Olfactory Perception and Different Decongestive Response of the Nasal Mucosa During Menstrual Cycle.

BACKGROUND: Sex hormones are known to have some influence on nasal functions, but their effect on the decongestive response of the nasal mucosa during menstrual cycle is still undetermined. OBJECTIVES: The aim of this study was to examine the nasal physiology, the interconnectedness of olfactory and respiratory nasal function and the decongestive response of the nasal mucosa during menstrual cycle. METHODS: This study included 101 healthy women aged 23.26 ± 4.81 years with a regular menstrual cycle. The nasal respiratory function and the decongestive response of the nasal mucosa were examined by rhinomanometry. Subjective sense of nasal obstruction and the subjective odor intensity were assessed by standardized questionnaires. The odor identification ability was assessed by Sniffin' Sticks test. RESULTS: Statistically significant higher values of nasal resistance (0.311 ± 0.107 Pa/cm3/s) and NOSE score (11.893 ± 13.83) were observed in the ovulatory phase compared to the luteal (0.281 ± 0.084 Pa/cm3/s and 9.029 ± 11.12). An odor identification test score was significantly higher in luteal phase (12.476 ± 1.48) compared to the ovulatory phase (11.971 ± 1.51), opposite of odor intensity. The difference of nasal resistance before and after decongestion was significantly higher in ovulatory phase (0.105 ± 0.097 Pa/cm3/s) compared to the luteal (0.084 ± 0.079 Pa/cm3/s). Correlation between subjective and objective parameters of the examinated nasal functions was not statistically significant in any menstrual phase. CONCLUSION: In the population of women studied, total nasal resistance and NOSE score were significantly lower in the luteal phase of the menstrual cycle. Odor identification was significantly higher in the luteal phase but odor intensity significantly higher in the ovulatory phase. The decongestive response of nasal mucosa was better in the ovulatory phase of the menstrual cycle.

Comparison of Voice Handicap Index in Patients with Esophageal and Tracheoesophageal Speech after Total Laryngectomy.

BACKGROUND: Successful speech rehabilitation has a great impact on the quality of life in totally laryngectomized patients. OBJECTIVES: The aim of this paper was to compare the self-assessed voice handicap of totally laryngectomized patients with two different methods of alaryngeal speech - esophageal (ES) and tracheoesophageal speech (TES). METHOD: The research comprised 83 totally laryngectomized, disease-free patients, split into two groups. The first group included 43 participants with successfully rehabilitated ES, and the second group included 40 participants with successfully established TES after secondary implantation of Provox 2TM voice prosthesis. All subjects filled in the Serbian version of the Voice Handicap Index (VHI-30). The results (overall score and three VHI subscales) were analyzed and compared with those of the subjects of both groups. The impact of age in the subgroups (<65 years old and ≥65 years old) and previous irradiation on the examined VHI values were also analyzed. RESULTS: The median value of the overall VHI score in the participants with TES was 29.03 ± 23.479 (range: 0-97), and in the participants with ES it was 64.51 ± 21.089 (range: 19-99). The VHI scores (overall and three VHI subscales) were significantly higher in participants with ES compared to those with TES (p < 0.01), indicating a larger voice handicap. No significant difference was found in the overall VHI score and VHI subgroups in terms of age subgroups and previous irradiation (p > 0.05). CONCLUSIONS: Our data reveal a significantly higher voice handicap in participants with ES compared to the TES group, with a large interindividual variation within both groups. VHI values are not significantly different between the two age subgroups, nor are they significantly influenced by irradiation.

Clinical stage of laryngeal carcinoma and lost time at the moment of diagnosis with 15-year-long interval. Are there any changes?

