Changes in management of head and neck malignancies during the COVID-19 pandemic.

Objective: Despite multiple studies from high-income countries, reports from low- and middle-income countries on the impact of COVID-19 on head and neck cancer care remain sparse. This study aimed to assess the effects of the COVID-19 pandemic on head and neck cancer patients at a tertiary reference centre in Bosnia and Herzegovina. Methods: We included 228 patients with malignant head and neck tumours evaluated and treated between January 1, 2019, and December 31, 2021. Patient demographics, histological characteristics, and treatment modalities were retrospectively obtained and compared between the pre-pandemic period (pre-COVID-19 group) and the period after the implementation of COVID-19 restrictive measures (COVID-19 group). Results: Patients were significantly older during the COVID-19 pandemic. In particular, 63 patients (44.7%) were under 65 and 78 (55.3%) were 65 or older, while in the pre-COVID-19 period, 53 patients (60.9%) were under 65 and 34 (39.1%) were 65 or older (p = 0.017). The pre-COVID-19 and COVID-19 groups did not significantly differ regarding other patient- and tumour characteristics, or primary treatment modalities. Conclusions: During the COVID-19 pandemic, significantly fewer patients were under 65 at the time of initial work-up, potentially reflecting the more enhanced disease-related anxiety of the younger population. Future studies are warranted to address this population's specific educational and psychological needs to ensure appropriate cancer care.

Interobserver variability of cochlear duct measurements in pediatric cochlear implant candidates.

PURPOSE: The objective of the study was to evaluate the proposed cochlear duct length estimation based on the cochlear 'A value'. Furthermore, we assessed the interobserver variability between radiology and otolaryngology attending physicians and otolaryngology trainees. METHODS: Thirteen pediatric cochlear implant candidates were retrospectively analyzed by three otolaryngology physicians (attending physician, second year, and fourth year trainees) and a radiology attending. The cochlear duct length was calculated based on the formula of Grover et al. The differences in acquired measurements between observers were compared using the Wilcoxon matched signed-rank test. RESULTS: The differences in measurements between the attending otolaryngologist and radiologist were not statistically different, while several significant differences were observed with regard to measurements of attending doctors compared to both residents. In particular, a significant difference between the second year otolaryngology resident and otolaryngology and radiology attending was observed for one side (right ear p = 0.034 and p = 0.012, respectively). Moreover, the fourth year resident calculated significantly different cochlear duct measurements when compared to the attending otolaryngologist (left ear p = 0.014) and radiologist (right ear p = 0.047). Interestingly, differently experienced otolaryngology residents provided significantly different measurements for both ears. CONCLUSIONS: Based on these results, cochlear duct length measurement according to the proposed method may be a reliable and cost-effective method. Indeed, otolaryngology training may be sufficient to provide measurements comparable to radiologists. On the other hand, additional efforts should be invested during otolaryngology training in terms of the evaluation of radiological imaging which may increase the capabilities of otolaryngology residents in this regard.

Changes in Acoustic Aspects of Vocal Function in Children After Adenotonsillectomy.

BACKGROUND: Adenotonsillectomy is one of the most common pediatric surgical procedures. Postoperative voice changes are a very common concern among patient's parents. Therefore, the aim of this study is to analyze acoustic voice parameters after adenotonsillectomy, tonsillectomy, and adenoidectomy in pediatric patients in a tertiary referral academic center. PATIENTS AND METHODS: All pediatric patients undergoing an adenotonsillectomy, tonsillectomy or adenoidectomy in a single center from 2002 to 2018 were included in the study. Change of fundamental frequency, jitter, shimmer, and harmonic-noise ratio at first, seventh and 30th postoperative day compared to preoperative values were the primary outcome parameters. Statistical analysis was performed using repeated measures analysis of variance model. RESULTS: A total of 1258 patients were included in the study. The mean age of patients at the time of surgery was 8.3 years (range 3.0-18.0 years). Around 698 were male (55.5%) and 560 female (44.5%). The values of fundamental frequency increased significantly after the first and seventh postoperative day (P = 0.001 both) but normalized 1 month after surgery (P = 0.962). At the first postoperative month, values of jitter and shimmer decreased significantly (P = 0.005 and P = 0.002, respectively). Measurements of harmonic-noise ratio revealed a significant increase 30 days after surgery (P = 0.004). CONCLUSION: Statistically significant differences in objective voice parameters within the first postoperative month after tonsillectomy, adenoidectomy, and adenotonsillectomy were observed. The fundamental frequency returned to normal 1 month after surgery. These findings can contribute in soothing the concerns of parents regarding postoperative voice changes.

