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Background and Aim:: Sudden sensorineural hearing loss (SSNHL) is an audiologic emergency. It is defined as sensorineural hearing loss of 30 dB or greater over at least three contiguous audiometric frequencies occurring within a three-day period. Although it rarely endangers patient’s life it significantly reduces patient’s quality of life, negatively influence on their workplace productivity and puts them at risk for accidents. The aim of this study was to investigate the impact of age on clinical characteristics in SSNHL. Method: We performed a retrospective medical review of 100 patients with SSNHL treated at our hospital in period between January 2016 and February 2022. All patients were treated according to Croatian guidelines for SSNHL. Audiological evaluation was done before and after treatment. Hearing recovery was defined according to modified Sigel’s criteria. Patients were divided in 2 groups: 65 years. Age related clinical characteristics and treatment outcomes were investigated. Results: Hearing improvement in total 100 patients was 48%. Complete recovery in group > 65 years was significantly lower than that of the

Background: Over the last few decades there have been some groundbreaking changes in the treatment of the head and neck tumors, particularly laryngeal tumors. However, there is still room for improvement because mortality rate is still relatively high. According to NCCN guidelines (version 3.2021), the treatment modalities of early stage glottic malignancy are radiotherapy, laryngeal laser resection or partial laryngectomy. Our experiences with patients who underwent frontolateral laryngectomy are presented. Methods: Patients with an early stage glottic malignancy treated with frontolateral laryngectomy at a tertiary care center were included in this retrospective study. Patient’s demographics, tumor stage, histopathological examination and oncological outcome were evaluated. Results: 45 patients were treated with aforementioned surgery due to T1 (60%) or T2 (40%) laryngeal squamous cell cancer without nodal involvement. 3 female (6, 7%) and 42 male (93, 3%) patients were included in the study. Mean age was 62, 7 ± 8, 1 years. Only 2 patients experienced local and one regional recurrence. Both patients who developed local recurrences had anterior commissure involvement. 5-year disease specific survival was 100%. 5-year overall survival was 93, 3%. During the follow-up (mean 92 months) ten patients died. Secondary primary tumors or other causes unrelated to primary cancer were the causes of death. Complications, granuloma and synechia, were noticed in 7 and 1 patients, respectively. Conclusion: Laryngeal cancer has a very good prognosis when its caught at early stage. When results were compared to the results of studies where the treatment modality was RT, laser surgery or transoral robotic surgery, a similar success rate was observed. Certainly, new modalities have some advantages, but in certain cases of patients, frontolateral laryngectomy is a viable option.

Malignant mesenchymal tumors of oropharyngeal mucosa are rare. Those with fibroblastic and histiocytic differentiation in the skin are called atypical fibroxanthoma (AFX) and in the soft tissue undifferentiated pleomorphic sarcoma (UPS). Here we present a case of an older patient with a history of multiple basal cell carcinomas and recently with a rapidly growing polypoid lesion in the mucosa of posterior oropharyngeal wall with AFX/UPS morphology. The differential diagnosis, histological pitfalls of this poorly characterized mesenchymal lesions, and the challenges associated with treatment are discussed.

Aim of the study: Membrane EGFR (mEGFR) protein overexpression is frequently found in the head and neck squamous cell carcinoma (HNSCC). It has been found that mEGFR upon stimulation translocates to nucleus and its nuclear localisation is associated with poor prognosis in many cancers. The main focus of this study is to asses if nuclear EGFR (nEGFR) expression affects biologically more aggressive tumor behaviour in comparison to mEGFR expression in laryngeal SCC. Material and Methods: We examined 42 laryngeal squamous cell carcinomas (SCC) for nEGFR and mEGFR expression as well as cell cycle proliferative markers Ki-67, p53, cyclin D1 using immunohistochemistry. Results: In our study group, we found in 28.57% (12/42) SCC cases a strong (3+) nEGFR expression, 64.28% (27/42) SCC had weak to moderate (1+/2+) nEGFR expression while 7.14% (3/42) cases were negative for nEGFR. The majority of patients with SCC had strong (3+) mEGFR (52.38% or 22/42) expression and 45.23% (19/42) had weak to moderate (1+/2+) mEGFR expression and one case (1/42) was negative for mEGFR. The mean values ± standard deviation (%) of Ki-67, p53 and cyclin D1 expression in our study group were 39.04 ± 18.08, 38.88 ± 32.22 and 43.82 ± 18.34, respectively. When assessing the association of nEGFR with mEGFR and cell cycle proliferation markers there was statistically significant negative correlation between nEGFR and mEGFR expression (τ = -0.389 ; P = 0.002) and statistically significant negative correlation between nEGFR and cyclin D1 (τ = -0.274 ; P = 0.032). In the analysis of mEGFR correlations with the examined cell proliferation markers there were no statistically significant associations. We also observed that higher number of patients with strong nEGFR expression and concomitant negative/weak to moderate mEGFR expression died (70% or 7/10 patients) in comparison to number of patients with strong mEGFR expression and negative/weak to moderate nEGFR expression (40% or 8/20 patients). Moreover, univariate statistical analysis showed a statistically significant correlation between strong nEGFR protein expression with worse overall survival in laryngeal SCC, alone or in co-expression with strong cyclin D1 and high Ki-67 (P=0.025, P=0.046, P=0.043, respectively). However, there was no statistically significant difference in the overall survival, when we analyzed strong mEGFR expression, alone or in co- expression with cyclin D1 and Ki-67 cell cycle proteins (P=0.953, P=0.731, P=0.647, respectively). Conclusion: Our data indicate that nuclear EGFR cellular localization with strong expression might influence the more aggressive biological behaviour of laryngeal SCC carcinoma with poor patient survival.

