Acute mastoiditis and intracranial complications in children

Objectives: Characterisation of clinical manifestations in children who had acute mastoiditis (AM) -related intracranial complications (ICCs) and to determine the incidence of ICCs in the study group. To define children with a higher risk of ICCs and gain new information on aetiological microbial agents of AM. Methods: A retrospective analysis of 137 paediatric patients with AM treated at a tertiary centre using standard dia­gnostic and therapeutic protocol between 2002 and 2019. Results: Altogether 137 patients with AM were hospitalised at our centre between 2002 and 2019. During this time, the occurrence of ICC in children with AM was low (n = 3, incidence 2.19%). Due to the low number of patients with ICC with AM in our patient group, we were unable to define a specific group of patients with a higher risk of ICC development in AM. Despite this fact, the average value and median of CRP were considerably higher in patients with AM-associated ICCs. The most frequent aetiological agent was Streptococcus pneumoniae. Conclusions: The low incidence of ICC in patients with AM in our patient group might be caused by routinely performed paracentesis in developed acute otitis, rational antibio­tic therapy and the good availability of an ENT specialist in the Czech Republic. The most common aetiological agent of AM was Streptococcus pneumoniae. Keywords: Streptococcus pneumoniae – acute mastoiditis – intracranial complications – aetiological agent – antibio­tic therapy – antromastoidectomy

Vztah mezi presbyakuzí a poruchou kognitivních funkcí ve stáří PDF uzamčeno English info

Age-related hearing loss, presbycusis, is one of the most frequent sensory impairments in the ageing population. It is associated with pathologies of both inner ear and the central parts of the auditory system. Intact cognitive functions are necessary for the proper processing of complex auditory information. Since the beginning of the 80s, there is an increasing amount of evidence linking presbycusis to cognitive impairment and increased risk of dementia. The exact cause, which connects these two pathologies, is still unknown, although there are several hypotheses with various levels of evidence available. This review aims to describe the role of cognitive functions in the auditory processing, to summarize published evidence for a relationship between the hearing loss and cognitive impairment with a possible mechanism, which would explain this link. In addition, we discuss specific features of cognitive assessment in a person with hearing loss and describe the effect of hearing loss treatment, e. g. with hearing aids, cochlear implant and cognitive-hearing training on cognitive functions. Keywords: dementia – hearing loss – presbycusis – cognitive decline

Sphenoid sinus mucocele with unilateral blindness – a case report

Mucocele of the paranasal sinuses are benign cystic lesions filled with mucus. They occur in the sphenoid sinus in 1–2% of all paranasal sinuses, most often in the fourth decade of life. Clinical manifestations are non-specific, caused by pressure expansion into anatomical structures immediately adjacent to the sphenoid sinus. They are manifested by headaches, dropped eyelids, impaired movement of the globe, and impaired vision. In the differential dia­gnosis, it is necessary to distinguish them from tumour processes and processes propagating from the intracranium. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in the dia­gnosis, the definitive dia­gnosis is determined by perioperative findings and histological examination. Curative surgical options include endoscopic transnasal sphenoidotomy with marsupialization. In this article, we present a case of a patient with a mucocele of the sphenoid sinus, which was the cause of unilateral blindness. Keywords: marsupialization – mucocele – sphenoid sinus – endoscopic transnasal sphenoidotomy

Course variations of the internal carotid artery and their significance in pharyngeal surgery

The internal carotid artery is one of the major vessels of the neck. It usually originates from the common carotid artery at the level of the 3rd–4th cervical vertebra and continues perpendicularly to the skull base in the neurovascular bundle. During common surgical procedures in the pharynx, such as adenoidectomy or tonsillectomy, the artery is usually in a safe distance from the pharyngeal wall and the risk of injury is low. However, several anatomical variations have been described that may cause medialization of the vessel closer to the pharyngeal wall, which significantly increases the risk of injury and occurrence of life-threatening haemorrhage. Keywords: internal carotid artery – tonsillectomy – haemorrhage – adenoidectomy – vascular anomalies