High Electrode Impedance Values in Pediatric Cochlear Implant Recipients May Imply Insufficient Auditory and Language Skills Development.

BACKGROUND: Measurements of electrode impedance values are routinely performed after cochlear implantation. The primary objective of the study was to determine if pediatric, prelingually deafened patients with different postoperative performances showed significantly different impedance values one year after implantation. METHODS: This study comprised 42 pediatric cochlear implant recipients provided with the device in a single academic tertiary referral center between 1 January 2000, and 31 December 2016. Medical chart analysis was performed in order to assess evolution of impedance values during the first postoperative year on a monthly basis. Electrode impedance values measurements one year postoperatively were compared between children with successful and unsuccessful auditory and language skills development assessed using the EARS protocol (a name of a performance test). Furthermore, values were compared among recipients of different implant types and among different cochlear segments. RESULTS: A gradual rise of average impedance values was found during the first months of implant use (1st month, 7.32 kΩ; 3rd month, 7.86 kΩ) with the peak at the 4th postoperative month (7.96 kΩ), followed by a gradual decrease towards the 12th month (6th month, 7.62 kΩ; 12th month, 6.86 kΩ). Lower values at the 12th postoperative month were observed in recipients with successful development compared to patients presented with unsuccessful development (6.22 kΩ vs. 7.82 kΩ; p = 0.001). Mean impedance values were different when compared among cochlear segments and among different implant types. CONCLUSION: High electrode impedance values one year after implantation in pediatric patients may imply insufficient auditory and language skills development. Further studies are needed in order to validate our results.

Correlation Between the Parathyroid Glands Size and Parathormones Value in Patients with Hyperparathyroidism.

INTRODUCTION: Hyperparathyroidism is a common endocrine disorder with potential complications of bone, renal, neurocognitive and cardiovascular system. AIM: To determine the correlation between the size of parathyroid glands and parathormone values in the patients with hyperparathyroidism. METHODS: We analyzed a retrospective-prospective database of 79 consecutive patients who underwent parathyroidectomy for hyperparathyroidism at our institution between January 2011 and February 2018. The values of parathormone, calcium and phosphorus were determined in all patients before and after surgery. Ultrasonography were performed before surgery. Imaging results were confirmed by pathology. We analyzed the correlation between the sizes parathyroid glands obtained trough ultrasonography and pathology with parathormone values. RESULTS: The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. Our study demonstrated that between actual glands sizes (volumes), expresses in millimeters, measured on pathohistological analysis and ultrasound examination and size value of parathormone its increased value does not affect the size of the gland. We investigate the correlation between the size of glands measured according to the pathohistological finding and the value of parathormone we obtained the correlation results close to the statistical features. The correlation value of parathormone and glands sizes according to the pathohistological finding measured trough the determined assessment scale we determined the statistically important of medium value. CONCLUSION: One of the important factors for parathyroidectomy is the value of parathormone. Serum parathormone level might be predictable by a total size of parathyroid glands and could be an effective the predictor of gland localisation.

Death as a Consequence of Foreign Body Aspiration in Children.

AIM: To analyze the rate of mortality in children with foreign body aspiration (FBA). METHODS: We outlined a retrospective review of hospital data of patients between 1971 and 2013. FBA occurring in children 0 year to 14 years was considered for inclusion (patient ages ranged from 0.6 to 15 years, with a median age of 2.2 years). The gender structure within the investigated cases was 75.8% males and 24.2% females. During the study period, 772 patients undergoing rigid bronchoscopy with the diagnosis of FBA were included. Deaths on arrival were excluded. RESULTS: Total rate of mortality (for whole investigated period) was 0.785. For last fifteen years of the investigated period the rate of mortality was zero. CONCLUSION: For prevention of foreign body aspiration in children and its mortality should be taken two strategies: non-medical (alterations in product design and public education campaigns) and medical (education of medical staff and improvement of equipment).

A novel approach for comparing patterns of foreign body injuries across countries: A case study comparing European Countries and Bosnia and Herzegovina.