PURPOSE: Despite the fact that laryngeal cancer causes symptoms early, the patients often present with advanced disease. The aim of this paper was to determine how much time had been lost from the beginning of the symptoms to establishing the diagnosis, and what was the clinical stage of the laryngeal cancer at the time of diagnosis in two examination years (2001 and 2016). METHODS: The research involved 108 patients of both genders, 54 during each examination year, with whom the diagnosis of laryngeal carcinoma was established. The charts of the patients were reviewed, and the data were analyzed and compared. RESULTS: The median lost time from the time when the symptoms started to the time of diagnosis was 8.22 months during 2001 versus 8.77 months during 2016, with no statistically significant difference (p=0.774). Early clinical T stage of the disease in 2001 was present in 57.4% of the cases and 70.4% in 2016, with no statistically significant difference (p=0.161). Early clinical TNM stage in 2001 was in 48.1%, and 64.8% in 2016, with no statistically significant difference (p=0.081). Tracheotomy at the time of establishing the diagnosis was necessary in statistically significantly greater number of patients in 2001 compared to 2016 (59.3% versus 31.5% ;p=0.004). CONCLUSION: The diagnosis of laryngeal carcinoma is established late, with a long lost time. Favourable is the statistically significant decrease in the number of patients who require tracheotomy at the time of establishing the diagnosis with a 15-year-long interval.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal.

INTRODUCTION: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. OBJECTIVE: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. METHODS: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. RESULTS: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients' assessment (p<0.001) and by nasal endoscopic examination (p=0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. CONCLUSION: The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

Clinical stage of laryngeal carcinoma and lost time at the moment of diagnosis with 15-year-long interval. Are there any changes?

PURPOSE: Despite the fact that laryngeal cancer causes symptoms early, the patients often present with advanced disease. The aim of this paper was to determine how much time had been lost from the beginning of the symptoms to establishing the diagnosis, and what was the clinical stage of the laryngeal cancer at the time of diagnosis in two examination years (2001 and 2016). METHODS: The research involved 108 patients of both genders, 54 during each examination year, with whom the diagnosis of laryngeal carcinoma was established. The charts of the patients were reviewed, and the data were analyzed and compared. RESULTS: The median lost time from the time when the symptoms started to the time of diagnosis was 8.22 months during 2001 versus 8.77 months during 2016, with no statistically significant difference (p=0.774). Early clinical T stage of the disease in 2001 was present in 57.4% of the cases and 70.4% in 2016, with no statistically significant difference (p=0.161). Early clinical TNM stage in 2001 was in 48.1%, and 64.8% in 2016, with no statistically significant difference (p=0.081). Tracheotomy at the time of establishing the diagnosis was necessary in statistically significantly greater number of patients in 2001 compared to 2016 (59.3% versus 31.5% ;p=0.004). CONCLUSION: The diagnosis of laryngeal carcinoma is established late, with a long lost time. Favourable is the statistically significant decrease in the number of patients who require tracheotomy at the time of establishing the diagnosis with a 15-year-long interval.

Endoscopic repair of cerebrospinal fluid rhinorrhea.

INTRODUCTION: Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. OBJECTIVE: The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. METHODS: This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. RESULTS: Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. CONCLUSION: Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate.

Dysfunctional ectopic thyroid gland: a case report.

INTRODUCTION: Lingual thyroid gland is a rare anomaly of thyroid gland development, occurring more frequently in females. If it causes local symptomatology such as dysphagia, dysphonia or dyspnea it is diagnosed in childhood, however, if it is asymptomatic it is usually diagnosed in adulthood. CASE OUTLINE: We present a 23-year-old female patient in whom we diagnosed lingual thyroid gland coincidentally during diagnostic procedures of a concomitant disease. The application of 131I scintigraphy showed an oval field of intensive accumulation of radio markers in the zone of medial face line, around tongue base, with the absence of thyroid gland in its physiological position. Functional testing proved primary hypothyroidism and we started the application of substitution therapy. The application of levothyroxine resulted in reaching euthyroid state and the reduction of thyroid gland size. CONCLUSION: We present a very rare anomaly of the thyroid gland, and so far there have been no clear attitudes about further treatment. The general condition of the patient, age, the size of ectopic thyroid gland and the existence of local symptomatology or complications represent the factors that have influence on the choice of treatment method.

Correlation between subjective and objective nasal breathing assessments in examinees with nasal septum deformities.

