Abstracts

Abstract title:
“WAIT AND SCAN” METHOD IN PATIENTS WITH VESTIBULAR SCHWANNOMA: A CASE REPORT AND REVIEW OF THE LITERATURE

Authors and co-authors names:
Domas Turčinas, Aistė Paškonienė MD

Authors and co-authors institutions, country:
Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Keywords:
Vestibular schwannoma, conservative treatment, tumor

Abstract text:
Introduction: Vestibular schwannomas are the third most common intracranial benign neoplasms stemming from myelin-forming Schwann cells, that are found on the VIIIth cranial nerve. The incidence rate is 3 cases per 100000 per year, with women being the more frequently affected sex. Ionizing radiation and leisure noise are well-known risk factors. MRI scanning is considered crucial to monitoring the growth of vestibular schwannoma. Conservative management of the tumor proposes a better life quality compared to actively treated patients. We report a female patient with a vestibular schwannoma, who is observed with the “Wait and scan” method. Case presentation: A 39-year-old female patient was referred to the Ear, Nose, Throat and Eye Clinic for congestion and tinnitus of the left ear, which were present for four months. As the symptoms progressed, after two years an MRI was performed and the diagnosis of a vestibular schwannoma on the left was established. After careful consideration, the „Wait and Scan“ method was chosen. No significant negative dynamics were observed during a follow-up. Conclusion: In this case report we present a female patient with a vestibular schwannoma, who was monitored with the “Wait and Scan” method. Vestibular schwannomas are slow-growing tumors that may be conservatively managed until 20mm, afterward even with the possibility to shrink. We suggest, that the “Wait and Scan” method is a beneficial way to maintain a higher quality of life in patients with a vestibular schwannoma.

Abstract title:
Acoustic analysis of the voice of patients with vocal cord nodules

Authors and co-authors names:
Alieva M. (1), Nadjimutdinova N. (2), Inoyatova F. (3), Abdukayumov A. (4)

Authors and co-authors institutions, country:
1-department ENT, The Republican Specialized Scientific and Practical Medical Center of Pediatrics. Uzbekistan, Tashkent 2- department ENT, The Republican Specialized Scientific and Practical Medical Center of Pediatrics. Uzbekistan, Tashkent 3- scientific head of department ENT, The Republican Specialized Scientific and Practical Medical Center of Pediatrics. Uzbekistan, Tashkent 4 - head physician The Republican Specialized Scientific and Practical Medical Center of Pediatrics. Uzbekistan, Tashkent

Keywords:
voice, acoustic analyses, computer spectral analysis

Abstract text:
Voice assessment in diseases of the vocal apparatus has important clinical implications for determining treatment management. Speech recognition technology is used in various areas of human activity: mobile devices, telephony, household appliances and robots, desktops and laptops, cars, social services for people with disabilities. At the present stage, this technology is based on computer spectral analysis of the voice (acoustic voice analysis - AAV), which can also be used in assessing the function of the vocal cords in patients with dysphonia. The purpose of the study was to study the qualitative and quantitative characteristics of the acoustic parameters of the voice in patients with vocal cord nodules. Research: a study was performed in children aged 5-7 years with nodules of the vocal cords - 36 children; the average age was 5.2±0.6 years. Control - 20 children of the appropriate age with a normal voice without pathology of the ENT organs. The acoustic characterization of the voice was carried out on the basis of spectral acoustic analysis in a soundproof cabinet. The voice was recorded by a microphone with a built-in noise level meter (no more than 40 dB). The recording was carried out on a computer with audio signals of the wav format with a sampling frequency of 44100 Hz and mono type in the software environment for recording audio data "Audacity". The calculation of the acoustic parameters and their statistical analysis was carried out in a specially developed spectral program. The following 5 indicators of the acoustic parameters of the voice were analyzed: Energy of discrete signals, Entropy, Maximum signal value, Minimum signal value, Zero points number. Results: The characteristic of the energy indicator (the power expended on voice production) both before and after treatment is quite high, which indicates that the power expended during UGS is significantly higher than necessary for voice production, above the standard from 5.5 to 7.5 times. In our study, the entropy index (an indicator of unhelpful noises) before treatment was above the standard, after treatment the index was below entropy, which means an improvement in the individual vocal characteristics of the voice. However, the minimum and maximum values of the signal significantly exceed those of the standard, which indicates an increase in the work of the ligaments for producing voice. The Zero score after treatment improved compared to the score before treatment, but did not reach the benchmark. The lower the indicator, the more proportional the movements of the ligaments, the more synchronous their vibrations. Even after treatment, this indicator is almost 3 times higher than the standard. Discussion. The results of an acoustic analysis of the voice with nodules of the vocal cords showed that in this case, the pathology is not associated with physical changes in the mucosa, since the entropy indicator returned to normal and approached the ideal. There are other factors such as an increase in the load on the vocal apparatus - which, both before and after treatment remained quite high (energy) and the factor of asynchrony of ligament vibrations was also associated with psychophysical instability. This indicates that the use of the tactics of only removing the pathological substrate - nodules will not lead to an improvement in the voice, measures are needed that have an effect on the mental and physiological state of the vocal apparatus - fonopedic and neurological effects. Conclusion. Most of the parameters used to characterize the voice can be consciously changed by a person - the volume, pitch and other parameters of the voice, even the frequency of the fundamental tone can vary widely, having only maximum and minimum values. However, all these indicators are subjective. Indicators of the acoustic characteristics of the voice are objective characteristics, while their use in diagnosis will affect the choice of treatment.