OBJECTIVES: The present study aimed at analyzing the characteristics of FB injuries from Bosnia and Herzegovina (B&H), a rapidly growing newly industrialized country, and to compare them with cases from European countries. METHODS: The analysis is based on FB injury cases included in the Susy Safe registry. Cases from the Ear-Nose-Throat (ENT) Clinic, University Clinical Center of Tuzla (B&H) were compared with cases from European countries participating in the Susy Safe project. Multiple Correspondence Analysis (MCA) was performed to elucidate differences within a large data set regarding mechanisms and objects causing injuries. RESULTS: The results of the MCA showed that the first three dimensions explained 43% of the variability. The first dimension was identified by children hospitalized for FB ingestion, the second one by children hospitalized for FB aspiration (lower airways), and the third one by children with an FB in the ear or in the upper airways. The analysis of the median of coordinates of factors contributing to each dimension showed that the greatest difference between B&H and European countries regarded the third one. Looking at the profile of these patients, it might be suggested that the proportion of males and females and the type of activity in which they were involved at time of injury occurrence are different among the countries considered CONCLUSIONS: This study proposes a simple tool for assessing differences among countries in the distribution of FB injuries. This case study shows that B&H has different patterns of FB injuries in the upper respiratory tract.

The Discrepancy Between Subjective and Objective Findings After Septoplasty.

INTRODUCTION: Surgical and medical treatments of nasal obstruction are a common parts of otolaryngologist practice. The definitive treatment of deviated nasal septum is septoplasty. AIM: In this study was to evaluate the values of subjective parameters, and active anterior rhinomanometry parameters prior and three months after the septoplasty. PATIENTS AND METHODS: We analyzed the subjective parameters ("NOSE" scale), the active anterior rhinomanometry parameters according to International Committee on Standardization of Rhinomanometry, on 40 patients. Thirty healthy adult volunteers participated belonged to the control group. None of the patients or healthy volunteers had previous history of nasal surgery or active rhinological disease. RESULTS: The post-operative improvement in symptoms of nasal obstruction obtained in 92,5% patients and improvement parameters of the active anterior rhinomanometry in 42,5% patients. CONCLUSION: The correlation between the findings with rhinomanometry and subjective sensation of nasal patency remains uncertain. There still seems to be only a limited argument for the use of rhinomanometry for quantifying surgical results. Three months postoperative findings are very early results to interpret the permanent effects.

Foreign body impaction in esophagus: experiences at Ear-Nose-Throat Clinic in Tuzla, 2003-2013.

OBJECTIVES: This study aims to report our experience in the management of foreign body (FB) impaction in esophagus in the Ear-Nose-Throat Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina. PATIENTS AND METHODS: Seventy-one patients (44 males, 27 females; mean age 32.99±28.57 years; range 1 to 81 years) who admitted to our clinic between January 2003 and December 2013 with a history of a FB in esophagus were retrospectively analyzed including head and neck examination. All patients were performed rigid esophagoscopy under general anesthesia. RESULTS: A total of 32 FBs were detected in children (23 males, 9 females; mean age 4.6 years; range 1 to 11, mod 1) with coins being the most common (56.31%). A total of 39 FBs were detected in adults (21 males, 18 females; mean age 56.2 years; range 16 to 81) with bones and food being the most common (43.6%). Foreign bodies impacted in the upper esophageal sphincter in 87.5% of children and in 66.7% of adults. The duration of localization of FBs in esophagus was between one hour and six months. All procedures were performed without complications; the FBs were completely extracted without the requirement to repeat the procedure. CONCLUSION: Our study results suggest that use of rigid endoscope is reliable in removing FBs in the esophagus.

Thyroid cancer in Tuzla region of Bosnia and Herzegovina: a 10-year study (1999-2008).

Bosnia and Herzegovina (B&H) is one of the Eastern European countries with lacking data on thyroid cancer (TC) epidemiology. We aimed to assess the incidence of TC in Tuzla Canton of B&H during a 10-year period (1999-2008). We retrospectively evaluated 65000 hospital records of both inpatients and outpatients with possible thyroid symptoms residing in Tuzla Canton of B&H (total of 496280 inhabitants) between 1999 and 2008. Patients with histological proof of TC were included in study. Incidence rates were calculated with age standardisation using European standard population. Trends in incidence were evaluated as moving three-year averages. During observed period 117 patients met the diagnostic criteria for TC with male to female ratio of 1:4.85. Median age of all cases was 51 years (interquartile range: 41 to 60) with men in average 9 years older than women at the time of diagnosis. The mean annual standardized incidence was found to be 2.30/10(5) (% 95 CI = 1.38-3.22) inhabitants ranging from 1.0 to 3.2 per 10(5). The average crude incidence in men was 0.82/10(5) and 3.83/10(5) in women. The prevalence of TC, at the end of the observed period was found to be 23.58/10(5) (% 95 CI = 19.3-27.58). There is a slight decline of incidence in our region during the observed period, but with the increase in the latest years of the study. This increase is probably the result of combination of various factors, mainly the better detection of new cases due to wider availability of diagnostics. Based on depicted trends, we believe that in the future years, TC incidence in our region will continue to rise.

