DYMUS-Hr self-assessment questionnaire (Croatian version) for dysphagia in multiple sclerosis-validity, reliability, and cross-cultural adaptation.

BACKGROUND: The prevalence of dysphagia in the early phases of multiple sclerosis is 30-40%, with an estimated of 30% of cases going undiagnosed cases. Such complications can lead to malnutrition, dehydration, and aspiration pneumonia and have a great impact on the quality of life and psychosocial status of a person with MS. The aim of this study was the validation of dysphagia in multiple sclerosis self-assessment questionnaire (DYMUS) in the Croatian language. METHODS AND PATIENTS: The cross-cultural adaptation process included a back-forward translation technique of the English language version of DYMUS to the Croatian language, with pilot testing on 30 participants. The validity and reliability of the Croatian version of DYMUS (DYMUS-Hr) was applied to 106 MS patients, with comparison to the Eating Assessment Tool (EAT10), the Water Swallowing Test (WST), and a dichotomous self-assessment question. In the assessment of test-retest reliability, 99 MS patients were included. RESULTS: Internal consistency of DYMUS-Hr was very good (Cronbach's alpha-0.837); Cronbach's alpha was 0.819 for the "dysphagia for solids", and 0.562 for "dysphagia for liquids" subscale. A significant correlation (p < 0.001) was found between DYMUS-Hr and EAT10 (Spearman's rho-0.787), and WST (Spearman's rho-0.483). Construct validity was assessed with the self-assessment question and interpreted with the Mann-Whitney U test. Test-retest reliability showed moderate to substantial Cohen's Kappa reliability for each item. CONCLUSION: DYMUS-Hr is a valid and reliable screening assessment tool for patients with MS. There is a general lack of awareness about dysphagia symptoms among patients with MS; consequently, this disorder receives inadequate attention and often goes untreated.

PREOPERATIVE SINGLE ANTHROPOMETRIC SCREENING TESTS OF DIFFICULT FACE MASK VENTILATION AND DIFFICULT DIRECT LARYNGOSCOPY INTUBATION IN PATIENTS UNDERGOING OTORHINOLARYNGOLOGICAL SURGERY: A PROSPECTIVE, OBSERVATIONAL, SINGLE CENTER STUDY.

The aim of this study was to assess preoperative airway history data and single anthropometric screening tests of difficult face mask ventilation (FMV) and difficult direct laryngoscopy intubation (DLI) in otorhinolaryngological surgery. Final analysis included 62 patients aged ≥14 years undergoing elective surgery with endotracheal intubation at a single center during a one-month period. Data on difficult intubation history, airway symptoms and pathology related to difficult airway were prospectively collected. Han scoring classification of FMV and Intubation Difficulty Score (IDS) were used. There were 14 (22.6%) patients with a history of current airway tumors or abscesses. Only two (3.2%) patients were preoperatively evaluated as anticipated difficult airway. Both were slightly difficult to ventilate and scored IDS 5 and IDS 8. FMV was graded as easy in 50 (80.5%), slightly difficult in 10 (16.1%) and difficult in 2 (3.2%) cases. There were 29 (46.78%) slightly difficult DLIs and one (1.6%) case of difficult DLI. The study confirmed clinically relevant incidence of difficulties with FMV and DLI in otorhinolaryngologic surgery patients. However, there should be stronger evidence to identify a single preoperative variable predicting difficult airway.

ASSESSMENT OF STANDARD ANTHROPOMETRIC AIRWAY CHARACTERISTICS RELEVANT FOR AIRWAY MANAGEMENT OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME DURING SLEEP BREATHING DISORDER SURGERY: A RETROSPECTIVE, SINGLE CENTER STUDY.