Abstract title:
ANALYSIS OF THE POSTOPERATIVE DYNAMICS OF THE WELL-BEING OF PATIENTS OVER A 30 DAYS PERIOD AFTER TONSILLECTOMY

Authors and co-authors names:
MD PhD Alina Kuzminiene (1), Kamile Macyte (1)

Authors and co-authors institutions, country:
1 - The Department of ENT of the Kauno klinikos of Hospital of the Lithuanian University of Health Sciences, Kaunas, Lithuania

Keywords:
Tonsillectomy; Postoperative period; Dynamics of the well-being

Abstract text:
The aim of this research was to evaluate the changes in patients’ well-being on a daily basis for the first 30 days after tonsillectomy. Tasks: 1. To analyse the most frequent complaints of patients and complications in the postoperative period of tonsillectomy. 2. To document and analyze the daily self-assessment of patients or daily assessment made by parents of patients who underwent tonsillectomy at the ENT department of Kaunas Clinic of LUHS for 30 days after surgery, noting the presence and/or intensity of symptoms in questionnaires. 3. Compare the group data obtained with each other. 4. Based on the data obtained, prepare methodological material/memo for patients or their parents about possible changes in well-being in the postoperative period of tonsillectomy. Methodology. Patients' self-assessments were documented and analyzed on a daily basis for 30 days after tonsillectomy with particular attention paid to the presence and intensity of symptoms noted on a questionnaire. Pain was evaluated using the Analog Pain Scale, while other factors such as swallowing, eating, speaking, sleep disorders, unpleasant breathing and discomfort were assessed using the Stapel scale. Results. All subjects (n=52) experienced sore throats, which increased over a period of 5-6 days, with an average pain score of 6 points. The most unsettling symptom was pain radiating from the throat to the ears with assessment as mild or moderate and the greatest anxiety occurred in the first week after surgery. Sleep quality decreased for 43 patients (83%) in the first 7 days after surgery (on average 5 points). The study found that more intense pain was associated with a higher score of sleep disorders (p<0.05, r=0.31). Of the 52 subjects, 45 patients (87%) experienced an unpleasant odor from the mouth, while 41 patients (79%) reported difficulty swallowing. Dry cough occurred in 19 cases (37% of patients) and these symptoms improved over time. Speech problems after tonsillectomy were rare and were observed in 4 patients (8%). Conclusions. The most common complaints reported by patients in the postoperative period after tonsillectomy are sore throat, ear pain, swallowing and eating difficulties, bad breath and sleep disturbances. The most severe symptoms typically occurred during the first 10 days after surgery and usually lasted for 20 to 21 days. There were no significant differences observed in terms of age or gender.