Influence of surgical therapy on serum values of alpha 1-antitrypsin in patients with head and neck tumors.

INTRODUCTION AND AIM: The aim of this study was to quantitatively evaluate serum concentration of alpha 1-antitrypsin (A1AT) in patients undergoing surgery of head and neck malignant tumors. PATIENTS AND METHODS: Fifty patients undergoing surgery because of head and neck tumors in the years 2007-2008 were analyzed. Serial determinations were performed in all patients in three times: preoperative day--A1AT1; first postoperative day--A1AT2, and thirtieth postoperative day--A1AT3. Concentrations of A1AT were determined by nephelometry method. RESULTS: The patients' age varied from 39 to 86 years, 46 male and 4 females. Serum values of A1AT in patients with stage III and IV are statistically significant elevated after operation (and after one month), but in patients with lower stages (I and II) there were not. In patients with laryngeal malignancies recorded statistical significant elevation of serum values of A1AT postoperatively (and after one month). Other tumor locations did not recorded the same results. CONCLUSION: The above results suggest that measurements of A1AT may have an ancillary role in the diagnosis and monitoring of head and neck tumors.

Cochlear implantation in children: socioeconomic family characteristics.

PURPOSE: The aim of the study is to analyse the socioeconomic status of implanted children families, candidates for implantation families and families of deaf children whose parents elicit not to proceed with cochlear implantation and to find out if the socioeconomic status has an influence on parental decision-making process. The following variables describe the socioeconomic status: place of living (urban/rural area), parental educational level and household monthly income (in Euro). WORK METHOD: Forty children divided in two groups were included in the study: Group 1 (23 implanted children and 7 candidates for implantation) and Group 2 (10 deaf children whose parents elicit not to proceed). Data were obtained from parents of children by phone. It was not possible to establish the contact with parents of three children. WORK RESULTS: As for the place of living, 20 families were from urban area, 17 families were from rural area and the place of living of 3 families was unknown. Average number of completed school grades by parents was respectively: Group 1- 5.92 and Group 2 - 5.33. CONCLUSION: Concerning the place of living, parental educational level and household monthly income no differences can be seen between groups. Therefore, the authors concluded that socioeconomic status has no influence on making decision process.

[Quality of life in children with obstructive sleep apnea after adenotonsillectomy]. / Kvalitet ivota u djece sa opstruktivnim nocnim apneama nakon adenotonzilektomije.

UNLABELLED: Obstructive sleep apnea (OSA) caused by enlarged tonsils and adenoids is common in pediatric population. The prevalence of pediatric obstructive sleep apnea syndrome has been estimated to be between 1% and 3% in preschool and school-aged children. The aim of this study was to examine quality of life in children before and after adenotonsillectomy. SUBJECTS AND METHODS: This study was prospective and it was carried out in the period from mid-November 2005 to end-June 2006. Specific exclusion criteria were: no existing of OSA, neuromuscular disorders, constitutional maxillofacial anomalies, septal deviation, mental retardation, obesity (BMI > 30). Anamnesis was taken from parents or caregiver, each child was examined from ENT specialist, Pediatar and Anestesiolog. The adenoid size was estimated by palpation or/and X-ray examination of nasopharynx. The tonsils size was estimated by Brodsky scala. OSA-18 quality of life survey was used to estimate improvement of quality of life after adenotonsillectomy. The children that had asserted symptoms of OSA by OSA-18 quality of life survey, were analyzed by this survey 5 weeks after surgery. The results before and after surgery were compared. The adenotonsillectomy was done with standard operation technique at our ENT department (cold dissection using termocauter), and comprehends removal palatinal tonsils and adenoids, that are removed by adenotom with uniform anestesiology protocol. RESULTS: At 13 patients (43.3%) undergone adenotonsillectomy, OSA had a small impact on quality of life, at 11 (36.7) patients had a moderate impact and at 6 (20%) patients had large impact. Statistical significant improvement of quality of life after adenotonsillectomy was found in all domains using OSA-18-QOL survey: sleep disturbance (P < 0.0001), physical suffering (P < 0.0001), emotional distress (P < 0.0001), daytime problems (P = 0.0081) and caregiver concerns (P < 0.0001). The mean OSA-18-QOL total change score showed significant improvement of quality of life in patients suffering from OSA who undergone adenotonsillectomy. CONCLUSION: Adenotonsillectomy improves quality of life in children suffering from OSA caused by adenotonsillar hypertrophy.