BACKGROUND/AIM: Nasal obstruction is one of the most frequent disorders because of which patients see their Ear, Nose and Throath (ENT) doctors. Impaired nose breath ing is a subjective symptom and it often does not coincide with clinical nose findings and functional tests of breath ing function. Therefore, the aim of this study was to es tablish if there is an accordance between a subjective nose breathing assessment and objective methods (rhinoma nometry and acoustic rhinometry) in assessing nose breathing function in patients with diverse nasal septum deformity degrees, as well as to establish an accordance between these two objective methods. METHODS: This study involved the total of 90 examinees divided into three groups. The group I consisted of examinees with nasal septum deformities less than 10 degrees. The group II consisted of examinees with nasal septum deformities ranged from 10 degrees to 15 degrees. The group III involved examinees with nasal septum deformities over 15 degrees. Each examinee had subjec tively graded his/her nasal breathing on the side of the nose septum deformity from 0 to 10, and afterwards the whole noses. Rhinomanometry and acoustic rhinometry were done on the side of the nasal septum deformities and after that on the other side of the nose using the Interacoustics SRE 2000 device. RESULTS: In the groups II and III there was a positive correlation between a subjective nose breathing assessment and rhinomanometric values both on the side of the nasal septum deformities and the nose as a whole, (p < 0.05), and no correlation between these traits in the group I (p > 0.05). In none of the exam ined groups correlation was found between a subjective nose breathing assessment and rhinometric values, both minimum cross-sectional area (MCA) and volume (VOL), both on the side of the nasal septum deformities and the nose as a whole (p > 0.05). There was no correlation found between rhinomanometric and rhinometric MCA and VOL values in either on the sides of nasal septum deformities or the nose as a whole in any of the examined groups (p > 0.05). CONCLUSION: Rhinomanometry significantly correlates with the subjective nose breathing assessment and it can be used as a reliable and objective indicator of nose breathing in everyday clinical practice. Acoustic rhinometry, on the other hand, which does not correlate with a subjective nose breathing assessment could have a greater significance in a scientific sense than in clinical applying.

[Nasal hump--five year analysis].

INTRODUCTION: The nose has a prominent central position in the face and therefore it considerably contributes to the esthetic appearance and facial harmony. On the anterior view, the face is dominated by the nasal length and width, as well as medial location. On the lateral view, the nasal dorsum is most important; although it is the dimension we cannot see ourselves, it is the most common cause of surgery. MATERIAL AND METHODS: This five-year retrospective study included 216 patients of both sexes; their average age was 22 years, and they underwent surgery at the Ear, Throat and Nose Clinic in Novi Sad in the period from 2001 to 2006. There were 89 male, and 127 female patients. RESULTS: Most patients were aged 18-22 years (57%). A nasal pyramid deformity with septal deviation was present in 81.1% of patients, whereas 18.9% (41 patients) presented only with a nasal pyramid deformity. Out of the total number of patients, 24 patients had both nasal kyphosis and scoliosis. All patients underwent closed rhinoplasty with obligatory correction of the tip of the nose. The nasal hump removal with lateral osteotomy was also performed in all patients. Two patients underwent reoperation, due to small dorsal humps within the cartilage, while one patient had a postoperative septal perforation. One patient presented with a postoperative abscess of the nasal dorsum, which was conservatively managed. CONCLUSION: Nasal hump is the most common nasal pyramid deformity, often without a nasal septum deviation. It is quite easily treated by surgery. Two patients have already undergone reoperation with good results, and two patients had postoperative complications. Postoperative complications were recorded in 1.85% of patients.

Laryngeal mask airway as the only choice for primary airway control in newborn with tracheal stenosis.

Congenital tracheal stenosis is a rare disorder characterized by the presence of focal or diffuse complete tracheal cartilage rings, resulting in afixed tracheal narrowing. The prognosis for this disorder is currently assumed to be poor, with some sources stating that the natural outcome of this problem is inevitably fatal. Tracheal stenosis requires a tracheostomy at delivery for the infant to survive before the definitive reconstruction. The laryngeal mask airway is the most commonly used airway device in pediatric anaesthesia as well as the primary airway control during the resuscitation. We present a premature infant with congenital tracheal stenosis, in whom the airway could be controlled only by the laringeal mask. In this case the laryngeal mask airway was a life saving device for the airway control in the period before tracheostomy was done. Tracheostomy was made in first few hours after birth. In severe tracheal stenosis the laryngeal mask airway can be a device of choice for the initial control of the airway.