Abstract title:
Anthropological and Airflow Measurements for Voice Range Assessment of Professional Singers

Authors and co-authors names:
Dins Sumerags (1), Mara Pilmane (2), Gunta Sumeraga (3)

Authors and co-authors institutions, country:
1 - Cesu Klinika Hospital, Slimnicas Street 9, Cesis, Latvia LV-4101; 2- Department of Morphology, Institute of Anatomy and Anthropology, Riga Stradins University, Dzirciema street 16, Riga, Latvia LV-1007; 3 -Department of Otorhinolaryngology, Riga Stradiņš University, Dzirciema street 16, Riga, Latvia LV-1007

Keywords:
voice categories, anthropological measurements, airflow tests

Abstract text:
The study aimed to develop a methodology for determining the voice type of singers before the start of vocal studies by using spirograph measurements of the volume of the peak expiratory flow and Ximatron CX simulator for airways measurements. of representatives of various voice categories. The Ethical Committee of Riga Stradins University approved the research. Sixty professional singers participated in the study, including 10 sopranos, 10 mezzo-sopranos, 10 altos, 10 tenors, 10 baritones, and 10 basses, with ages ranging from 19 to 77 years. The study measured various parameters such as height, weight, the lungs' vital capacity, and the airflow volume per second in the big, middle, and small bronchial tubes. Based on the data provided, there are significant differences in various physiological measurements between different voice categories. For example, the average vital capacity of the lungs, peak expiratory flow per second, and volume of airflow per second in the big bronchial tubes are all higher for baritones and basses compared to other voice categories. The data were analyzed using descriptive statistics, one-factor disperse analysis (ANOVA), and linear and nonlinear regression methods. The results showed significant differences between in terms of body height, weight, the vital capacity of the lungs, volume of the airflow per second in the bronchial tubes, and the length, diameter, and area of the larynx. Similarly, the length, diameter, and volume of the larynx are also bigger for baritones and basses than other voice categories. The study provides a foundation for developing a methodology for determining the voice type of singers before the start of vocal studies.

Abstract title:
Asghar memarzadeh

Authors and co-authors names:
Farinaz sirafiyan

Authors and co-authors institutions, country:
Pars clinc-mehreganhospital esfahan iran

Keywords:
Over projection good projection

Abstract text:
Correction of over projected nose(magic nose)The people named the long nose and big depth of dorsum and hyper projection said magic noseMany surgeon creat magic noseMany surgeon remove big hump and suture the dome highest the supratip and help to this category because when the surgeon used ids and tds he length the llc the ids change the circle to strait and long llc and usage of long strat and suture in new dome help to create magic noseEtiology1- Change the circle to strait line and circle to triangle2-use of long strut and seg3-remove big humpMethod of treatment1-alar base resection2-graft in dorsum3-surgery in LLCI explain more information in videoAsghar memarzadeh MD Sent from my iPhone

Abstract title:
Association of E2F1 rs3213183, rs3213180, E2F2 rs2075993 and rs3820028 single gene polymorphisms in laryngeal squamous cell carcinoma carcinogenesis

Authors and co-authors names:
Jakstas Tomas, Ulozas Virgilijus, Ugenskiene Rasa, Bartnykaite Agne

Authors and co-authors institutions, country:
1. Department of Otorhinolaryngology, Lithuanian University of Health science, Kaunas, Lithuania 2. Department of Otorhinolaryngology, Lithuanian University of Health science, Kaunas. 3. Lithuanian University of health science, Faculty of medicine, Department of Genetics and molecular medicine. 4. Lithuanian university of Health science, Faculty of medicine, Institute of oncology, Laboratory for oncology science.

Keywords:
Single nucleotide polymorphism, larynx, cancer, genetics.