Sekretorni otitis definira se kao prisustvo tekućine u šupljini srednjega uha, bez znakova ili simptoma akutne upale. Čest je kod male djece i spontano se povlači u do 90% slučajeva. Ako traje dulje od 3 mjeseca smatra se kroničnim sekretornim otitisom. U ovim smjernicama dan je sažeti opis tijeka bolesti, te upute o načinu dijagnostike i liječenja sekretornog otitisa kod djece.

Akutna upala srednjega uha učestala je bolest čija dijagnostika i liječenje uključuje suradnju liječnika različitih specijalnosti. U ovim smjernicama navedeni su najčešći uzročnici akutne upale uha, dijagnostika upale uha, diferencijalna dijagnoza, te simptomatsko i antibiotsko liječenje. Posebno je naglašen prvi izbor antibiotika, te njegovo doziranje kod djece i odraslih, antibiotsko liječenje nakon neuspjeha liječenja prvim izborom antibiotika, te liječenje recidiva akutne upale srednjega uha. Navedene su indikacije za liječenje akutne upale srednjega uha, te praćenje takvih bolesnika nakon remisije simptoma od strane otorinolaringologa.

A case of a child implanted 11 years ago with the gradual degradation of performance without any other audiological or otological symptoms. Clinical examination confirmed the diagnosis of cholesteatoma. On the CT scan extracochlear extrusion of the electrode was noticed. The question is raised about the mechanism of pathology: has the extrusion of the electrode caused marginal defect of the eardrum and the consequent cholesteatoma or has the cholesteatoma developed by the other mechanisms and "pulled" the electrode out of the cochlea. Accordingly, this raises a question about fixing the electrode in certain cases.

We sought to evaluate the effects of awareness of rhinomanometric results on subjective sensation of nasal breathing in patients after septoplasty. Dedign: Prospective randomised study. Setting: Clinical Hospital Rijeka. A study of 60 patients (45 M, 15 F) who underwent septoplasty was performed at the ENT Clinic, Clinical Hospital Rijeka. The patients were randomised into two groups ; group A was shown their rhinomanometry scores at 3 months postoperatively, while group B remained unaware of their rhinomanometry results. Main outcome measure: The assumption is that in the same settings patients aware of their rhinomanometric results have better performances of their Nasal Obstruction Symptom Evaluation (NOSE) scale and thereby a better quality of life (QOL) after septoplasty. The differences in rhinomanometric results and NOSE scale prior and after septoplasty were statistically significant (P

Juvenile angiofibromas are benign fibro-vascular tumours of the nasopharynx that develop in prepubertal and adolescent males. Typical symptoms are longstanding unilateral nasal obstruction occasionally followed by epistaxes and frequent severe intraoperative haemorrhage of the discovered mass.We report the case of a 14-year-old boy histologically diagnosed with a juvenile angiofibroma in spite of the atypical localisation of the polyploid mass of the left maxillary sinus.

U radu se uspoređuju dva pristupa liječenju kronične sekretorne upale uha kod djece: adenoidektomijom i adenoidektomijom s timpanotomijom i aplikacijom aerizacionih cijevki. U zaključku se iznosi da može klinički status bubnjića predstavljati dodatni kriterij u odabiru pristupa terapiji kroničnog sekretornog otitisa u djece.

Kod 56 uha se prikazuju dugogodišnji (prosječno 11 godina nakon operacije) anatomski i funkcionalni rezultati nakon hrskavične palisadne timpanoplastike s interpozicijom glavice maleusa.

