QUALITY OF LIFE IN DYSPHONIC CHILDREN MEASURED ON PEDIATRIC VOICE-RELATED QUALITY OF LIFE (PVRQOL) SCALE IN SERBIA.

Hoarseness occurs in children of both genders, from the earliest age and beyond, and is caused by improper use or overuse of vocal apparatus. The study included 91 hoarse children aged 6-12 (study group) and 243 healthy children (control group) of the same age. The study group underwent detailed medical history, phoniatric examination, larynx fiber endoscopy, allergy treatment, audiologic treatment, and pulmonary treatment. Pediatric Voice-Related Quality of Life questionnaire, Serbian version (PVRQOL) was completed by parents of both groups of children. We did not find statistically significant differences in the hoarse children based on diagnosis (muscle tension disorder and vocal fold nodules) and age in physical domain, socio-emotional and global domain score (p>0.01). The results showed that parents did not recognize hoarseness as a health problem in children. There were significant gender differences in the group of children with hoarseness, i.e. parents in all three PVRQOL questionnaire domains recognized hoarseness as a significant health problem in girls, but not in boys. The presence of hoarseness impairs the quality of life in pediatric population. Social and emotional domains indicated greater impact in boys.

Primary nasal tuberculosis: a case report.

INTRODUCTION: During the past two decades, tuberculosis (TBC) both pulmonary and extrapulmonary, has emerged to be a major health problem. Nasal tuberculosis is a specific inflammatory process which is, in most cases, joined by the inflammation of neck lymph nodes. CASE REPORT: Thirty-year-old man presented with shortness of breath through the nose and periodical headaches. Clinical examination showed signs of chronic rhinitis, with slight granular changes of nasal septal mucosa. Laboratory analyses were within the reference ranges. Nasal and throat swabs for bacteria and fungi were normal. Skin allergy testing to standard inhalatory allergens was positive. Computer rhinomanometry showed increased nasal resistance at medium difficulty level, on the right. Radiography of paranasal sinuses indicated chronic polysinusitis on the right. Anti-allergy therapy was prescribed. The patient came for checkup after a month with subjective deterioration and a neck tumefact on the right. Nasal endoscopy revealed the presence of dark red infiltrates with the 3 mm diameter on nasal septal mucosa, dominantly on the right, with small greyish nodules. This findings indicated a potential specific nasal inflammatory process. In the upper jugulodigastric area, on the left, painless tumefact 3 x 5 cm in size was palpated, it was mobile comparing to supra- and infrastructure, with unaltered skin above. The definite diagnosis was established on the basis of the results of nasal mucosa biopsy. After histopathological diagnosis was obtained, we started with antituberculosis therapy at once. CONCLUSION: Due to actual trends of TBC incidences, otolaryngologist should have in mind nasal TBC, when granulomatose lesions are found in nose.

Nasal septum extramedullary plasmacytoma.

INTRODUCTION: Plasmacytomas are malignant tumors characterized by abnormal monoclonal proliferation of plasma cells. They originate in either bone--solitary osseous plasmacytoma, or in soft tissue--extramedullary plasmacytoma (EMP). EMP represents less than 1% of all head and neck malignancies. CASE REPORT: We presented a case of EMP of the nasal septum in a 44-year-old male who had progressive difficulty in breathing through the nose and frequent heavy epistaxis on the right side. Nasal endoscopy showed dark red, soft, polypoid tumor in the last third of the right nasal cavity arising from the nasal septum. The biopsy showed that it was plasmacytoma. Bence Jones protein in the urine, serum electrophoresis, bone marrow biopsy, skeletal survey and other screening tests failed to detect multiple myeloma. This confirmed the diagnosis of EMP. The mass was completely removed via an endoscopic approach, and then, 4 week later, radiotherapy was conducted with a radiation dose of 50 Gray. No recurrence was noted in a 3-year follow-up period. CONCLUSION: EMP of the nasal cavity, being rare and having long natural history, represents a diagnostic and therapeutic challenge for any ear, nose and throat surgeon. Depending on the resectability of the lesion, a combined therapy is the accepted treatment.

Subdural empyema, retropharyngeal and parapharyngeal space abscess: unusual complications of chronic otitis media.

INTRODUCTION: Otitic complications arise from expansion of the middle ear infection. Subdural empyema is a rare otitic complication, and both retropharyngeal and parapharyngeal abscesses have been described in just a few cases. CASE REPORT: A 30-year-old male was, admitted as an emergency case because of breathing difficulties, secretion from the ear, and fever. Clinical examination had shown a purulent, fetid secretion from the ear, swelling on the roof of epipharynx, left tonsil pushed medialy, immobile epiglottis, reduced breathing space. Computed tomography revealed thick hypodense content filling cavity, mastoid entering the posterior cranial fossa, descending down throw the parapharyngeal space to the mesopharynx. On the roof and posterior wall of the epipharynx hypodense collection was also present. Tracheotomy was conducted, and incision of the parapharyngeal and retropharyngeal abscess and radical tympanomastoidectomy were performed. The patient's state deteriorated on the tenth postoperative day with hemiparesis and consciousness disorder. Magnetic resonance imaging was done. It showed subdural empyema of the left frontoparietal region and next to the falx, so craniotomy and abscess drainage were conducted. CONCLUSION: Parapharyngeal, retropharyngeal abscess and subdural empyema are rare otitic complications. Adequate antibiotic therapy and radical surgical treatment make possible an outcome with survival.

Risk factors for the appearance of minimal pathologic lesions on vocal folds in vocal professionals.

BACKGROUND/AIM: An excessive use or misuse of voice by vocal professionals may result in symptoms such are husky voice, hoarse voice, total loss of voice, or even organic changes taking place on vocal folds--minimal pathological lesions--MAPLs. The purpose of this study was to identify the type of MAPLs which affects vocal professionals, as well as to identify the risk factors that bring about these changes. METHODS: There were 94 vocal professionals who were examined altogether, out of whom 46 were affected by MAPLs, whereas 48 of them were diagnosed with no MAPLs, so that they served as the control group. All these patients were clinically examined (anamnesis, clinical examination, bacteoriological examination of nose and pharynx, radiography of paranasal cavities, allergological processing, phoniatric examination, endo-video-stroboscopic examination, as well as gastroenterologic examination, and finally endocrinological and pulmological analyses). RESULTS: The changes that occurred most often were identified as nodules (50%; n = 23/46) and polyps (24%; n = 11/46). Risk factors causing MAPLs in vocal professionals were as follows: age, which reduced the risk by 23.9% [OR 0.861 (0.786-0.942)] whereas the years of career increase the risk [OR 1.114 (1.000-1.241)], as well as the presence of a chronic respiratory disease [OR 7.310 (1.712-31.218)], and the presence of gastro-oesophageal reflux disease [OR 4.542 (1.263-16.334)]. The following factors did not contribute to development of MAPLs in vocal professionals: sex, a place of residence, irritation, smoking, endocrinologic disease and the presence of poly-sinusitis. CONCLUSION: It is necessary to introduce comprehensive procedures for prevention of MAPLs, particularly in high-risk groups. Identification of the risk factors for MAPLs and prevention of their influence on vocal professionals (given that their income depends on their vocal ability) is of the highest importance.