[Psychogenic hearing impairment in differential diagnosis of sudden hearing loss].

INTRODUCTION: Acute hearing impairment or deafhess may manifest as unilateral or bilateral. The etiopathogenetic substrate may be organic, functional and of unknown origin, the so-called idiopathic. The functional causes of impaired hearing and deafness also include psychogenic factors, where the essential dysfunction exists between the conscious simulation of hearing impairment and deafness for benefits versus psychogenic hearing impairment in conversion disorders where physical symptoms result as a symbolic expression of long-term psychological problems or conflicts. Acute hearing impairment, pseudohypacusis, as a symptom of conversion disorder, where hearing impairment is without evidence of organic cause, is a rare pseudosensory form of this disease. Numerous literature data indicate that these disorders are most common among children, whereas in adults only individual cases are reported. In otorhinolaryngological practice, other symptoms of conversion disorders are much more common (psychogenic aphonia and dysphonia, globus pharyngeus, sensation disorder in the head and neck region). CASE REPORT: The paper includes a detailed presentation of the diagnostic procedure, clinical course, differential diagnostic dilemmas and therapeutic procedure in cases of acute bilateral psychogenic hearing impairment in adolescents. CONCLUSION: Acute hearing impairment caused by organic substrate is irreversible in most cases, whereas in psychogenic hearing impairment the prognosis is excellent, particularly among children and adolescents. Identification of the etiologic factors of reversible hearing loss, including psychogenic ones, by the otorhinolaryngologist is of utmost importance in order to provide early differential diagnosis and timely inclusion of a psychiatrist and a clinical psychologist into the diagnostic-therapeutic.

[Rhinoplasty--five years retrospective analysis].

Rhinoplasty is a specific surgical procedure, where the indication for surgery is not based only on the physician's professional judgment, but often on patient's wishes. Most patients have a deviated septum and a nasal pyramid deviation. Postoperative complications occur in 4%-18.8% of patients, whereas revision of rhinoplasty may be required in 5%-15% of patients. This 5-year retrospective study included 243 patients of both sexes, average age being 24 years, who underwent rhinoplasty at the Ear, Nose and Throat Clinic in Novi Sad in the period 2001-2006. There were 105 male, and 138 female patients. Most patients were aged between 18 and 22 years (54%). The deviation of the nasal pyramid and deviated septum were present in 81.1% of patients, while 18.9% of patients requested surgery for esthetic reasons. 227 patients underwent closed procedures, whereas decortication was the treatment of choice in 16 patients. Postoperative complications were recorded in 5.34% of patients; in 10 patients they were transient and managed in the early postoperative period, whereas 3 patients presented with nasal septum perforation. 3.29% of patients were scheduled for reoperation, either because of patient dissatisfaction, or due to objectively poor results. Five patients have already undergone reoperation with good results, and three patients are still awaiting reoperation.

[Surgical techniques and outcomes in the treatment of malignant tongue base tumors].

INTRODUCTION: Prognosis of patients with malignant tongue base tumors is poor. Survival is low, in spite of different treatment modalities. Most patients seek treatment too late, when their disease has already progressed to stage III or IV. The aim of this investigation was to compare different treatment modalities in patients with malignant tongue base tumors. MATERIAL AND METHODS: We have analyzed a total of 82 patients (72 men and 6 women) treated at the ENT Clinic, Clinical Center Novi Sad, between 1992 and 2004. The average age of our patients was 59 years. In regard to lifestyle habits, out of 82 patients, 67 were smokers and 57 were alcohol users (16 of the latter were treated alcoholics). The majority (54/82) of patients were both smokers and alcohol users. RESULTS: There were 6% of patients (5/82) with stage I disease, 15% ofJ patients (12/82) with stage 11, 24% of patients (20/82) with stage III and 55% of patient (45/82) with stage IV disease. Planocellular cancer was diagnosed in 79/82 patients, and the remaining (3182) had transitional cell carcinoma. Surgical treatment alone was performed in 17 patients, seven were treated with radiation only, and nine only with chemotherapy. Combined surgical and radiation therapy was performed in 28 patients, and 5 were treated with all three. Ten patients were not treated with any therapy. Tongue base resection only was performed in 12 patients, tongue base resection with epiglottectomy in 20, tongue base resection with supraglottic laryngectomy in 13 and tongue base resection with total laryngectomy in 5 patients. In radiation only cases, 25% of patients survived 20 months, whereas in surger) only cases, 25% of patients survived 27 months. Five-year survival after combined surgical and radiation therapy was 35% CONCLUSION: Development of tongue base carcinoma is strongly associated with alcohol and tobacco consumption. Survival is low, despite various treatment modalities. However, combined therapy is the therapy of choice in cases with tongue base carcinoma.