Ispitivan je utjecaj pokazivanja rinomanometrijskih rezultata pacijentu nakon septoplastike na subjektivni osjećaj disanja na nos. Pretpostavka je da u istim uvjetima pacijenti svjesni rezultata imaju bolji rezultat Nasal Obstruction Symptom Evaluation (NOSE) upitnika, a time i bolju kvalitetu života nakon septoplastike. U studiji je sudjelovalo 60 pacijenata (45 M, 15 Ž) operiranih na Klinici za otorinolaringologiju i kirurgiju glave i vrata KBC Rijeka. Pacijenti su nasumično podijeljeni u dvije grupe: grupu kojoj su pokazivani rezultati rinomanometrijskih mjerenja (A), i grupu neinformiranu o rezultatima rinomanometrijskih mjerenja (B). Razlika u rezultatima rinomanometrijskih mjerenja i NOSE upitnika prije i poslije operacije je statistički značajna (p < 0, 001). Postoperativno su u svim mjerenjima pacijenti postigli bolje rezultate. Nije primijećena statistički značajna razlika u rezistenciji (F = 0, 004 ; p = 0, 948) i poboljšanju rinomanometrijskih rezultata u postoperativnim mjerenjima (F = 0, 110 ; p = 0, 896) između grupa A i B. Simptomi mjereni NOSE upitnikom preoperativno i mjesec dana nakon septoplastike su podjednako izraženi u obje grupe (F = 2, 906 ; p = 0, 094). Tri mjeseca nakon septoplastike grupa A ima bolji rezultat NOSE upitnika (M = 11, 67 ; SD = 12, 34) nego grupa B (M = 27, 50 ; SD = 18, 04). Rezultati studije sugeriraju da informacija o rinomanometrijskim mjerenjima nakon septoplastike može popraviti subjektivan osjećaj disanja i kvalitetu života operiranog pacijenta.

Cilj: Totalna laringektomija opsežan je operativni zahvat koji se može izvesti sa ili bez resekcije vrata. Tijekom ovog postupka u potpunosti se odstranjuje grkljan, a traheja se mobilizira te pričvrsti za kožu u obliku trajnog otvora za disanje – traheostome. Najsloženiji problem u vezi s rekonstrukcijom funkcije larinksa, kojemu je posvećen najveći broj istraživanja, ponovno je uspostavljanje govora. Osnovne mogućnosti govorne rehabilitacije nakon totalne laringektomije jesu razvijanje vještine ezofagealnog govora, korištenje elektrolarinksa i traheoezofagealna punkcija s uporabom govorne proteze. Traheoezofagealna punkcija s govornom protezom je kirurška metoda izbora za govornu rehabilitaciju bolesnika. Punkcija može biti izvedena primarno, istovremeno s laringektomijom, i sekundarno, tjednima ili godinama nakon izvršene laringektomije. Materijali i metode: U razdoblju od 1. 1. 2004. do 31.12. 2008. godine na Klinici za otorinolaringologiju KBC-a u Rijeci liječeno je 125 laringektomiranih bolesnika. Indikacija za izvođenje totalne laringektomije bio je T3 ili T4 karcinom larinksa u 58 (46%) bolesnika, a u 67 (54%) bolesnika izvršena je parcijalna laringektomija. Rezultati: Metode govorne rehabilitacije bile su uspostava traheoezofagealnog (91%) i ezofagealnog (6%) govora i uporaba elektrolarinksa (3%). Govorne proteze postavljene su u 49 bolesnika primarnom punkcijom, a u 36 bolesnika sekundarnom punkcijom. Srednje vrijeme trajanja proteza iznosilo je 7,9 mjeseci. 10% proteza zamijenjeno je nakon manje od 3 mjeseca korištenja, 46% nakon 3 do 6 mjeseci, a 44% proteza korišteno je dulje od 6 mjeseci. Zaključak: Učinkovita rehabilitacija glasa bitna je i omogućava bolesniku povratak normalnim životnim funkcijama. Traheoezofagealni govor postao je metoda izbora za govornu rehabilitaciju nakon izvršene laringektomije., Aim: Total laryngectomy is an expansive operation and can be performed with or without neck dissection. During this procedure the entire larynx is removed, the windpipe is brought out to the skin and secured there in the form of a permanent tracheostome. The most difficult aspect of laryngeal function to reconstruct, and the one to which most research is dedicated to is the reattainment of speech. The main options for voice restoration after total laryngectomy are esophageal speech, electrolarynx speech, and tracheoesophageal speech. Tracheoesophageal puncture with prosthesis is currently the surgical method of choice for vocal restoration after total laryngectomy. This puncture tract can be created primarily, at the time of total laryngectomy, or secondarily, weeks or years following the laryngectomy. Patients and Methods: Between the period of 01.01.2004. and 31.12.2008., 125 laryngectomized patients have been rehabilitated at the Otorhynolaryngology Department of the Clinical Hospital Center Rijeka. The indication for total laryngectomy was T3 or T4 laryngeal carcinoma in 58 (46%) patients, and 67 (54%) patients underwent a partial laryngectomy. Results: The methods of voice rehabilitation were tracheoesophageal speech (91%), esophageal speech (6%) and artificial larynx (3%). A voice prosthesis could be inserted in 49 patients by primary puncture, in 36 patients by secondary puncture. The median device lifetime was 7,9 months. 10 % of the prostheses were replaced with a lifetime of less than 3 months, 46% from 3 to 6 months, and 44% devices longer than 6 months. Conclusion: Effective restoration of voice is critical to enabling the patient to return to normal functioning in their life. Tracheoesophageal speech has become the method of choice for postlaryngectomy voice restoration.

