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.

[Applicability of visual-analogue scale in patients with orofacial ain].

INTRODUCTION: Orofacial pain occurs in various disorders of the orofacial region. OBJECTIVE: The aim of this study was to examine applicability of the visual-analogue scale (VAS) in patients with orofacial pain (model of acute and chronic pain). METHODS: The study involved 60 patients, aged 18-70 years. The first group consisted of patients with dentin hypersensitivity, and the second group of patients with chronic rhinosinusitis. All patients were asked to fill-in a pain questionnaire and to rate pain intensity on the modified visual analogue scale (VAS; 0-10). Air indexing method was performed in the patients with dentin hypersensitivity in order to provoke pain, while the patients with chronic rhinosinusitis underwent CT imaging of paranasal sinuses. Wilcoxon's test and Pearson's correlation coefficient were used for statistical analysis. RESULTS: In patients with dentin hypersensitivity provocation increased subjective feeling of pain, but without statistical significance (t = 164.5; p > 0.05). In patients with chronic rhinosinusitis a significant statistical correlation (r = 0.53; p < 0.05) was found between subjective pain assessment of VAS and CT findings. CONCLUSION: Applying VAS in the evaluation of acute and chronic pain can indicate progression or regression of pathological state under clinical conditions. This study showed that VAS, as a method for follow-up of pathological state, is more applicable and efficient when applied in chronic pain evaluation.

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.

Sudden death of a swimmer in water caused by heterotopic intracranial ossification and anomaly of the skull base.

BACKGROUND: Expression of immersion syndrome implies sudden and unexpected death of swimmer in water. A drowned swimmer is still a riddle for the forensic and clinical doctors. Pathophysiological mechanisms which cause immersion syndrome may be divided into vegetatively regulating and mechanical ones. CASE REPORT: We presented heterotopic intracranial ossification with the anomaly of the skull base bones development in a young man, a swimmer, drowned after entering water and where the circumstances required expertise in forensic medicine. CONCLUSION: Intracranial heterotopic ossification with or without a disorder in the development of skull bones may be one of the causes of immersion syndrome.

[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.

Comparison between auditory steady-state responses and pure-tone audiometry.

BACKGROUND/AIM: A more recent method, the auditory steady-state response (ASSR), has become more and more important test method due to difference that was found in previous investigations between hearing thresholds determined by the ASSR and the pure-tone audiometry (PTA). The aim of this study was to evaluate the reliability of the ASSR in determining the frequency specific hearing thresholds by establishing a correlation between the thresholds determined by PTA, as well as to evaluate the reliability of ASSR in determining the hearing threshold with respect to the level of hearing loss and the configuration of the PTA findings. METHODS: The prospective study included 46 subjects (92 ears) which were assigned to groups based on their level of hearing loss and audiometric configuration. All the subjects underwent determination of hearing thresholds by PTA and ASSR without insight into their previously obtained PTA results. RESULTS: The overall sample differences between the ASSR and PTA thresholds were 4.1, 2.5, 4.4, and 4.2 dB at 0.5, 1, 2, and 4 kHz, respectively. A high level of correlation was achieved in groups with different configurations of PTA findings. The correlation coefficients between the hearing thresholds determined by ASSR and PTA were significant in subjects with all levels of hearing loss. The differences between hearing thresholds determined by ASSR and PTA were less than 10 dB in 85% of subjects (ranging from 4 dB for moderately severe hearing loss to 7.2 dB for normal hearing). CONCLUSION: The ASSR is an excellent complementary method for the determination of hearing thresholds at the 4 carrier frequencies, as well as determination of the level of hearing loss and the audiometric configuration.

Gustatory rhinitis.

Gustatory rhinitis is characterized by watery, uni- or bilateral rhinorrhea occurring after ingestion of solid or liquid foods, most often hot and spicy. It usually begins within a few minutes of ingestion of the implicated food, and is not associated with pruritus, sneezing, nasal congestion or facial pain. It is considered to be a non-immunological reaction. Immunohistological and pharmacological observations suggest that this disease is most likely caused by stimulation of trigeminal sensory nerve endings located at the upper aerodigestive track. Recent evidence suggests that sensory nerve stimulations could be associated with a parasympathetic reflex and activation of cholinergic muscarinic receptors, sensitive to atropine. There are various types of gustatory rhinitis, including age-related, posttraumatic, postsurgical and associated with cranial nerve neuropathy. Avoidance of the implicated foods, is the first treatment option, but it is rarely sufficient. The intranasal topical administration of anticholinergic agents such as atropine, either prophylactically or therapeutically has been shown effective. Surgical therapy in the form of posterior nasal nerve resection or vidian nerve neurectomy is not recommended because of its short lasting result and frequent unpleasant side effects.