Some aspects of balance disorder in patients with multiple sclerosis.

The aim of this study was to analyze: frequency of balance disorder (vertigo and disequilibrium), frequency of abnormalities in auditory evoked potentials (AEP) and magnetic resonance imaging (MRI) changes of the brain in multiple sclerosis (MS) patients with balance disorder, relation of patient's disability status to balance disorder and relation of the changes in MRI of the brainstem to AEP abnormalities. It was analyzed 60 patients with relapsing-remitting form of MS. Two groups of patients were made consecutively under Expanded Disability Status Scale score (EDSS): A (EDSS < or =4,5) and B (EDSS > or =5,0). The study was retrospective-prospective. After the neurological exam AEP and MRI of the brain have been done. Balance disorder has been verified as initial symptom in 29 (48,4%) and out of them disequilibrium experienced 24 (83,4%) patients. During the relapses balance disorder experienced 48 (80%) patients and in 37 (77,1%) it was disequilibrium. Among them 33 (68,7%) were with lower EDSS (< or =4,5) and 15 (31,3%) with higher EDSS score (> or =5). There is no correlation between disability status and vertigo which means that vertigo is not more frequent in more disabled patients and vice-versa. The AEP were pathological in 57 (95%) patients. Of all 29 patients with vertigo AEP were pathological in 28 (96,5%) while in 31 patients without vertigo pathological AEP were in 29 (93,5%) but it is not statistical significant. The most frequent characteristic of AEP changes were prolonged inter-peak latency III-V waves (48 patients or 80%). The plaque in brainstem visualized by MRI was found in 41 (71,8%) of patients (38 or 92,6% of them had pathological AEP and in three patients AEP were normal). In group of patients with pathological AEP, 38 (66,6%) of them had plaque in brainstem. In other three patients with normal AEP it was visualized plaque in brainstem. In the group of 29 patients with balance disorder, 20 (68,9%) had plaque in brainstem as well as 21 (67,7%) out of 31 patients without balance disorder had plaque in the brainstem. This difference is not statistical significant. It is concluded that the vertigo (including disequilibrium) is relatively often (48,4%) initial symptom of MS. Vertigo is not more frequent in patients with higher EDSS score and vice-versa. Pathological AEP are frequent neurophysiologic finding in both (95%) patients with (96,5%) and without (93,5%) vertigo. The most often pathological characteristic of AEP are prolonged interpeak latency of III-V waves (78,5%), as well as abnormalities of V and than IV wave. MS plaques in brainstem visualized by MRI technique are frequent in both groups of patients with and without pathological finding of the AEP.

Pattern of head and neck malignant tumours in a Tuzla ENT clinic--a five year experience.

Head and neck neoplasia can affect certain fundamental functions, including eating, drinking, speaking and respiration. One overriding factor in deciding on treatment policy is the tendency for head and neck malignancy to be limited to the primary site and regional lymph nodes with surgery and chemotherapy and radiotherapy. The aim of the study was to analyze the occurrence of Head and Neck tumours operated at ENT clinic Tuzla, University Clinical Center Tuzla, Bosnia and Herzegovina. Medical records of patients with histopathologically confirmed head and neck malignancies over a 5 year period (2003-2007) were analyzed. Eight hundred and eight one (881) cases, made up of 519 (58,8%) males and 362 (41,1%) females were found. The most common sites for head and neck malignancies were found to be in the larynx (26,1%), oral cavity (21,7%), the thyroid gland (14,64 %) and the neck (8,51%). A total of 230 patients were diagnosed with laryngeal carcinoma (M:173; F:57), showing the increasing number of female patients. The histopathological tumour types found in this work were mostly squamous cell carcinoma (72,09%), papillary carcinoma (12,2%), while many other minor histopathological variants accounted for 13%. The most patients were presented with stage I and stage III of disease (27% and 28,3%), and 19,9% with stage IV. About 40% of patients did not have data about smoking habit and alcohol drinking. The incidence of head and neck tumours seems to be relatively high, but without significant increase during investigated period. More investigation concerning risk factors, diagnostic procedures, and management strategies should be done in future.