[Our results in surgical treatment of laryngotracheal stenosis--ten years experience].

INTRODUCTION: There are numerous techniques for the treatment of laryngotracheal stenosis. The aim of this paper was to present surgical techniques and results of treatment of laryngeal and laryngotracheal stenosis in a ten-year period by retrospective analysis. MATERIAL AND METHODS: Medical records of 34 patients (17 male and 17 female) surgically treated for laryngeal or laryngotracheal stenosis between 1995 and 2004 were analyzed. 19 (55.9%) patients had previous surgical procedures, whereas fifteen patients (44.1%) were diagnosed and treated for the first time. RESULTS: 5 patients had a glottic-subglottic stenosis, 11 patients had a subglottic stenosis, 16 patients had subglottic-tracheal stenosis and 2 patients had a glottic-subglottic-tracheal stenosis. 21 patients had normal vocal cord motion, 8 patients showed unilateral vocal cord fixation, and 5 had bilateral vocal cord fixation. Laryngotracheoplasty with anterior-posterior costal cartilage graft was performed in 24 patients, while single stage segmental laryngotracheal resection of the stenotic part was performed in 8 patients. One patient was operated in direct laryngomicroscopy and one with dilatation of the stenotic segment with T tube insertion. The most common complication was the development of granulation due to use of the Montgomery T-tube which was removed in direct laryngomicroscopy. Except for one patient, 33 (97%) patients were decannulated. There was no perioperative mortality. CONCLUSION: Although laryngotracheoplasty with anterior-posterior costal cartilage graft placement cannot be used in all cases of laryngotracheal stenosis, it was the method of choice in previously operated patients with segmental resection of the stenotic segment. This method requires use of Montgomery T-tube or anesthesiological tube, which is very hard to keep clean. Better recovery, short hospitalization and excellent results were obtained with the cricotracheal segmental resection.

[Value of panendoscopy in metastases of unknown origin].

INTRODUCTION: Neck metastases of unknown origin are metastatic solid tumors wth primary undetactable by physical examination, chest x-ray, rutine blood and urine studies and histologic evaluation. MATERIAL AND METHODS: This study included 77 patients of both sexes, average age 57 years, undergoing a diagnostic procedure at ENT clinic, Clinical Center Novi Sad, in the period from 1992 to 2001. RESULTS: The prymary tumor was detected in 51% of all cases by panendoscopy and bilateral tonsillectomy. In 14 of 26 patients (54%), in whom the site of the primary tumor was not detected, after telecobalt therapy and radical neck dissection, no relapses occurred. Pathohistological examination revealed planocellular carcinoma in 50 (65%) cases, transitional cell carcinoma in 9 (11.7%) cases and lymphoma in 7 (9.1%) cases. CONCLUSION: Cervical metastases with unknown primary tumor are the first sign of head and neck malignant disease. Panendoscopy with bilateral tonsillectomy and multiple mucosal biopsies are necessary procedures in detecting the primary tumor site.

[Nasal polyposis and allergic rhinitis--our experience].