Abstract text:
Laryngeal squamous cell carcinoma (LSCC) is one of the most common types of cancer that affects the upper part of the respiratory system. LSCC often has a high mortality rate and a poor prognosis for patients. In 2020, 184615 new cases ofLSCC were diagnosed, and 99840 patients died from this cancer worldwide. Although tobacco and alcohol consumption are of great significance in LSCC carcinogenesis, only a small part of smokers and drinkers are diagnosed with LSCC. This finding suggests that there are genetic factors involved in LSCC development. This is the reason for an increased attention on identifying genetic factors in order to create new diagnostic methods and treatments for LSCC. Several studies have demonstrated importance of gene variants that play role in the development and prognosis of LSCC. The purpose of this research was to investigate the connection between four SNPs in the genes E2F1 (rs3213183 andrs3213180) and E2F2 (rs2075993 and rs3820028) and their association with the risk of LSCC development and its clinical and morphological manifestation. A group of 200 men that were diagnosed with LSCC at the department of Otorhinolaryngology were selected for this study. Information about TNM grading and both tumor stage and tumor differentiation grade were collected. The reference group consisted of 200 men that were recruited in the outpatient clinic that had no previous records or suspicion of any location cancer. Data is being analyzes and will be provided during conference.  

Abstract title:
Audiologic impairment in Systemic Vasculitis

Authors and co-authors names:
Vija Vainutienė (1,2), Justinas Ivaška (1,2,3), Jolanta Dadonienė (4), Tatjana Ivaškienė (1) , Eugenijus Lesinskas (2,3).

Authors and co-authors institutions, country:
1- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania. 2- Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania. 3- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 4- Centre of Rheumatology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania

Keywords:
systemic vasculitis, hearing loss, audiometry.

Abstract text:
Background and aim. Systemic vasculitis is a heterogeneous group of autoimmune diseases with various etiologies and clinical manifestations. The prevalence and nature of hearing impairment in systemic vasculitis population is still uncertain. Audiovestibular dysfunction in systemic vasculitis diseases may have different clinical presentations. The aim of the present study was to evaluate hearing function in patients with systemic vasculitis. Method. A total of 56 individuals participated in the study. The age ranged from 18 to 65 years old, the participants from both groups matched for age and sex. The participants underwent a complete audiological evaluation with otoscopy, impedance audiomety, pure tone audiometry, speech audiometry – evaluation of speech tresholds and speech recognotion in quite. Both ears were tested. All of the participants of the study were native Lithuanian speakers. Data were statistically analysed using Statistical Analysis System software SAS® Studio 9, 4. P value < 0.05 was regarded as statistically significant Results. 65,4 % patients from Systemic vasculitis group reported hearing – related symptoms: hearing loss, tinnitus, ear fullness. There was a significant difference in hearing thresholds between the groups. The average oh hearing thresholds of both ears at 500-2000 Hz and high frequency range of patients with systemic vasculitis were significantly higher than in healthy individuals. The statistically significant difference was noted for both speech detection threshols and speech recognition threshold values between two groups. Conclusions. The frequency of hearing loss and the average hearing thresholds in systemic vasculitis patients were higher than in healthy individuals. The most common type of hearing loss was sensorineural. Speech thresholds were observed to be higher in the group of systemic vasculitis. Audiological assessment should be considered in routine evaluation of patients with systemic vasculitis diseases to prevent hearing related handicap.

Abstract title:
Benign parapharyngeal space tumors

Authors and co-authors names:
Vykintas Liutkevičius1, Nora Ulozaitė-Stanienė1, Marius Kašėta2, Gintarė Čiburaitė3

Authors and co-authors institutions, country:
1-Department of Otorhinolaryngology, Lithuanian University of Health Sciences 2-Fi Clinica, Lithuania 3-Marijampole Hospital, Lithuania

Keywords:
Parapharyngeal space, benign tumor, surgery.

Abstract text:
The parapharyngeal space (PPS) is an anatomically complex area, commonly described as an inverted pyramide where the temporal bone is regarded as the base and the hyoid – the apex. PPS tumors are rare, usually benign and their diagnosis, treatment – challenging. They can be managed with surgical treatment or observation. The authors present the investigation, surgical treatment and outcomes of 3 cases of benign PPS tumors.