Timpanotomija s aplikacijom ventilacijskih cijevki u liječenju kroničn sekretorne upale uha (CSOM) u djece je najčešće izvođen otokirurški zahvat. Povezan je s nizom komplikacija i sekvela. Liječenje CSOM-a samo adenoidektomijom u djece s normalnim izgledom bubnjića doprinos je algoritmu liječenja CSOM-a u djece.

The case presented is of a neonate with extreme respiratory distress immediately after birth, caused by a large laryngeal cyst. The vertical diameter of the cyst was larger than the height of the neonatal larynx. First excision of the cyst was performed in the region of the prominent aryepiglottic fold. Three weeks later, because of a recurrence of dyspnea, excision of the prominent wall of an obstructing cystic lesion was performed in the ventriculus Morgagni.

The authors conclude that patients can dive after cartilage palisade tympanoplasty.

Cilj rada: Analizirati i statistički obraditi funkcionalne i onkološke ishode bolesnika s ranim stadijem skvamoznog karcinoma grkljana tretiranih frontolateralnom laringektomijom. Ispitanici i metode: Retrospektivnim istraživanjem obuhvaćeno je 45 pacijenata, od čega su 3 bila ženskoga, a 42 muškoga spola. Akt gutanja, respiratorna i fonatorna funkcija su komponente na temelju kojih se procijenio funkcionalni ishod. Respiratorna funkcija se smatra urednom u slučaju nepostojanja stenoza te uspješnog dekanilmana. Pomoću anamneze i fiberlaringoskopskog pregleda procjenjivan je akt gutanja. Evaluacija glasa provodila se auditivno-perceptivnom procjenom (GRBAS skala), spektralnom akustičnom analizom kao objektivnom metodom, te subjektivnom procjenom glasa bolesnika pomoću VHI 30 upitnika (Voice Handicap Index 30). Kaplan-Meierovim krivuljama ukupnog preživljenja (overall survival), preživljenja bez bolesti (disease free survival) i preživljenja vezanog uz bolest (disease specific survival) prikazan je onkološki ishod. Rezultati: Svi bolesnici imali su tumor glotičkog dijela grkljana, te su bili svrstani u T1 (60 %) ili T2 (40 %) stadij bolesti. Zbog limfovaskularne invazije tumora ili R1 resekcijskih rubova, postoperativna radioterapija primijenjena je u 15 (33,3 %) bolesnika. U svih pacijenata uredno je izvršen dekanilman, te su svi imali urednu respiratornu funkciju. Nijednom bolesniku nije verificiran poremećaj gutanja. Rezultati evaluacije glasa ukazuju da bolesnici imaju umjerene vokalne poteškoće. Analiza onkološkog ishoda iznosi da je petogodišnje preživljenje vezano uz bolest 100 %, petogodišnje ukupno preživljenje 93,3 %, dok je petogodišnje preživljenje bez bolesti iznosilo 86,7 %. Lokalni recidiv bolesti razvio se u dva bolesnika, a regionalni u jednog. Zaključak: Frontolateralna laringektomija pruža odličan onkološki ishod, te treba biti alternativna metoda liječenja u odabranim slučajevima., Objective: To analyze and statistically process the functional and oncological outcomes of patients with early stage squamous laryngeal carcinoma treated by frontolateral laryngectomy. Materials and methods: 45 patients were included in the retrospective study, 3 were female and 42 were male. The functional outcome was assessed based on respiratory and phonatory function, and the act of swallowing. Respiratory function is considered normal in the absence of stenosis and successful decannulation. The act of swallowing was assessed using the anamnesis and fiberlaryngoscopy examination. The evaluation of voice was carried out by auditory-perceptual evaluation (GRBAS scale), spectral acoustic analysis as an objective method, and subjective evaluation of the patient's voice using the VHI 30 questionnaire (Voice Handicap Index 30). Kaplan-Meier curves of overall survival, disease-free survival and disease-specific survival show the oncological outcome. Results: All patients had a tumor in the glottic region of the larynx, and were classified as T1 (60%) or T2 (40%) of the disease. Due to lymphovascular tumor invasion or R1 resection margins, postoperative radiotherapy was applied in 15 (33.3%) patients. Decannulation was properly performed in all patients, and all had normal respiratory function. A swallowing disorder wasn’t verified in any of the patients. The results of the voice evaluation indicate that the patients have moderate vocal difficulties. The analysis of the oncological outcome shows that the five-year survival related to the disease is 100%, the five-year overall survival is 93.3%, while the five-year survival without the disease was 86.7%. Local recurrence of the disease developed in 2 patients, and regional recurrence in one. Conclusion: Frontolateral laryngectomy provides an excellent oncological outcome, and should be an alternative method of treatment in selected cases.