The aim of this study was to explore standard anthropometric airway characteristics of patients with obstructive sleep apnea syndrome (OSAS) and determine the incidence and risk factors for difficult airway management. Final analysis included 91 patients with polysomnography-verified diagnosis of OSAS who underwent sleep breathing disorder surgery under general anesthesia with direct laryngoscopy oroendotracheal intubation. The incidence of difficult manual mask ventilation during anesthesia induction, difficult intubation and immediate postextubation respiratory complications was 17.6%, 7.7% and 7.7%, respectively. Compared to patients without difficult manual mask ventilation, the group of OSAS patients with difficult manual mask ventilation had a higher rate of body mass index (BMI) ≥25 kgm-2 (p=0.010), Mallampati score ≥3 (p=0.024) and Cormack-Lehane score ≥3 (p=0.002). The OSAS patients with difficult intubation had more Cormack-Lehane score ≥3 (p=0.002) in comparison to those without difficult intubation. Our study demonstrated that manual mask ventilation during anesthesia induction was the most troublesome airway management task in OSAS patients during sleep breathing disorder surgery. Cormack-Lehane score was a relevant determinator of difficult mask ventilation and difficult intubation, while Mallampati score and BMI were relevant determinators only for difficult manual mask ventilation.

Poorly differentiated sarcoma of the maxillary sinus: a histopathology dilemma of a rare tumor.

Sarcomas are a rare heterogeneous group of neoplasms of mesenchymal origin. In the redistribution of all head and neck malignancies, sarcomas are represented by only 1%. Herein, we report a case of a 66-year-old patient with right maxillary sinus sarcoma that spread through the ostiomeatal complex, infiltrated the septum, all ethmoid cells, frontal sinus, involved the entire right nasal cavity and penetrated to the nasopharynx. Patient was treated with neoadjuvant chemotherapy, surgery and adjuvant radiotherapy. The histopathology indicated poorly differentiated sarcoma with elements of Ewing's sarcoma, but also with elements consistent with osteosarcoma. Molecular pathological analysis excluded Ewing's sarcoma. Samples were also sent for review to the other Pathology Clinics. They suggested poorly differentiated high-grade pleomorphic sarcoma with elements of osteosarcoma. The accurate diagnosis of the head and neck sarcoma type can be a histopathology dilemma posing a great challenge in the choice of therapeutic approach, and thus the treatment outcome.

An unusual case of hyalinizing clear cell carcinoma in a sinonasal cavity and cranial base.

Hyalinizing clear cell carcinoma (HCCC) is a rare, predominantly minor salivary gland tumor. Most of these tumors occur in the oral cavity, mainly the palate and tongue. Primary localization of the tumor in the region of the nasal cavity and paranasal sinuses is extremely rare and, with only a few cases reported in the literature so far. We present an extremely rare case of a 61-year-old woman with hyalinizing clear cell carcinoma (HCCC), occupying the left posterior nasal and nasopharyngeal cavity, as a primary tumor location. The patient total recovery was uneventful, and she is now free of disease at three years postoperative follow-up.

Validation of self-reported hearing loss among adult Croatians: the performance of the Hearing Self-Assessment Questionnaire against audiometric evaluation.

OBJECTIVE: The aim of this study was to validate the performance of a self-assessment hearing loss screening tool for adults against audiometric evaluation. Different audiological measurements were compared with the results of a 10-item Likert-type questionnaire named the Hearing Self-Assessment Questionnaire (HSAQ) to investigate its psychometric characteristics. DESIGN: Participants underwent audiological evaluation and completed the HSAQ. The screening performance of the HSAQ was evaluated against three definitions of hearing loss: better-ear mean pure-tone thresholds >25 dBHL at 500-2000 Hz, 500-4000 Hz and 1000-4000 Hz. STUDY SAMPLE: The study enrolled 112 participants aged between 24 and 88 years (mean age 56.24 years, ±12.92). RESULTS: The HSAQ had high Cronbach's alpha and intraclass correlation coefficients and showed construct, concurrent and discriminant validity. Its screening characteristics proved very good or excellent, depending on the definition of hearing loss. Receiver operating characteristic curve analysis showed excellent accuracy of the HSAQ in the identification of better-ear high-frequency hearing loss and better-ear speech-frequency hearing loss, with respect to different cut-off points. CONCLUSIONS: Given the ease with which it is administered and its good screening properties, the HSAQ can be useful in deciding whether adult clients should be referred to audiological evaluation due to reasonable suspicion of hypoacusis.