Abstract title:
Bilateral vocal fold palsy management

Authors and co-authors names:
Arnoldas Morozas (1), Marius Polianskis (1)

Authors and co-authors institutions, country:
Department of ENT, Vilnius University Hospital Santaros clinics - 1

Keywords:
Bilateral vocal cord palsy, treatment, management

Abstract text:
Bilateral vocal fold palsy (BVFP) refers to the paralysis or immobility of both vocal folds due to bilateral nerve injuries, specifically the bilateral recurrent laryngeal nerves (RLN) or vagus nerves. BVFP can lead to airway obstruction and significant morbidity The primary objective in managing BVFP is to address the narrowing of the airway caused by the paramedian position of both vocal folds, which results in inspiratory dyspnea . Various treatment options have been explored, with glottic widening surgery being a common approach. GWS procedures aim to widen the glottic space to alleviate airway obstruction . The outcomes of different GWS procedures should be safe decannulation of tracheostomy. But it is not always possible to dot because of other conditions like aspiration or dysphagia. Additionally, the management of BVFP involves considering the underlying etiology. BVFP can occur secondary to bilateral nerve injuries, such as in cases of trauma or iatrogenic injury during surgery . The specific cause of BVFP should be identified to guide treatment decisions. The patient management should account for factors such as diagnosis, treatment options, and overall quality of life . In conclusion, the management of BVFP involves addressing the airway obstruction caused by bilateral vocal fold paralysis. Treatment options include glottic widening surgery and consideration of the underlying cause. It is crucial to consider the impact on patient quality of life when making management decisions. Further research and evaluation of treatment outcomes are necessary to refine and improve the management of BVFP.

Abstract title:
Blind children hearing and normal hearing children: comparative data.

Authors and co-authors names:
Inga Julija Sruogienė

Authors and co-authors institutions, country:
Vilnius University Hospital Santaros Clinics, Children's Hospital, ENT Department

Keywords:
blind people hearing, high frequency audiometry, free field speech audiometry

Abstract text:
The aim of the study was to obtain and compare psychoacoustic audiological quantitative parameters in blind from birth children and normal hearing children. Study purposes were: to obtain and compare the statistical values of the air conduction hearing thresholds at the conventional frequences (250-8000Hz) and high frequences (9000-16000Hz) in the tested groups; to estimate and compare speech range (500,1000,2000Hz) and high frequency range (9000-16000Hz) the statistical values of the hearing thresholds in the tested groups; to obtain and compare free field speech reception threshold's (SRT - 50% speech perception, dB SPL) quantitative values in the tested groups. Analysis of the study is based on investigation and estimation quantitative parameters of 73 persons with normal hearing. Testing group consisted of 18 (data of 36 ears) totally blind persons. Explanations of the results will be discussed.

Abstract title:
Breathing effect for facial growth

Authors and co-authors names:
Orthodontist Dovilė Drungilaitė

Authors and co-authors institutions, country:
Private Practise, Lithuania

Keywords:
oral breathing, craniofacial growth, multidisciplinary approach

Abstract text:
The association between nasal respiratory impairment and craniofacial morphology has been studied for more than a century and for decades it has been strongly accepted that physiological breathing plays an active role in harmonious craniofacial development, but when external factors alter its mechanism, its influence on the development of the skull leads to functional and skeletal alterations such as backward and downward rotation of the mandible, increase in the mandible plane angle, a higher palatal plane, and narrowing of both upper and lower arches. So there should be a close multidisciplinary approach between otorhinolaryngologist and orthodontist to solve breathing problems, establish a good nasal breathing function and control a good craniofacial growth as soon as the problem occurs.

Abstract title:
Case report - Sinonasal Glomangiopericytoma

Authors and co-authors names:
Maija Kaša (1), Arturs Barščevskis (2)

Authors and co-authors institutions, country:
1 - Riga Stradiņš University, Residency in Otolaryngology 2 - Pauls Stradiņš Clinical University Hospital, ENT Doctor