Karcinom grkljana čini trećinu svih karcinoma glave i vrata, te predstavlja značajan uzrok smrtnosti. Glavni čimbenici rizika za karcinom grkljana su pušenje i alkohol. Mogućnosti liječenja karcinoma grkljana su kirurški zahvati, radioterapija, kemoterapija i imunoterapija. Cilj rada je analizirati utjecaj vremena čekanja na dijagnostičke i terapijske postupke kod karcinoma grkljana. Istraživanje je provedeno retrogradnom analizom bolesnika sa karcinomom grkljana liječenih na Klinici za otorinolaringologiju i kirurgiju glave i vrata Kliničkog bolničkog centra Rijeka u razdoblju od 2011. do 2023. godine. U retrospektivno istraživanje uključeno je 169 kirurški liječenih bolesnika s karcinomom grkljana.Medijan dobi kod prvog posjeta otorinolaringologu bio je 65 godina, a od obrađenih bolesnika sa karcinomom grkljana njih 61,5% su pušači, te 11% bolesnika navodi redovitu konzumaciju alkohola. Onkološki ishod prikazan je Kaplan-Meierovim krivuljama ukupnog preživljenja i preživljenja vezanog uz bolest, a u odnosu na vrijeme čekanja od prvog simptoma, odnosno prve posjete otorinolaringologu pa do kirurškog liječenja. Utjecaj vremena čekanja do kirurškog zahvata, a od pojave prvih simptoma ili prve posjete otorinolaringologu nije se pokazao statistički značajnim na ukupno preživljenje. Kaplan-Meierove krivulje preživljenja vezane uz bolest su pokazale značaj na razini trenda ukoliko se promatra vrijeme od prvih simptoma pa do kirurškog liječenja, odnosno statističku značajnost ukoliko promatramo vrijeme od prve posjete otorinolaringologu do početka liječenja. Vrijeme čekanja od prvih simptoma bolesti kao i čekanje na dijagnostičke i terapijske postupke kod karcinoma grkljana treba uzeti kao bitne čimbenike koji utječe na onkološki ishod oboljelih., Laryngeal carcinoma represents one-third of all head and neck cancers and is a significant cause of mortality. The main risk factors for laryngeal carcinoma are smoking and alcohol consumption. The treatment options for laryngeal carcinoma include surgical procedures, radiotherapy, chemotherapy, and immunotherapy. The aim of this study is to analyze the impact of waiting time on diagnostic and therapeutic procedures for laryngeal carcinoma. The research was conducted through a retrospective analysis of patients with laryngeal carcinoma treated at the Department of Otorhinolaryngology and Head and Neck Surgery of the Clinical Hospital Center Rijeka from 2011 to 2023. The retrospective study included 169 surgically treated patients with laryngeal carcinoma. The median age at the first visit to the otorhinolaryngologist was 65 years, and among the patients with laryngeal carcinoma, 61.5% were smokers, while 11% reported regular alcohol consumption.The oncological outcome was presented through Kaplan-Meier curves of overall survival and disease-specific survival, based on the waiting time from the first symptom or the first visit to the otorhinolaryngologist to surgical treatment. The impact of waiting time until surgical intervention, from the onset of symptoms or the first visit to the otorhinolaryngologist, did not show statistical significance on overall survival. However, Kaplan-Meier curves for disease-specific survival indicated a significant trend when observing the time from the first symptoms to surgical treatment, or statistical significance when considering the time from the first visit to the otorhinolaryngologist to the start of treatment. Waiting time from the onset of symptoms and waiting for diagnostic and therapeutic procedures in laryngeal carcinoma should be considered as significant factors affecting the oncological outcome of patients.

Grkljan je specifičan dio našeg tijela zbog multifunkcionalnosti, te sudjeluje u mehanizmima disanja (respiratio), gutanja (deglutitio) i govora (fonatio). Sam mehanizam fonacije počinje u grkljanu, u kojem se i stvara osnovni larningealni ton. Stoga i ne čudi kompleksnost njegove anatomije i fiziologije. Disfonije (promuklost) su poremećaji glasa kojeg karakterizira svako odstupanje od normalnih obilježja, visine i intenziteta glasa, a mogu pobuditi sumnju na benigne ali i maligne bolesti regije te su od izuzetne važnosti u prevenciji i dijagnostici te pravovremenoj terapiji patoloških stanja grkljana. Osim toga mogu pobuditi sumnju i na neka sustavna oboljenja, hormonalne disbalanse, ali i psihogene poremećaje. Glas je dakle stoga i pokazatelj našeg fizičkog ali i psihičkog zdravlja. Osim što je naše osnovno sredstvo komunikacije, prikaz je i naših emotivnih stanja. Zaključno, glas otkriva ne samo patološka stanja grkljana, već ponekad i sustavna oboljenja, ali je i slika naše osobnosti, karaktera i naše duše., The larynx is a specific part of our body due to its multifunctionality, and it participates in the mechanisms of breathing (respiratio), swallowing (deglutitio) and speech (phonatio). The phonation mechanism itself begins in the larynx, where the basic laryngeal tone is created. Therefore, the complexity of its anatomy and physiology is not surprising. Dysphonias (hoarsenesses) are voice disorders characterized by any deviation from the normal features, pitch and intensity of the voice, and can arouse suspicion of benign as well as malignant diseases of the region and are extremely important in the prevention and diagnosis and timely therapy of pathological conditions of the larynx. In addition, they can arouse suspicion of some systemic diseases, hormonal imbalances, and psychogenic disorders. The voice is therefore also an indicator of our physical and mental health. In addition to being our basic means of communication, it is also a representation of our emotional states. In conclusion, the voice reveals not only pathological conditions of the larynx, sometimes also systemic diseases, but it is also a picture of our personality, character and our soul.

