Browsing by Author "Baletić, Nenad (24398182100)"

Background/Aim. A short-term high-intensity noise from a gunshot impulse that occurs when using infantry weapon, can result in onset of auditory symptoms such as tinnitus, impaired hearing or feeling of pressure in one or both ears. The aim of this study was to examine the effect of live ammunition shooting from an automatic rifle on the hearing sense in professional military personnel. The examination was done in correlation with the conditions of the common shooting practice procedure. Methods. The research has been conducted on 22 professional soldiers serving in the Serbian Military, during their regular peacetime training shooting from the automatic rifle AP 7.62 mm M70. The training was conducted on the formational shooting field “Bubanj Potok”. The written consent from all subjects was acquired. All subjects were submitted to medical examination prior and after the shooting session. The medical examination consisted of anamnesis, clinical otorhinolaryngological examination, audiometry and impedancemetry. All subjects filled out the following questionnaire forms: “The Questionnaire prior to shooting” and “The questionnaire after shooting.” Subjects who were incapable to undergo shooting practice, whether from psychological or physical reasons were excluded from this study. Results. After the assessment of received data from 22 subjects, the results were as followed: in 2 (9%) subjects hearing impairment was diagnosed. Tinnitus was registered in 5 (22.7%) patients. One (4.5%) patient reported the feeling of pressure in one ear. One of two cases of one ear hearing impairment was on the rifle holding side and second case was on opposite lateral side. In both cases, hearing loss was of sensorineural type of milder degree, with a scotoma at 4,000 Hz in one case up to 50 dB and the second up to 55 dB. Conclusion. Auditory effects of impulse noise that occurs when shooting from automatic rifles cause hearing impairment, tinnitus and a feeling of pressure in the ears. The practical significance of this study lies in prevention which includes the mandatory use of personal protective equipment and functional arrangement of the practice shooting field. © 2018, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim. Impulse oscillometry (IOS) is a method for estimating lung function which is used for early detection of bronchial hyperresponsiveness (BHR) and asthma. The aim of the study was to determine the prevalence of BHR, the correlation between spirometry and IOS and sensitivity and specificity of IOS in proving BHR in patients with persistent allergic rhinitis. Methods. The study included 81 patients with allergic rhinitis. From all of them, medical history was taken, allergy testing was done, as well as measurements of parameters of lung function by the IOS and spirometry before and after nonspecific bronchial provocation test with histamin via Aerosol provocative system. Changes of the IOS parameters to fall in FEV1 of 20% were measured and compared with changes in the spirometry parameters. After bronchial challenge test subjects were divided into two groups: the group with BHR (group 1) and that without BHR (group 2). Results. The mean age of participants was 25.7 ± 5.7 years, and 50.5% were men. Out of the total number of subjects with allergy rhinitis, 56 (58.9%) had a positive BPT. After bronchoprovocation an average increase in the group 1 was 88.15% for Rrs5, 111.98% for Fres, and for AX 819.69%. The high degree of correlation between the IOS and spirometry was proven in the group 2, while the whole group 1 had a weak correlation between parameters of these two methods. High sensitivity and low specificity for Rrs5 and Fres compared to FEV1 in diagnosing BHR was proven. Conclusion. The study demonstrated a high prevalence of BHR in the study group of patients with persistent allergic rhinitis, poor correlation in relation to the spirometric measurements in the group with BHR and a high sensitivity and low specificity of IOS for the detection of early changes in the airways. © 2018, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Background/Aim. Attic cholesteatoma is an epithelial cystic pseudotumor which arises in the top compartment of the middle ear. Surgery is the only therapeutic treatment for attic cholesteatoma. The aim of this study was to analyze the surgical and audiological results in tympanoplasties that use a logical application of several techniques for the management of attic cholesteatoma. Our hypothesis was that the tympanoplasty technique with cartilage/bone reconstruction of the achieve better outcome than the tympanoplasty technique with only temporal fascia reconstruction of the lateral attic wall. Methods. This retrospective clinical study included 80 patients, aged 16–65 years, with attic cholesteatoma undergoing canal “wall up” tympanoplasty with lateral attic wall reconstruction, under general anesthesia in the Eear, Nose and Throat Clinic, Military Medical Academy in Belgrade between 2006 and 2010. The patients were divided into two groups according to the type of lateral attic wall reconstruction: the group I of 60 patients with cartilage/bone plus temporalis fascia lateral attic wall reconstruction and the group II of 20 patients with only temporal fascia lateral attic wall reconstruction. Postoperative follow-up examinations were done at least 5 years after the surgery. The χ2 test was used to compare postoperative sequelae for two groups of operated patients with lateral attic wall reconstruction. The independent and paired samples t-test of air conduction and air-bone gap were used to compare the results of preoperative and postoperative hearing tests. Results. The differences between hearing