Prevalence of the palmaris longus through clinical evaluation.

PURPOSE: Most standard textbooks of hand surgery report on the rate of palmaris longus muscle absence of 15%. The aim of the study was to determine the absence of palmaris longus and to correlate it with age, sex and body side. METHODS: The study included 800 subjects (400 male and 400 female). They were initially asked to do the standard test for the assessment of the palmaris longus tendon. If the tendon was not visualized or palpable, four additional tests were done to confirm its absence. RESULTS: Unilateral absence of the palmaris longus was recorded in 173 (21.6%) and bilateral in 127 (15.9%) study subjects. According to body side, right-sided absence of palmaris longus was found in 69 (8.6%) and left-sided in 104 (13%) subjects, yielding a statistically significant difference. Bilateral absence was slightly more common in men. The prevalence of palmaris longus absence on the right and left side was similar in men, whereas in women it was significantly more common on the left side. Differences between the three age groups (young, middle-aged and old) were not significant; however, the middle-aged and young groups showed a lower rate of palmaris longus presence as compared to old-age group. CONCLUSIONS: It has been suggested that this tendon is rapidly disappearing in humans. The results of our study show a relatively high incidence of tendon absence and pointed to more pronounced loss of the muscle on the left side.

[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.

[Influence of anatomic variations of the structures of the middle nasal meatus on sinonasal diseases].

INTRODUCTION: The most common anatomic variations of the structures of the middle nasal meatus are variations of agger nasi cells, variations of the middle turbinate, variations of uncinate process, variations of the ethmoidal bulla, deviations and deformations of nasal septum in the region of the middle nasal meatus, Haller's cell (orbitoethmoidal) and Onodi's cell (sphenoethmoidal cell). In 1997, the Otorhinolaryngology-Head Neck Surgery, Task Force on Chronic Rhinosinusitis defined chronic sinusitis and nasal disease initially by including sinusitis and rhinitis with one term-chronic rhinosinusitis. This was done because it was apparent to many that nasal disoders often affected the sinuses, and vice versa. Also they established baseline parameters, major and minor signs and symptoms, for definition of rhinosinusitis. Two major factors or one major factor and two minor factors constitute a strong history for rhinosinusitis. MATERIAL AND METHODS: The following methods were used in the study: 1. Anamnestic data processing about: disease symptoms that were recognized by American Academy for ENT as major and minor criteria in diagnosing nosinusitis; the duration of symptoms; the kind of sinonasal disorder and the secondary disorders. 2. Data processing obtained by anterior/posterior rhinoscopy. 3. Data processing obtained by endoscopic examination. 4. Data processing obtained by CT of paranasal cavities and the nose. The data about anatomic variations were statistically processed by Eives's correlation coefficient that indicates the degree of correlation between sinonasal disorders and anatomic variation. RESULTS: By analyzing the obtained data in the examined patients with sinonasal disorders, anatomic variations were present in over 50% of the patients and are defined by percentage. 1. The deviation of nasal septum in 83.33% patients. 2. The variations of the form of the middle nasal chonha in 58.92% patients. 3. The presence of agger nasi cells in 50% patients. 4. Variations of the form of ethomoidal bulla in 50% patients. Eives's correlation coefficient i.e. the degree of correlation between sinonasal disorders and the presence of anatomic variation statistically significantly correlate at r > or = 0.05 of anatomic variation of the middle nasal chonha (r = 0.23) and the presence of deviation/deformation of nasal septum (r = 0.6) with sinonasal disorders. DISCUSSION AND CONCLUSION: Anatomic variations of the structures of the middle nasal meatus can additionally complicate the anatomy of the lateral nasal wall and the conditions of the ostiomeatal unit. Therefore we must view these variations as factors predisposing to more rapid and frequent appearance and persistence of chronic inflammations. Also, familiary with the variations in sinonasal anatomy is a prerequisite to safe and effective surgical treatment of sinonasal disease. Recognition of this anatomic variation should minimize catastrophic violation of vital structures such as orbit or skull base.

[Endonasal endoscopy and computerized tomography in diagnosis of the middle nasal meatus pathology].