Efficiency of radiofrequency assisted uvulopalatopharyngoplasty in the treatment of snoring.

Snoring is an acoustic phenomenon, which is a consequence of vibrations of the soft tissue caused by partial obstruction of the upper breathing pathway while sleeping. It is estimated that 20% of men and 5% of women between 30 and 35 years of age snore and this rate increases to 50% of men and 30% of women over 60 years of age. The aim of this study was to evaluate the efficiency of radiofrequency assisted uvulopalatopharyngoplasty in the treatment of snoring by comparing snoring index and other polysomnography values before and after surgical treatment. The study included 22 patients (men 87% and women 13%), mean age 43.09 +/-9.6 (range, 28-67) years, treated for obstructive sleep apnea syndrome at University Department of ENT and Head and Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, during a 2-year period. Snoring was evaluated by preoperative and postoperative polysomnography at Department of Psychophysiology, Vrapce Psychiatric Hospital, Zagreb. Results were analyzed using Wilcoxon test. Postoperative reduction of snoring was statistically significant (P = 0.00052). Snoring index was decreased in 83% of patients, yielding a mean reduction of 83%. In 50% of patients, reduction of snoring index was over 95%. These results confirm the high efficiency of the procedure in the treatment of patients suffering from snoring.

Effects of hearing loss on the voice in children.

The object of this paper is to report on preliminary acoustic characteristics obtained from a group of 10 to 12 year old males from special institution from Zagreb with more than mild sensorineural hearing losses. The study was structured as an investigation of voice and resonance characteristics of Croatian children with and without sensorineural hearing loss, using sustained phonation of the vowel /a/ which was recorded using a high-quality tape recorder carried out by two voice clinicians. The samples were digitized and analyzed for frequency and spectral characteristics by EZVoice and Bruel & Kjaer Real-time Frequency Analyzer and high quality sound level meter (mouth-to-microphone distance = 30 cm). Differences were observed in perturbation measures; F0 variability; vocal intensity. Spectral deviations were also observed. Discussion focuses on application of these findings by Croatian speech and hearing specialists with the hearing impaired population. Results indicated the following: measures of jitter were significantly elevated in the hearing loss group as compared to the normal controls. A similar result was observed for measures of shimmer. Lack of voice professional's awareness of importance for making pleasant voice quality of hearing-impaired individuals was the initial idea of this study. Patients with hearing losses have been reported to show a wide variety of voice disturbances.

Some characteristics of voice in near-total laryngectomy.

Some vocal characteristics were compared in two groups of examinees: patients after near-total laryngectomy and a control group of healthy examinees. Acoustic analysis was carried out using Multi Dimensional Voice Program and Spectra LAB program. Analyzed parameters were: fundamental frequency, the range of fundamental frequency, maximum phonation time, jitter, shimmer, noise to harmonic ratio, voice turbulence index, degree of voice breaks and intensity of voice. We found that voice after near-total laryngectomy had normal mean fundamental frequency, larger range of fundamental frequency, jitter and shimmer were high, as were noise to harmonic ratio and voice turbulence index. Maximum phonation time was short and intensity was lower compared to control group. Degree of voice breaks was significant in near-total laryngectomy group.

Speech and voice analysis after near-total laryngectomy and tracheoesophageal puncture with implantation of Provox 2 prosthesis.

Vocal characteristics were compared in two groups of patients who were operated on due to laryngeal cancer. One group was composed of patients after near-total laryngectomy and the other after total laryngectomy followed by tracheoesophageal puncture with implantation of Provox 2 prosthesis. Acoustic analysis was carried out using the EZ Voice Plus program and included the following parameters: fundamental frequency, jitter, shimmer, harmonic to noise ratio, range of fundamental frequency, maximal phonation time and intensity.