Operativni postupci štitne žlijezde smatraju se jednim od najizvođenijih, ali i najsigurnijih kirurških postupaka. Učestalost operativnih postupaka štitne žlijezde u dinamičnom je porastu. Rizik od postoperativnih komplikacija postoji zbog posebnosti u anatomiji i fiziologiji štitne žlijezde. Komplikacije se dijele na minor i major. Svrha rada je definirati i okarakterizirati te nadalje statistički obraditi učestalost komplikacija operacije štitne žlijezde kod bolesnika podvrgnutih operaciji na Klinici za otorinolaringologiju i kirurgiju glave i vrata KBC Rijeka. Istraživanje je provedeno retrogradnom analizom podataka bolesnika podvrgnutih operacijskom postupku štitne žlijezde u razdoblju od 17. studenog 2014. do 13. srpnja 2020. godine. U navedenom razdoblju analizirana je medicinska dokumentacija 270 bolesnika, od čega je 84,4% bilo ženskog, a ostalo muškog spola. Totalna tireoidektomija učinjena je u 50,4% bolesnika, a lobektomija u preostalih 49,6% slučajeva. Većina bolesnika, odnosno njih 79,3% bili su podvrgnuti operativnom postupku zbog benignog stanja štitne žlijezde, dok je kod 20,7% bolesnika uočen malignitet. Incidencija unilateralne pareze glasnice iznosila je 11,5%, dok trajnu bilježimo u 1,9% bolesnika. Veći dio bolesnika koji je razvio unilateralnu parezu glasnica bio je podvrgnut totalnoj tireoidektomiji. Bilateralna pareza glasnice javila se u 5,1% slučajeva podvrgnutih totalnoj tireoidektomiji. Pojavnost postoperativnog krvarenja iznosila je 1,1%. Hipokalcijemiju je razvilo 14, 8% bolesnika, od čega ih je većina imala prolaznu hipokalcijemiju. Trajnu hipokalcijemiju smo registrirali u 4,4% slučajeva. Ovakve studije su koristan alat u evaluacija postojećeg stanja, potpomažu poboljšanju zdravstvene usluge i kvalitete života oboljelih., Thyroid surgery is considered to be one of the most performed, but also the safest surgical procedures. The frequency of thyroid surgeries is on the rise. The risk of postoperative complications exists due to peculiarities in the anatomy and physiology of the thyroid gland. Complications are divided into minor and major. The purpose of this paper is to define and characterize and further statistically process the frequency of complications of thyroid surgery in patients undergoing surgery at the Clinic for Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Rijeka. The study was conducted by retrograde analysis of data from patients undergoing thyroid surgery in the period from November 17, 2014 to July 13, 2020. In the mentioned period, the medical documentation of 270 patients was analyzed, of which 84.4% were female and the rest were male. Total thyroidectomy was performed in 50.4% of patients and lobectomy in the remaining 49.6% of cases. The majority of patients (79.3%) underwent surgery due to a benign condition of the thyroid gland, while malignancy was observed in 20.7% of cases. The incidence of unilateral paresis of the vocal cords was 11.5%, while permanent was recorded in 1.9% of patients. The majority of patients who developed unilateral vocal paresis underwent total thyroidectomy. Bilateral paresis of the vocal cords occurred in 5.1% of cases undergoing total thyroidectomy. The incidence of postoperative bleeding was 1.1%. Hypocalcemia was developed in 14.8% of patients, most of whom had transient hypocalcemia. Persistent hypocalcemia was registered in 4.4% of cases. Studies like this one, are a useful tool in the evaluation of the existing situation, help to improve health services and the quality of life of patients.