Academician Antonín Přecechtěl died 50 years ago

Antonín Přecechtěl was born on 6 November 1885 in the village of Srbce in the Prostějov region (Moravia) in a peasant’s family. He graduated from the secondary grammar school in Kroměříž and studied medicine at the Czech Medical Faculty of the Charles-Ferdinand University in Prague. After graduating in 1910, he started his career as a surgeon at prof. Kukula’s surgery clinic in Prague. As a surgeon, he participated in the Balkan Wars and the First World War. In 1918 he began to work at prof. Kutvirt’s ear clinic in Prague. Here he obtained habilitation in otology and pharyngology in 1920, and in 1924 he was appointed associate professor. After Kutvirt’s death, he became the head of the clinic in 1930, and in the same year, he also received habilitation in rhino-laryngology, thus completing the process of unifying the teaching of otorhinolaryngology as one field. He held the position of head of the Otolaryngology Clinic for 30 years. He was a founding member of the Czech Otolaryngological Society (1921) and in the period 1935–1951, he was its chairman. In 1926, as a founding member, he participated in the founding of the prestigious organization Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum. He also participated in the establishment and management of the international journal Otolaryngologia Slavica, and the journal Czechoslovak Otolaryngology began to be published in 1952 on his initiative. The results of his scientific work have been published in almost 400 publications in both domestic and foreign journals. Přecechtěl was also involved in laboratory and experimental research, especially on the vestibular apparatus. In 1954 he was appointed a full member of the Czechoslovak Academy of Sciences, in which he founded the Otolaryngological Laboratory. Professor Přecechtěl created his own otorhinolaryngology school and trained many experts. He died on 5 February 1971, at the age of 85. Keywords: history – Antonín Přecechtěl – remembrance – commemoration – Czech otorhinolaryngology – ENT

The value of flexible endoscopy with Narrow Band Imaging for the evaluation of recurrence of laryngeal and hypopharyngeal tumours after radiotherapy

Background: The dia­gnosis of recurrent upper aerodigestive tumours is difficult, especially in the case of previous curative radiotherapy (RT) or chemoradiotherapy (CRT). Progress in the dia­gnostics of head and neck cancer came with the development of optical endoscopic imaging methods. The aim of this study was to analyse the benefits of flexible Narrow Band Imaging (NBI) in the visualization of suspected recurrence of malignancy in patients after curative RT (CRT). Methods: A total of 58 examined patients in follow-up after curative RT or CRT for laryngeal and hypopharyngeal squamous cell carcinoma were enrolled in the study. All patients underwent transnasal flexible endoscopy in conventional white light and NBI in local anaesthesia. Changes in microvascular architecture (intraepithelial papillary capillary loops – IPCL) have been classified according to Ni. IPCL I–III were considered to be non-suspicious, and therefore no histopathological examination was indicated. IV and V type findings were verified using HDTV NBI intraoperatively with bio­psy sampling and subsequent histopathological correlation was performed. Results: Transnasal videoendoscopic examination with NBI revealed a suspicious finding (IPCL type IV and V) in 23/58 (39.7%) patients, non-suspicious finding (IPCL I–III) in 35/58 (60.3%). Histopathological examination verified the positive finding (precancerous or malignant changes) in 12/23 (52.2%) and negative finding in 11/23 (47.8%) cases. The sensitivity, specificity, positive and negative predictive value of flexible NBI endoscopy were 100%, 76.1%, 52.2% and 100% respectively. According to the Kappa index (K = 0.568), we proved a moderate concordance between flexible NBI endoscopy and histopathological results. Conclusions: Transnasal flexible endoscopy with NBI in outpatient settings contributes to an early detection of pathological changes also in post-radiation altered mucosa of the larynx and hypopharynx, while a correct interpretation of in NBI findings is required to reduce the incidence of false positive results. Keywords: squamous cell carcinoma – Larynx – radiotherapy – narrow band imaging – Ni classification – hypopharynx