measurements of the two groups according to preoperative and postoperative auditory thresholds of the air conduction and the air-bone gap were considered no statistically significant. The difference between the two groups recarding to recurrent attic retraction pocket appearance and recurrence of cholesteatoma was considered statistically significant and the results were much better in the group I of the operated patients with cartilage/ bone lateral attic wall reconstruction. Conclusion. “Wall up” tympanoplasty for attic cholesteatoma with lateral attic wall reconstruction leads to good anatomical and audiological results. A significant hearing improvement was obtained in both the types of lateral attic wall reconstructions in this study. Reconstruction with cartilage or mastoid cortex bone showed favorably long-term functional and anatomical results compared to primary tympanoplasty using only temporal fascia for lateral attic wall reconstruction in cases of attic cholesteatoma. © 2017, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Surgical site infection (SSI) is a significant factor of morbidity and mortality in patients surgically treated for laryngeal carcinoma. The aim of this prospective study in 277 patients was to determine the incidence of SSI in patients surgically treated for laryngeal squamous cell carcinoma and to identify risk factors for development of SSI. Patients with previous chemotherapy and/or radiotherapy were excluded. All patients had tracheostomy postoperatively and received antibiotic prophylaxis with cephalosporin, aminoglycoside and metronidazole. The overall incidence of SSIs in our cohort was 6.5% (18 patients): 4 (22.22%) patients with superficial infections, 11 (61.11%) with deep infections and 3 (16.66%) with organ-space infections. The remaining infections included pneumonia (1 case) and Clostridium difficile colitis (2 cases). The median hospital stay in patients having developed SSIs was longer than in those without SSIs (33.5 vs. 16 days, p<0.001). By using univariate analysis American Society of Anesthesiologists score ≥3, duration of surgery longer than 120 minutes and National Nosocomial Infections Surveillance risk index ≥1 were found to be significantly associated with the occurrence of SSI. Age, sex, body mass index, history of smoking, underlying diabetes and preoperative length of stay were found not to be associated with SSI. The most frequently isolated microorganism was Klebsiella spp.

Background/Aim. Hyperreactivity of the airways caused by inflammation in asthmatics is the most important pathophysiological change. It represents a suitable ground that in the presence of risk factors and the drivers of asthma, asthmatic attack occurs. Atopic constitution is one of the most important risk factors for the development and expression of asthma. The aim of our study was to investigate the relationship between nonspecific airway hyperreactivity and atopic constituton in asthmatics. Methods. This retrospective analysis was conducted considering the results of nonspecific bronchoprovocative test with histamine, skin tests to inhalant allergens and total IgE levels in the serum of asthmatic patients with controlled bronchial asthma. The sample consisted of 162 asthmatics examined during one-year period. Results. The examinees were male asthmatic patients, aged between 18 and 30 years. We found that the examinees with a pronounced non-specific hyperreactivity had more significant skin reaction to inhaled allergens and higher levels of total IgE in serum. Conclusion. The results of our study show that the intensity of airway hyperresponsiveness to histamine in asthmatics is directly related to atopic constitution. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Background/Aim. Sudden sensorineural hearing loss is manifested by the loss of hearing for more than 30 dB at three consecutive frequencies in the timeframe of 72 h. It is of unclear etiology and pathogenesis, which leads to the use of different therapeutic methods. Treatment protocols are not compliant, making it difficult to objectively quantify their impact. The aim of this study was to show the effect of hyperbaric oxygen therapy as the only method for the treatment of sudden sensorineural hearing loss. Methods. This retrospective study included 20 patients treated for sudden sensorineural hearing loss with hyperbaric oxygenation (HBO) in the period from 2004 to 2014. The study was conducted in the specialized medical clinic for hyperbaric and underwater medicine, HBO Medical Center in Belgrade. The patients were treated according to the following protocol: a session of 60 min at the pressure of 2 bars (2ATA) two times a day, a total of 30 sessions. Assessment of the therapy effects was performed by observing the change in the hearing threshold at the frequencies of 500, 1,000, 2,000 and 4,000 Hz at the end of the treatment. Results. After the completion of treatment according to the protocol, a full hearing recovery (total improvement of hearing damage or achieving final hearing threshold above 25 dB) was found in 11 (55%) of the patients. A partial recovery (hearing improvement of up to 15 dB, and a final hearing threshold below 45 dB) occurred in 4 (20%) of the patients. In 5 (25%) of the patients, improvement was not verified (there was no recovery or it was less than 5 dB). The average absolute hearing recovery was 24.94 dB. The mean relative hearing recovery was 65.45%. Conclusion. Because of the unclear multifactorial etiopathogenesis of this disease, there are many therapeutic protocols. Based on the results of our study HBO therapy could be recommended primarily as the treatment for sudden sensorineural hearing loss. © Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.