnosu na odrasle.Prikaz bolesnika. Dvanaestogodisnji decak, u pratnji majke, je zbog naglonastalog, crvenog i bolnog otoka oba ocna kapka levog oka, bola u levomoku i povisene temperature do 38,5oC hitno upucen u otorinolaringoloskoodeljenje Univerzitetske bolnice Foca. Nakon urađene laboratorijske iCT imidžing dijagnostike, pregleda oftlamologa i stacionarnog klinickognalaza nakon 36h od ordinirane parenteralne trojne antibiotske terapije,pacijent je upucen u ustanovu tercijarnog tipa radi daljeg lecenja. Isto jesprovedeno konzervativno, tokom sest dana hospitalizacije.Zakljucak. Inicijalno lecenje orbitalnih komplikacija u decijem uzrastu jekonzervativno. Lecenje treba zapoceti empirijski, trojnom antibiotskom terapijom.Izbor antibiotika i protokoli lecenja u pedijatrijskoj populaciji josuvek nisu usaglaseni. Ali, ako nakon 36-48h od zapocetog konzervativnoglecenja klinicki odgovor izostaje, bez obzira na stadijum orbitalne komplikacije,hirusko lecenje je apsolutno indikovano.

Introduction. Acute rhinosinusitis (ARS) encompasses a heterogeneous group of inflammatory disorders affecting nasal mucosa and paranasal sinuses. Rhinosinusitis is the most common condition in the United States. It is estimated that over 30 million people annually visit the doctor due to this condition, while every sixth adult suffers from ARS. Among all ARS complications, over 91% are orbital complications (OC) with an average prevalence of 6% and a higher incidence in children compared to adults. Case report. Twelve-year-old boy, accompanied by his mother, was urgently referred to the Department of Otorhinolaryngology at the University Hospital in Foca due to a sudden red and painful left periorbital edema, pain in the left eye and a fever reaching 38.5ºC. After laboratory and CT scan diagnostics, an ophthalmologic examination and inpatient clinical findings after 36 hours of parenteral triple antibiotic therapy, the patient was referred to a tertiary-type institution for further treatment. The same procedure was performed conservatively during the hospitalization within 6 days. Conclusion. The initial treatment of orbital complications in children is conservative. Treatment should be started empirically, using triple antibiotic therapy. The choice of antibiotics and treatment protocols among pediatric population have not been agreed yet. If 36-48 hours after the beginning of the conservative treatment, there is lack of the clinical response, surgical treatment is absolutely indicated, regardless of the stage of orbital complication.

Uvod. Matriks metaloproteinaza 9 (MMP-9) ima jednu od kljucnih uloga umigraciji inflamatornih celija i destruktivnom ponasanju stecenog holesteatomasrednjeg uha. Cilj studije je bio da se utvrde nivoi ekspresije MMP-9 kod hronicnog otitis media, sa i bez stecenog holesteatoma i njihovakorelacija sa patomorfoloskim promjenama na membrani timpani (MT).Metode. Imunohistohemijska studija je ukljucila 178 ispitanika oba pola,od 5 do 75 godina, koji su podvrgnuti mikrohirurskom lijecenju hronicnogotitis media (HOM) u Klinici za bolesti uha, grla i nosa, Univerzitetskog klinickogcentra RS, Banja Luka od 2015. do 2018. godine. Ispitanici su podijeljeniu dvije grupe na osnovu prisustva ili odsustva stecenog holesteatoma:97 (HHOM) i 81 (HOM). Uzorci perimatriksa stecenog holesteatoma(n=97) i inflamirane sluznice srednjeg uha (n=81) su uzeti intraoperativno.Intraoperativnom eksploracijom je ispitivano prisustvo retrakcije i pojedinihtipova i podtipova perforacije MT. Nivoi ekspresije MMP-9 su određeniimunohistohemijskom analizom.Rezultati. U prisustvu holesteatoma i visoko pozitivne ekspresije MMP-9,veca je vjerovatnoca pojave ivicnog tipa perforacije MT (p<0,01), dok je kodnegativne ekspresije MMP-9 u HOM grupi, veca vjerovatnoca centralnogtipa perforacije MT (p<0,01). Veca je vjerovatnoca prisustva atik podtipaperforacije MT kod ispitanika s holesteatomom i umjereno pozitivne ekspresijeMMP-9 (p<0,01). Nije dokazan statisticki znacajan doprinos nijednogod faktora u predikciji uticaja na pojavu retrakcije MT.Zakljucak. Prisustvo stecenog holesteatoma srednjeg uha i visoko pozitivnaekspresija MMP-9 cine statisticki znacajne prediktore ivicnog tipa i atikpodtipa perforacije MT. Nivoi ekspresije MMP-9 mogu da imaju potencijalniklinicki znacaj u nastanku ireverzibilnih patomorfoloskih promjena na MTkod holesteatoma srednjeg uha.