Nasal polyposis is a multifactor disease characterised by chronic eosinophilic inflammation of the nasal and sinal mucosae. Its aetiology is unknown, but it's often associated with other diseases: allergic rhinitis, asthma, and aspirin sensitivity in adult patients. In children, mucoviscidosis is possible. The aim of this paper is to determine the relationship between nasal polyposis and allergic rhinitis, and their link with idiopathic rhinitis. The study involved 100 patients of both sexes. Patients were divided into three groups: group I--with allergic rhinitis (65 patients), group II--with idiopathic rhinitis (25 patients), and group III--without any diseases of the upper airways (10 patients). All patients underwent ENT examinations, blood laboratory and microbiology tests, RTG tests, as well as skin prick tests on inhalant allergens. In the group with allergic rhinitis, 21 patients had nasal polyposis. In the group with idiopathic rhinitis, 7 patients had nasal polyposis. In the control group, all the patients exhibited normal endonasal findings. Statistically significant difference was present only between the group of patients with allergic rhinitis and the control group (p=0.034). Nasal polyposis is related to allergic rhinitis, although the reason why polyposis develops in some patients and not in others remains unknown.

[Sense of smell in patients with bilateral nasal polyposis]. / Osecaj mirisa kod pacijenata sa obostranom polipozom nosa.

INTRODUCTION: Sense of smell is susceptible to various changes, both in physiological and in numerous pathological conditions. Of quantitative disorders of smell, hyposmia and anosmia are quite common, whereas of qualitative disorders parosmia is most frequent. The aim of this paper was to examine impact of bilateral nasal polyposis on olfactory function. MATERIAL AND METHODS: The research was carried out at the Nose, Ear and Throat Clinic in Novi Sad. It included 80 examinees, 40 (20 male, 20 female) with bilateral nasal polyposis, while 40 examinees belonged to the control group (20 male, 20 female) without symptoms of nasal polyposes. Fortunato-Niccolini olfactometer was used for this examination. RESULTS AND DISCUSSION: In patients with bilateral nasal polyposis the average perception threshold values for examined odors were 15.50 ccm of odorous air, while in the control group they were 10.20 ccm of odorous air. The average identification threshold values for examined odors in patients with bilateral nasal polyposis were 18.80 ccm of odorous air, while in the control group they were 13.55 ccm of scented air. T-test showed that values of both thresholds were statistically significantly higher (p<0.01) in patients with bilateral nasal polyposis in relation to the control group. CONCLUSION: Olfactory deficit in patients with bilateral nasal polyposis is explained by difficult or impossible passage of odors into the olfactory region.

[Selective neck dissection in the treatment of pN1/2 lymph node metastases in the neck]. / Selektivna disekcija vrata u terapiji pN1/2 metastatskih limfnih cvorova vrata.

INTRODUCTION: As yet there is no single reliable and accurate method for detection of neck lymph node metastases. Therapeutic approaches differ from one author to other. The aim of this paper was to establish the extent to which, with good control of primary process, we can control spreading of malignant disease by means of selective neck dissection. MATERIAL AND METHOD: This retrospective study included 595 surgically treated patients in the period 1990-1998. There were 525 patients with malignant laryngeal tumors, and 70 patients with malignant hypopharyngeal tumors. Preoperative diagnostics of enlarged lymph nodes was based on palpation of the neck, without CT, US, NMR diagnostics. With all risky N0 patients, selective neck dissection was performed for presence of occult metastases. Intraoperative frozen section analysis was not performed. Adjuvant radiatitherapy was performed in all patients in whom presence of neck lymph node metastases was histologically proved. RESULTS: Selective lateral neck dissection was performed in 389 (65.4%) patients. In 78 (20%) patients, lymph node metastases were pathohistologically detected. In 5 (6.4%) transitional cellular cancer was histologically diagnosed, and the remaining 73 (93.6%) presented with squamous cell cancer. Postoperative radiation therapy was applied in 54 patients (69.2%) while 24 (30.8%) were not irradiated. 5-year survival was achieved in 18 (23.1%), and 3-year survival was achieved in 15 (19.2%) patients. Out of 45 patients who lived less than tree year, 18 (40%) presented with metastatic relapse and fatal outcome. Relapse of neck metastases appeared in 12 (11.9%) on the side and in the zones of lymph nodes which were included in neck dissection. Recurrence of neck metastases appeared in 8.3% of patients who were not irradiated postoperatively and in 32.1% of cases irradiated postoperatively. DISCUSSION: This study includes comparison of our results with results of literature data. CONCLUSION: Neck lymph node metastases point to advanced malignant process of the third or forth stage of the disease when results are the worst and 5-year survival decreases with or without adjuvant radiotherapy.