Keywords:
glomangiopericytoma, neoplasm, rare, sinonasal

Abstract text:
Introduction: Glomangiopericytoma (sinonasal type hemangiopericytoma) is a rare tumor that arises from pericytes (cells that line the walls of capillaries). This tumor accounts for 0.5% of all tumors of the nose and paranasal sinuses. It belongs to the category of soft tissue tumors of the nose and paranasal sinuses with low malignant potential. Case Presentation: Patient (male, 68 years old) was hospitalized for elective surgery in the ENT department with complaints of difficulty breathing through the right side of the nose, discharge from the nose. There have been complaints for several years. Investigating observes a pink polypous formation that completely obliterates the right side of the nasal cavity. In the performed CT - polyposis in the sinuses and nasal passages on the right side with complete obliteration of the sinuses. A functional endoscopic operation of the nasal cavity and sinuses was performed (right-sided infundibulotomy, ethmoidotomy, frontotomy, sphenotomy), excision of the formation was performed, the place of attachment of the formation to the nasal septum on the right side was identified, excision of this area was performed with an indentation in the healthy tissue together with septal cartilage and bone. Pathohistological conclusion - sinonasal glomangiopericytoma. Discussion: The average age at diagnosis is 59 years. Male to female ratio 1.2:1. Predominantly appear unilaterally, most often arise in ethmoidal cells. The most common symptoms are nosebleeds and nasal congestion. Despite the non-specific CT and MR findings, imaging is useful for differential diagnosis, tumor extent, size and non-aggressive tumor growth before surgery. It is characterized by slow growth with a low recurrence rate after complete endoscopic resection. Conclusion: To further improve the understanding of sinonasal glomangiopericytoma, it is necessary to report the diagnosed cases. This will improve the ability to identify treatment for these types of tumors and predict clinical outcomes.  

Abstract title:
Cervical Emphysema After Tonsillectomy: A Rare Complication.

Authors and co-authors names:
Justina Dapkute (1), Rimvydas Tolocka (1)

Authors and co-authors institutions, country:
Republican Vilnius University Hospital - 1

Keywords:


Abstract text:
Background. Tonsillectomy is one of the most common ENT procedures and is considered generally safe. Cervical emphysema is a rare and usually self-limiting complication that may occur after surgery. Case report. A 30 yar old female developed fever and neck swelling 1 day after a routine tonsillectomy. Subcutaneous and deep neck space emphysema was seen on neck CT as well as elevated CRP and neutrophilia. The patient fully recovered after one week of intravenous antibacterial treatment and was discharged. Conclusion. Though cervical emphysema after tonsillectomy is rare and usually benign, alertness and early diagnosis are necessary to avoid possible extension and serious infectious or respiratory complications.

Abstract title:
Chondrosarcoma of the sphenoid sinus: a case report

Authors and co-authors names:
Reinis Jansons (1,2); Ingus Vilks (1,2), Gunta Sumeraga (1,2)

Authors and co-authors institutions, country:
1 - Pauls Stradins Clinical University Hospital 2 - Riga Stradins University

Keywords:
FESS, skull base, oncology

Abstract text:
Background: Skull base chondrosarcoma is rare cancer that affects the bones of the skull base, arising from the cartilage cells. Only 2% of the total cases of chondrosarcomas are found in the nasal cavity thus representing only 0.1-0.2% of all head and neck cancers.  It is more common in adults, with a mean age of diagnosis in the fifth decade of life, and is slightly more common in males. The treatment for skull base chondrosarcoma involves a combination of surgery and radiation therapy, and the prognosis is generally good with appropriate treatment. Herein, we describe a clinical case of a 55-year-old woman diagnosed with a large sphenoethmoidal complex chondrosarcoma at Pauls Stradins Clinical University Hospital.  Case report: A 55-year-old woman presented with a persistent headache and was admitted to undergo a CT scan by an ENT specialist.  The scan revealed pathological tissue obliterating her sphenoidal sinus, which prompted the ENT specialist to conduct an MRI of her head and nasal cavity for a more accurate diagnosis. The results showed a large tumor involving all of the sphenoidal sinus walls, the medial wall of the right orbit, the cranial margin of the nasal septum, as well as the left ethmoidal air cells. An endoscopic endonasal biopsy was performed. The pathology report identified a Grade I Chondrosarcoma, therefore a decision was made to proceed with surgical resection of the tumour.  The resection was performed endoscopically and included three stages - the first stage involved resection of the tumor from posterior ethmoidal air cells, posterior margin of nasal septum as well as debulking of the tumor from the sphenoid cavity. The second stage of the surgery involved a careful resection of the tumour from the medial wall of the right orbit and posterior sphenoidal sinus wall.  A total resection of the tumor was achieved. The third stage of the surgery involved a reconstruction of the posterior sphenoidal sinus wall by using a middle turbinate flap, fibrin glue and hemostatic sponges. The patient had no neurological deficit after the surgery and was discharged from the hospital 2 weeks later. A follow-up MRI one month after the surgery showed no signs of residual tumor tissue.  Discussion: Chondrosarcomas located within the sphenoid sinus and sellar region are particularly uncommon and can present clinically similar to pituitary adenomas. Due to the high likelihood of tumor progression and recurrence, the recommended treatment is, altho technically difficult, maximal surgical removal followed by adjuvant radiotherapy.