AR je rasprostranjena bolest koja zahvaća sve dobne skupine te simptomi koji su loše kontrolirani mogu dovesti do nekvalitetnog sna, umora u dnevnom kognitivnom funkcioniranju što dovodi do dugoroĉno smanjene produktivnosti odnosno smanjenoj kvaliteti ţivota. Lijeĉenje AR inhalacionom terapijom poboljšava dnevnu produktivnost i općenito kvalitetu ţivota. Lijekovi se primjenjuju lokalno te djeluju toĉno tamo gdje su potrebni i zaustavljaju razvoj drugi srodnih procesa akutni sinusitis, upale uha ,bronhitis., AR is a widespread disease that affects all age groups and symptoms that are poorly controlled can lead to poor sleep, fatigue in daily cognitive functioning, which leads to long-term reduced productivity and reduced quality of life. Treatment with AR inhalation therapy improves daily productivity and overall quality of life. The drugs are applied topically and act exactly where they are needed and stop the development of other related processes acute sinusitis, ear infections, bronchitis.

Cilj istraživanja: Cilj ovog rada bio je istražiti utjecaj mikroklime odnosno mikroklimatskih faktora na ishod kronične sekretorne upale uha u djece i istražiti ima li mikroklima utjecaj na ishod kronične sekretorne upale uha pri različitim kirurškim metoda liječenja. Ispitanici i metode: U ovo istraživanje uključeno je 71 dijete s jednostranom ili obostranom kroničnom sekretornom upalom uha tako da je u ovom istraživanju ukupno obrađeno 130 ušiju. Uši su raspoređene u dvije mikroklimatske grupe pomoću mikroklimatskih faktora koji prevladavaju na području mjesta stanovanja te djece. Uspoređivan je ishod kronične sekretorne upale uha s obzirom na mikroklimatsku grupu. Ishod je analiziran pomoću tonalne audiometrije, prisutnosti sekreta te prisutnosti kliničkih sekvela: stupanj retrakcije pars flaccidae, miringoskleroza, uvučenje bubnjića s rotacijom maleusa te ožiljci i perforacija bubnjića. Rezultati: Usporedbom ishoda kronične sekretorne upale srednjeg uha u djece s obzirom na zadane mikroklimatske faktore nisu dobivene statistički značajne razlike. Isto tako nisu dobivene statistički značajne razlike u ishodu liječenja odabranom kirurškom metodom između mikroklimatskih grupa. Zaključak: Ovo istraživanje nam ukazuje da nema značajnijih razlika u ishodu kronične sekretorne upale uha između uspoređivanih mikroklima i da u uspoređivanim mikroklimama nema razlike u ishodu kod različitih metoda liječenja., Objectives: The aim of this study was to investigate the influence of microclimate on the outcome of chronic secretory otitis media in children and to investigate whether microclimate has an impact on the outcome of chronic secretory otitis media in different surgical treatment methods. Patients and methods: 71 children with unilateral or bilateral chronic secretory otitis media were included in this study, so that a total of 130 ears were treated in this study. Ears were divided into two microclimatic groups using microclimatic factors that predominate in the area of residence of these children. The outcome of chronic secretory otitis media was compared with respect to the microclimatic group. The outcome was analyzed using tonal audiometry, the presence of effusion, and the presence of clinical sequelae: degree of pars flaccida retraction, myringosclerosis, retraction of the eardrum with malleus rotation, and scarring and perforation of the eardrum. Results: By comparing the outcome of chronic secretory otitis media in children with respect to given microclimatic factors, no statistically significant differences were obtained. Also, no statistically significant differences in the outcome of treatment by the selected surgical method between microclimatic groups were obtained. Conclusion: This study indicates that there are no significant differences in the outcome of chronic secretory otitis media between the compared microclimates and that in the compared microclimates there is no difference in the outcome with different treatment methods.