Primary middle ear inverted papilloma – a case report

Inverted papilloma is a very rare finding in the middle ear. It is a benign, though locally aggressive tumour with a tendency towards malignant transformation. The dia­gnosis is usually established postoperatively, based on the histological examination, because the local finding is not specific and resembles chronically inflamed tissue in chronic otitis media. Surgery is the treatment of choice. Radiotherapy is reserved for inoperable tumours or a recurrent disease. In this case report, we present a case of a 62-year-old man, who underwent canal wall down tympanoplasty for chronic otitis media in a district hospital many years ago. A few years ago he was examined for pulsatile tinnitus and hearing impairment at our clinic. A combined-approach tympanoplasty did not reveal the expected tumour (only stiff scars) and a clearance of the middle ear cavity was performed. Histological examination revealed an inverted papilloma. A CT scan performed postoperatively proved a tumour persistence. Therefore, a radical mastoidectomy was indicated. The patient is disease-free with no signs of recurrence during 32-month follow-up. Keywords: inverted papilloma – Middle ear – radical mastoidectomy

Acute vertigo in the ENT emergency

Summary Introduction: Acute vertigo ranks among the common reasons for visiting the emergency department. The aim of this study was to evaluate the rate of peripheral vestibular syndrome (PVS) in patients with acute vertigo examined at the ENT emergency department and to compare the agreement of physical ENT examination with video-assisted vestibular testing. Methods: Patients eamined at the ENT emergency department from January to December 2019 were evaluated retrospectively. The patients who underwent basic ENT examination without video-assisted vestibular testing form group A. The patients who underwent basic ENT examination which was followed by video head impulse test (vHIT) and videonystagmography in the next four days form group B. Results: A total of 117 patients with acute vertigo were included in group A, PVS was found in 31 patients (27%). In total, 50 patients were included in group B; PVS was found in 15 patients (30%), vestibular neuronitis was dia­gnosed most often (10 patients). The difference in the dia­gnosis of PVS by basic ENT examination (27 patients, 54%) and by video-assisted vestibular testing (15 patients, 30%) was statistically significant (P = 0.0030). The gain of the lateral (P = 0.0101) and superior (P = 0.0043) semicircular canal proved to be statistically significant, while vHIT was lower in PVS in comparison to other causes of vertigo. Conclusion: After basic ENT examination, PVS as a cause of acute vertigo was dia­gnosed in 27%. Video-assisted vestibular testing proved a statistically significant lower incidence of PVS in comparison to basic ENT examination. Accessibility of video- -assisted vestibular testing in the emergency department might allow for higher accuracy in the dia­gnosis of acute vertigo. Key words acute vertigo – vestibular function tests – video head impulse test – videonystagmography

Multiple sclerosis in the otoneurology outpatient clinic: interdisciplinary cooperation between otoneurologist and neurologist

Summary Introduction: Multiple sclerosis (MS) is a chronic multifocal inflammatory disease affecting the CNS, with autoimmune and neurodegenerative processes involved in its pathogenesis. Otoneurology outpatient clinic patients presenting with hearing loss, tinnitus, and vertigo may eventually be newly dia­gnosed MS patients. An otoneurologist specialist may be the first physician to suspect MS and refer the patient for an MRI and neurological examination. Early dia­gnosis and subsequent treatment of MS can delay permanent disability. Aim: Analysis of the incidence of MS patients in an otoneurological outpatient clinic during a twenty-year period. To increase the otoneurologists’ awareness of MS dia­gnosis. Methods and materials: Of 6,000 patients, who were newly examined in an otoneurology outpatient clinic between 2000 and 2021, data of 11 patients (0,18%) (5 male/6 female, aged 25–58 years) with MS or suspected of MS were retrospectively evaluated. Results: In 11 patients, MS was suspected or ongoing. In 4 of those patients, otoneurological examination contributed to the first detection of MS by an otoneurologist. The first MS symptoms included hearing loss, tinnitus, instability, and post-infection visual disorder. Conclusion: The otoneurologist must consider that sudden hearing loss, tinnitus, and vertigo may be the first manifestations of MS. Early dia­gnosis of MS increases the likelihood that with treatment, the progression of the disease will be slowed. Interdisciplinary cooperation between the otoneurologists and neurologists is very important for the dia­gnosis of MS. Key words multiple sclerosis – sensorineural hearing loss – tinnitus – vertigo – otoneurology