Gastric pull-up reconstruction for the hypopharyngeal and cervical esophageal carcinoma in small thoracic unit.

The objective of this article is to review results of one surgical team for gastric pull-up reconstruction for carcinoma of the hypopharynx and cervical esophagus after pharyngolaryngo-esophagectomy in small thoracic unit. Between July, 2004 and December 2005, four patients underwent pharyngolaryngo-esophagectomy and gastric pull-up reconstruction for carcinoma of hypopharynx and esophagus. There were three female and one male patient with average age at the time of surgery 47 years. The study analyzed complications and mortality in early postoperative period after resections of the carcinoma. Squamous cell cancer in all patients was confirmed. There was no in-hospital mortality and non-fatal complications were occurred in 3 patients. It was recorded two year survival for two patients. Pharyngolaryngo-esophagectomy and gastric pull-up reconstruction can be performed for the patients with carcinoma of the hypopharynx and cervical esophagus with an acceptable operative mortality and morbidity rate even in small thoracic unit. Long term survival despite good early postoperative results still remains poor.

Tracheobronchial foreign bodies in children. Experience at ORL clinic Tuzla, 1954-2004.

OBJECTIVE: To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital. SETTING: Department of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center Tuzla, Bosnia and Hercegovina. METHOD: The analysis of the cases of aspirated foreign bodies within the period from January 1954 to December 2004. The analyzed patients were the children up to 14 years of age. All cases underwent the bronchoscopy. Each patient was analyzed for age, sex, nature and location of the foreign body, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways. RESULTS: Six hundred and sixty-two children who underwent bronchoscopy for removal of foreign body in the airways were evaluated. From evaluated children 66.8% were boys, ages ranging from 9 months to 14 years. Foreign bodies were more frequent in children under 3 years of age (65.2%). Most of the foreign bodies removed were organic (87.1%) and more frequently found in the right bronchial tree (53%). CONCLUSIONS: More attention is necessary to the prevention of aspirations. Prevention of aspiration of foreign bodies is better than cure. Public awareness through mass media needs attention to prevent foreign body inhalation.

[Dilatation of tracheal stenosis with esophageal balloon dilator]. / Dilatacija stenoze traheje ezofagealnim balon dilatatorom.

The solve of tracheal stenosis is problem which occupied a big number of experts. In this article was reported a case in which the problem of tracheal stenosis was solved by balloon dilatator which was used in a treatment of esophageal stenosis. We are thinking that esophageal balloon dilatation of trachela stenosis would be a one of the first steps in the problem solving.

[Anxiety and depression in deaf and hard-of-hearing adults]. / Anksioznost i depresivnost kod odraslih tesko slusno ostecenih i gluhih osoba.

The main purpose of this study was to determine the differences between the anxiety and depression degree in individuals with severe hearing impairments and deaf people in relation to sex and marital status. The sample consisted of 54 subjects, 35 males and 19 females, aged from 18-61 years, with hearing loss greater than 60 dB. We used "SCL-90-R" (Symptom Checklist-90-Revised), to assess the level of anxiety and depression. For the examination of marital stress we used "Stockholm Marital Stress Scale". The results showed that deaf and hard-of-hearing individuals demonstrated certain anxiety and depression levels which correlated significantly with marital status, marital stress, and communication problems. The married deaf subjects showed higher anxiety degree than single one. We determined the statistically significant differences for the anxiety level (p < .03861), age (p < .0006), and communication problems (p < .033) between the married and single deaf people. The females exhibited higher anxiety and depression levels than males, but these differences were not statistically significant. For the prevention of psychological problems in deaf and hard-of-hearing individuals it is necessary to pay attention to their communication problems which are a condition for adequate society integration.

The effects of caloric vestibular stimulation on EEGs in patients with central vertigo.

The EEGs of 30 patients with central vertigo were examined by caloric vestibular stimulation (CVS). The control group consisted of 30 persons without vertigo disturbances. In the standard procedure (and after hyperventilation), there was no statistically significant difference between the two groups of patients. In comparison to the EEGs of healthy persons, CVS produced statistically significant differences ( P<0.001) in the EEGs of patients with vertigo.