INTRODUCTION: Diagnostic nasal endoscopy enables clear visualization of all structures of the middle nasal meatus and of the ostiomeatal complex. It is a primary means for diagnosis of all anatomic variations and other pathogenic factors of the lateral nasal wall, which cannot be diagnosed by using anterior/posterior rhinoscopy. Furthermore, the effects of therapy can be endoscopically controlled and, if necessary, a surgical procedure may be performed. Computed tomography has become the imaging study of choice in the diagnosis and management of sinonasal diseases. It provides detailed information and an unparalleled view of the sinuses, especially the bony anatomy. MATERIAL AND METHODS: The following methods were used in the study: endoscopic examination and CT of the nose and paranasal cavities. Data processing and comparison of diagnostic methods tomography was done using a biostatistical apporach--kappa. RESULTS: The correlation between computerized tomography and endoscopy of the nose and sixty nasal cavities of examined patients is significantly high. with mean kappa coefficient of k = 0.89, kappa > 0.8. DISCUSSION AND CONCLUSION: The diagnosis of rhinosinusitis is generally based on clinical grounds. In 1997, the Task Force of Rhinosinusitis developed the major and minor criteria for diagnosing rhinosinusitis. The presence of two major or one major and two minor symptoms is generally sufficient to make a clinical diagnosis of rhinosinusitis. In order to make a specific diagnosis and provide specific treatment, ednonasal endoscopy is the method of choice. In cases with refractory rhinosinusitis, acute rhinosinusitis with complications, or atypical cases requiring confirmation of sinusitis, use of coronal and axial CT is necessary. This article confirms that diagnostic endoscopy of the nose and paranasal cavities with computer tomography of paranasal cavities represent an ideal combination and a widely recognized standard for diagnosis and treatment of nasal and paranasal cavity disorders in many countries.

[Classification and qualification of nose injuries--clinical and forensic aspects].

INTRODUCTION: Nose injuries are of great importance in ENT and medico-legal practice. The importance lies in the frequency of injuries, diverse approaches to diagnosis, treatment and qualification of injuries used in legal proceedings in court. Objective assessment of health impairements due to an injury, requires knowledge about morphofunctional nasal characterics, therapeutic procedures and medico-legal expertise. NOSE INJURES: ETIOLOGY AND DIAGNOSIS: Nasal fractures are the most common types of facial fractures which occur in different situations. They are often combined with soft tissue injuries. The diagnosis of nasal injuries involves clinical examination, radiography and nasal endoscopy. CLASSIFICATION AND THERAPY OF NOSE INJURIES: There are several classifications of nasal injuries depending on pathological findings. The most acceptable one is the modified categorization after Harrison. The treatment of nasal injuries depends on the type of injury and possible complications. QUALIFICATION OF NOSE INJURIES: Nasal soft tissue injuries, nasal fractures, dislocations and partial dislocations should be assessed at the time of diagnosis. CONCLUSION: Medical assessment of injuries is of utmost importance for legal purposes and regarding medico-legal aspects.

[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.

[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.

[Rhinolithiasis]. / Rinolitijaza.

INTRODUCTION: A rhinolith is a rock which forms in the nose. It occurs from the solidification of mucus and nasal debris: by mineral salts, calcium, magnesium phosphate and carbonate, and it leads to unilateral obstruction of the nasal airway followed by inflammatory changes of the nasal mucus membrane and paranasal cavities. This inflammatory process may lead to a purulent form with complications, intracranial propagation and dacryocystitis. CASE REPORT: This is a case report of a patient with rhinolithiasis, 30 years of age, complaining of breathing difficulties for 10 years, with nasal secretion, reduced olfactory function and headaches. She underwent the following procedures: frontal rhinoscopy, epipharyngoscopy, nasal mucus analysis (fungi and bacteria), x-ray check-up as well as pathohistological analysis of the removed rhinolith. DISCUSSION AND CONCLUSION: The significance of computer tomography of paranasal cavities was confirmed in coronal lines, as the most valid radiological analysis which provides adequate diagnosis, differential diagnosis and helps in making the decision on surgical treatment. Surgery is obligatory and in most cases it is endonasal endoscopy. Bigger nasal stones (rhinoliths), progressing into the surrounding anatomic structures, are treated using rhinotomy and trepanation (Caldweell-Luc). In cases of greater rhynoliths with propagation into neighboring anatomic areas, cases of surgical treatment by lateral rhynotomy and trepancy of the sinuses (Caldwel-Luc) were shown.