Introduction. Matrix metalloproteinase-9 (MMP-9) plays one of the key roles in the migration of inflammatory cells and the destructive behavior of acquired middle ear cholesteatoma. The aim of the study was to determine the expression levels of MMP-9 in chronic otitis media, with and without acquired cholesteatoma, as well as to determine the correlation between them and the pathomorphological changes in the tympanic membrane (TM). Methods. Immunohistochemical study included 178 patients of both sexes, aged 5-75 years, who underwent microsurgical treatment of chronic otitis media (COM) at the Ear, Nose and Throat Department of the University Clinical Center of the Republic of Srpska in Banja Luka from 2015 to 2018. Patients were divided into two groups on the basis of the presence or absence of acquired cholesteatoma: 97 (CCOM) and 81 (COMWC). The samples of the perimatrix of acquired cholesteatoma (n=97) and inflamed middle ear mucosa (n=81) were taken intraoperatively. The presence of retraction and certain types and subtypes of TM perforations were examined by intraoperative exploration. MMP-9 expression levels were determined by immunohistochemical analysis. Results. In the presence of cholesteatoma and highly positive expression of MMP-9, the marginal type of TM perforation was more likely to occur (p<0.01) while in negative expression of MMP-9 in the COMWC group, the central type was more likely to occur (p<0.01). There was a higher probability of the presence of attic subtype of TM perforation in patients with cholesteatoma and moderate positive expression of MMP-9 (p<0.01). There was not a statistically significant contribution of any of the factors in the prediction of the influence on the occurrence of TM retraction. Conclusion. The presence of acquired middle ear cholesteatoma and highly positive expression of MMP-9 are statistically significant predictors of the presence of marginal type and attic subtype of TM perforation. Expression levels of MMP-9 may have potential clinical significance in the development of irreversible pathomorphological changes on TM in middle ear cholesteatoma.

Introduction/Objective. Tonsillitis is a very common condition found in the pediatric population but also in adult patients. One of the consequences of such conditions is poor voice quality. Hoarseness, poor voice impostation, interruption, and hypernazalization are just some of the differences in patient voice quality. The objective of this paper was to examine the effects of tonsillectomy on the voice quality. Methods. The sample included 37 patients, 17 female and 20 male, ranging in age 3?39 years. The method involved recording patients one month before and one month after tonsillectomy with a digital sound recorder, with recordings analyzed in the Praat program. The variables monitored in the basic voice were as follows: voice pitch, standard deviation of voice, degree of voice interruption, jitter, shimmer, and signal-to-noise ratio. In the statistical analysis, in addition to standard descriptive analyzes, t-test and ACNOVA were also used. Results. The results showed that there are effects of tonsillectomy on standard deviation of baseline voice (p = 0.002), shimmer (p = 0.002), baseline voice interruption rate (p = 0.023), signal to noise ratio (p = 0.003). There were no differences in the effects of tonsillectomy with respect to the sex of the subjects. Conclusion. Based on the conducted research, there were some methodological conclusions that could be considered as a recommendation for future research: increase the number of persons in the sample, introduce a variable of chronological age, type of surgical intervention, and gradation of size of the tonsil and adenoid tissue.

Introduction. The optic nerve is supplied by the arterial branches of the supericial pial plexus and direct intraneural branches. The aim of the study was to study the morphological characteristics (origin, number of arteries, calibers, and branching pattern) of perioptic arterial vascularization and intraoptic vascular network of the extracranial sections of the optic nerve: canalicular and intraorbital. Methods. The study included 18 pairs of the optic nerves of both sexes (11 males and 7 females), aged 51 to 78 years, with no signs of changes in the structures of the nervous system. The vasculature of the optic nerves was microdissected and examined under the stereoscopic microscope, after injecting their arteries with 10% mixture of India ink and gelatin, and 5% formaline ixation. Results. The intracanalicular part of the optic nerve received ine blood vessels from the ophthalmic artery, usually in two branches in 29 (82.9%) cases, while in 6 (17.1%) specimens there was only one branch for the nerve. The intraorbital segment of the optic nerve was supplied by two interconnected systems of blood vessels, peripheral and axial, both coming from the central retinal artery. Conclusion. On the basis of the obtained results, it has been conirmed that both segments of the optic nerve have a rich and very delicate vascular network. The supericial pial arterial plexus of the intracanalicular segment of the optic nerve has been identiied as the only source of its vascular supply. The intraorbital part of the optic nerve has two interconnected systems of blood vessels: peripheral and axial.