Grkljan je organ koji je u našem organizmu smješten na granici respiratornog i digestivnog trakta. Iz tog razloga na njega imaju utjecaj kako inhalatorni agensi tako i alimentarni agensi. Zbog ovakvog smještaja, nije rijetkost da se bolesti koje zahvate primarno grkljan pojavljuju i na susjednim organima poput traheje, pluća, jednjaka i jezika. Kada govorimo o karcinomima, najčešće neoplazme grkljana su skvamozni karcinomi koji nastaju iz displastično promijenjenog epitela. Do displazije dolazi zbog ponavljanog djelovanja nekog kancerogena na samu sluznicu grkljana ali i okolnih organa. Na taj se način stvara tzv. polje kancerizacije u kojemu epitel s vremenom postaje displastično promijenjen. S obzirom da kancerogeni poput alkohola ili duhanskog dima ne djeluje samo na sluznicu grkljana već i na sluznicu svih organa s kojima dolaze u kontakt, nije čudno da je kod pojave laringealnih karcinoma česta pojava sinhronih i metahronih tumora koje smo nazvali sekundarne primarne neoplazme. Ekspresija markera koji su uključeni u onkogenezu kao što su P53, mEGFR i nEGFR, ciklin D1, TGF-α i Ki-67, mogla bi biti potencijalni indikator mogućnosti razvoja sekundarnih primarnih neoplazmi kod pacijenata s primarnim karcinomom grkljana. Svakako je potrebno naglasiti pacijentu važnost redovitih onkoloških kontrola s ciljem pravovremenog otkrivanja eventualnih sekundarnih primarnih tumora pogotovo u visoko-rizičnih pacijenata., Larynx is an organ located at the intersection of the respiratory and digestive systems. Consequently, it is influenced by both inhalatory and alimentary agents. The same noxae, can affect the surrounding organs ie. trachea, lungs, esophagus and tongue. When cancerology is concerned, the most common laryngeal neoplasms are squamous cell carcinomas that arise from dysplastically altered epithelium. Dysplasia occurs due to the continuous carcinogenic effects on the mucous membrane of the larynx and the surrounding organs. In this way, the so-called field of cancerization is made. In this area the epithelium becomes altered over time. Given that carcinogens such as alcohol or tobacco smoke affect not only the laryngeal mucosa but also the mucosa of all organs they come in contact with, onset of synchronous and metachronous tumors, which we call secondary primary neoplasms, is becoming quite common in patients with primary Larynx is an organ located at the intersection of the respiratory and digestive systems. Consequently, it is influenced by both inhalatory and alimentary agents. The same noxae, can affect the surrounding organs ie. trachea, lungs, esophagus and tongue. When cancerology is concerned, the most common laryngeal neoplasms are squamous cell carcinomas that arise from dysplastically altered epithelium. Dysplasia occurs due to the continuous carcinogenic effects on the mucous membrane of the larynx and the surrounding organs. In this way, the so-called field of cancerization is made. In this area the epithelium becomes altered over time. Given that carcinogens such as alcohol or tobacco smoke affect not only the laryngeal mucosa but also the mucosa of all organs they come in contact with, onset of synchronous and metachronous tumors, which we call secondary primary neoplasms, is becoming quite common in patients with primary laringeal cancers. Expression of oncogenic markers such as P53, mEGFR and nEGFR, cyclin D1, TGF-α and Ki-67, could be very important in the development of secondary primary neoplasms in primary laryngeal cancer. Moreover it is crucial for patients to be aware of the importance of regular oncologic follow ups whose goal is early discovery secondary primary neoplasms in high-risk patients.. Expression of oncogenic markers such as P53, mEGFR and nEGFR, cyclin D1, TGF-α and Ki-67, could be very important in the development of secondary primary neoplasms in primary laryngeal cancer. Moreover it is crucial for patients to be aware of the importance of regular oncologic follow ups whose goal is early discovery secondary primary neoplasms in high-risk patients.

Od prvog spominjanja riječi robot do pojave prvih robotskih sustav u medicini prošlo je skoro 100 godina. Robotski sustav da Vinci jedan od pionira ove tehnologije danas je najkorišteniji robotski sustav. Uz podosta nedostataka robotski sustavi i dalje pokazuju bolje rezultate od klasičnih zahvata. Osim unaprjeđenja postojećih robotskih sustava, razvojem novih tehnologija stvaraju se inovacije koje pokušavaju biti implementirane. Uz puno tehničkih inovacija robotskih sustava nemoguće je zanemariti ubrzano napredovanje umjetne inteligencije. Razvojem umjetne inteligencije omogućit će se bolji rezultati liječenja. Zahvaljujući brzom razvoju ove tehnologije broj novih robotskih sustava svakodnevno raste. Jedan od primjera je RONNA G3, robotski sustav korišten prilikom stereotaktičke biopsije mozga. Ovaj diplomski rad je pregledom literature prikazao uvid o robotskim sustavima u biomedicinskom području, te prikazao neke od najznačajnijih za ovo područje. Uz njihove prednosti i nedostatke u endoskopskim zahvatima, prikazane su tehnološke inovacije. Istaknuta je važnost primjene novih tehnologija u budućnosti i prikazana trenutna primjena robotskih sustava u Republici Hrvatskoj, From the first mention of the word robot almost 100 years passed before the first robotic system in medicine was developed. The Robotic System da Vinci one of the pioneers of this technology is today the most used robotic system. Despite the disadvantages of the robotics systems, they still show better results than the classic procedures. In addition to enhancing existing robotic systems, the development of new technologies creates innovations that are trying to be implemented. With a lot of technical innovations in robotic systems, it is impossible to ignore the accelerated advancement of artificial intelligence. By developing artificial intelligence, better treatment results will be provided. Thanks to the rapid development of this technology, the number of new robot systems is increasing every day. One example is RONNA G3, a robotic system used in stereotactic biopsies of the brain. This research paper presented an insight into robotics systems in the biomedical field and presented some of the most important in this area. In addition to their advantages and disadvantages in endoscopic procedures, technological innovations are presented. The importance of applying new technologies in the future and highlighting the current application of robotic systems in the Republic of Croatia was emphasized.