[Unilateral laryngeal paralysis]. / Unilateralne pareze larinksa.

INTRODUCTION: Phoniatric rehabilitation is mainly aimed at restoring satisfactory phonation. Voice quality depends on the capacity of intact vocal cords to compensate the deficiency involved, as well as on automatism of phonation. MATERIAL AND METHODS: The study included 50 patients. All subjects underwent history taking, reported symptoms that urged them to visit a phoniatrician; they were submitted to a clinical otorhinolaryngologic and phoniatric examinations, voice assessment by subjective acoustic analysis, spectral analysis by digital sonography and laryngostroboscopy. All patients underwent Seeman's method of laryngeal compression. RESULTS: The examined group of 50 subjects included 17 males (34%) and 33 females (66%). Vocal cord palsy was most often due to neck surgery (strumectomy) in 19 patients (38%), followed by an idiopathic palsy involved in 12 patients (24%). Disocclusion of 1-2 mm and 3-3 mm was registered in 54% and 24% patients, respectively. After treatment total occlusion was established in 20% of patients, while disocclusion of up to 1 mm, 1-2 mm or 2-3 mm persisted in 36%, 20% and 2% of patients, respectively. T-test revealed a statistically significant difference in glottic incompetence prior to and after treatment (p < 0.01). After treatment, using Seeman's method of digital compression of the larynx, 48% of patients regained satisfactory speech and voice clarity and 50% of them still presented mild dysphonia. Moderate dysphonia was registered in 2%, but none of the patients had severe dysphonia. DISCUSSION: Central laryngeal palsies made 4% of our examined group, while according to the literature they make 1.2-8.7% of all laryngeal palsies. In majority of cases, paralysis of the recurrent laryngeal nerve was due to neck surgery (38%), but literature reports indicate that iatrogenic palsies are mostly due to operation of the thyroid. The well known fact that the left recurrent nerve is more frequently paralysed, has been confirmed in our study as well. CONCLUSION: Accurate and efficient treatment of unilateral laryngeal palsies requires team work. Phoniatric rehabilitation of the disorder using Seeman's method has proved efficient in diminishing the glottic incompetence and dysphonia. Patients who fail to respond to phoniatric rehabilitation should be treated using other therapeutic modalities.

[The smooth tracking test and rotation stimulation test in disorders of the vestibular system caused by carbamazepine]. / Znacaj testa "glatko pracenje ocima" i testa "pendularna stimulacija" kod poremecaja vestibularnog sistema uzrokovanog primenom karbamazepina.

The examination was carried out in 10 healthy volunteers of both sexes, of the average age of 32.5 years, of the average weight of 77.4 kg. Seven volunteers were males. After dosage of 800 mg of carbamazepine in 2/7 volunteers the finding was unchanged, in 3/7 second stage disturbance was found and in 2/7 third stage of disturbance in the smooth tracking test was found. After the administration of 1200 mg the findings were worse, 1/10 volunteers had unchanged findings compared with control dose, 6/10 had second stage disturbance of the smooth tracking test, 1/10 third stage and 2/10 forth stage disturbance. After dosages of 800 mg and 1200 mg there was a statistically significant difference disturbance of the smooth tracking test finding compared to control. After dosage of 800 mg of carbamazepine in 1/7 of volunteers the finding was without significant changes in the torsion chair test, in 3/7 changes were minimal, in 2/7 changes were moderate and in 1/7 of volunteers changes were high. In 5/10 of volunteers there was third stage of disturbance after dosage of 1200 mg of carbamazepine and in the same group 4/10 of volunteers had fourth stage of disturbance. In all cases after 800 mg and 1200 mg of carbamazepine pathologic vestibular habituation appeared. With increased dosage of carbamazepine the finding of the torsion chair test and smooth tracking test showed increased disturbance level. Disturbance of balance primary was on the central level and after higher therapeutic carbamazepine dose peripheral part of vestibular system disappeared.