Uvod. Holesteatom se definise kao cisticna, ekspanzivna lezija temporalne kosti, ciju glavnu osobinu karakterise progresivan rast s erozijom okolne kosti. Cilj istraživanja je bio da se ispita status osikularnog lanca i kostanih zidova kavuma timpani kod ispitanika sa holesteatomom srednjeg uha. Metode. Studija je obuhvatila 100 ispitanika, oba pola, u dobi od 16 do 84 godine, operativno tretiranih zbog hronicne upale srednjeg uha u Klinici za bolesti uha, grla i nosa Univerzitetskog klinickog centra Republike Srpske, u razdoblju od 2015. do 2016. godine. Ispitanici su podijeljeni u dvije grupe od po 50 ispitanika prema prisustvu holesteatoma: eksperimentalnu grupu sa holesteatomom i kontrolnu grupu bez holesteatoma. Intraoperativnom eksploracijom ispitan je status osikularnog lanca i kostanih zidova kavuma timpani. Rezultati. U kontrolnoj grupi bez holesteatoma statisticki znacajno veci broj ispitanika je imao ocuvan anatomski integritet kostanih zidova kavuma timpani (47/50; χ2 = 38,720; p < 0,001) za razliku od eksperimentalne grupe gdje su statisticki znacajno ucestaliji bili ispitanici s destrukcijom pomenutih anatomskih struktura (41/50; χ2 = 22,224; p < 0,001). Utvrđena je statisticki znacajna razlika između grupe sa i bez holesteatoma u odnosu na status osikularnog lanca. U eksperimentalnoj grupi je zabilježena statisticki znacajno veca ucestalost ispitanika (36%) s nedostatkom inkusa i drske maleusa i erozijom suprastruktura stapesa, a u kontrolnoj statisticki znacajno veca ucestalost ispitanika (76%) s ocuvanim osikularnim lancem. Zakljucak. Destrukcija kostanih zidova kavuma timpani i osikularnog lanca je bila statisticki znacajno ucestalija kod ispitanika sa holesteatomom srednjeg uha. Prema stepenu destrukcije osikularnog lanca, statisticki najzastupljenija je bila kategorija ispitanika s nedostatkom inkusa, drske maleusa, kao i erozijom suprastruktura stapesa.

Uvod. Tireoglosalna cista predstavlja najcescu kongenitalnu anomaliju vrata i javlja se kod oko 7% ukupne populacije. Nastaje kao posljedica izostanka obliteracije ductus thyreoglossus-a za vrijeme tireoidne migracije tokom embrionalnog razvoja. Najcesce se dijagnostikuje u prvoj deceniji života, a dijagnoza se postavlja klinickim pregledom, ehosonografijom, multislajsnom kompjuterizovanom tomografijom (MSCT) i/ili magnetnom rezonancom (MRI) glave i vrata, finom iglenom aspiracijom (FNA) i citoloskom analizom punktata. Terapija je hirurska, operacijom po Sistrunk-u. Prikaz bolesnika. Cetrdesetogodisnji pacijent je hospitalizovan radi dijagnostike i lijecenja tumora podvilicne i podbradne regije i usne supljine, sa dislokacijom jezika, otežanim gutanjem, i govorom. Pacijent je u ranom djetinjstvu uocio potkožnu izraslinu ispod brade koja je postepeno rasla. Klinickim pregledom vidi se potkožna tumorska masa koja zahvata submentalnu i obje submandibularne regije predominantno lijevo uz intraoralnu prezentaciju submukoznog tumora koja u potpunosti ispunjava orofarinks i dislocira jezik udesno. MSCT poda usta i vrata ukazuje na nepravilno ovalni tumor velicine 120 x 95 x 90 mm, koji gornjim polom doseže do tvrdog nepca, zauzima usnu supljinu te se spusta anterolateralno i vise lijevo u regiju vrata do hioidne kosti, udesno dislocirajuci jezik, jednjak i strukture farinksa i larinksa. Citoloska analiza sadržaja ciste dobijenog FNA pokazuje da sadržaj odgovara tireoglosalnoj cisti. U uslovima opste nazotrahealne anestezije uradi se operacija po Sistrunk-u sa odstranjenjem cisticnog tumora i srednjeg dijela hioidne kosti uz repozicioniranje jezika. Postoperativni tok protekao uredno. Funkcije govora i gutanja u potpunosti rehabilitovane. Patohistoloski nalaz je potvrdio da se radi o tireoglosalnoj cisti. Zakljucak. Tireoglosalne ciste su najcesce kongenitalne anomalije vrata i uspjesno se lijece operativnim zahvatom sa zadovoljavajucim ishodom, niskom stopom komplikacija i malim procentom recidiva.