Abstract title:
COMPARISON OF CLINICAL, RADIOLOGICAL FINDINGS AND SUBJECTIVE COMPLAINTS IN PATIENTS WITH FIRST TIME AND REPEATED ENDOSCOPIC NOSE SURGERY IN CASE OF CHRONIC RHINOSINUSITIS WHIT NASAL POLYPS

Authors and co-authors names:
Rudolfs Janis Viksne 1; Gunta Sumeraga 2

Authors and co-authors institutions, country:
1- Daugavpils regional hospital, Daugavpils, Latvia. 2- Riga Stradins universtity, Department of Otolaryngology, Riga Latvia

Keywords:
Rhinosinusitis; Nasal polyps; Snot22

Abstract text:
Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) to this date remains a difficult disease to manage. Although several conservative treatment options, such as intranasal and systemic corticosteroids, long course of macrolide antibiotics and biologic medication are available, often surgery is used when medication fails. Objectives: To compare clinical, radiological findings and subjective complaints in patients with initial and repeated endoscopic nasal surgeries for chronic rhinosinusitis with nasal polyps. Materials and methods: 39 patients were included in the study, 18 of whom underwent surgery for polyps for the first time and 12 had a repeat surgery. The average age of the patients was 52.13 years, 59% (23 patients) were men and 41% (16 patients) were women. A survey was conducted for patients before a planned functional endoscopic surgery for nasal polyps, using the SNOT-22 test, a questionnaire that includes questions about previous treatment. Computed tomography findings of the paranasal sinuses were evaluated using the Lund-Mackay scale. Results: There was a statistically significant increase (p=0.004) in results of the Lund-Mackay scale in re-operated patients. The SNOT 22 result of the group of first-time operated patients was 42.44(±20.89) on average, while the average of re-operated patients was 48.58(±24.52). No significant (p=0.325) difference was observed. Re-operated patients more often received at least one course of oral corticosteroids during the last year (p=0.004). When evaluating the effect of long-term smoking on the time that has passed since the last operation, a statistically significant difference (p=0.05) was observed, patients with a long history of smoking took an average of 5 (±5.8) years to require repeated surgery, while patients without a history of long-term smoking took an average of 15.2 (±9.01) years to require a repeated surgery. Conclusions: The lack of difference in SNOT-22 results between the groups of first-time and re-operated patients indicates that the recurrence of nasal polyps has an equally significant impact on the patient's quality of life.Smoking significantly decreases time before requiring repeated surgery due to recurring nasal polyps.Systemic corticosteroids should be more often used before deciding for surgery for the first time.

Abstract title:
Comparison of Pre- and Postlingual Chronic Fatigue in women with Single-Sided Deafness: A Preliminary Study

Authors and co-authors names:
Emre Gürses

Authors and co-authors institutions, country:
Hacettepe University, Faculty of Health Sciences, Department of Audiology

Keywords:
Chronic fatigue, single-sided deafness, checklist individual strength questionnaire

Abstract text:
Background Information: Fatigue is primarily a subjective experience and is characterized by fatigue that is disproportionate to the intensity of effort that is undertaken, and has persisted for six months or longer. Objective: This preliminary study compares fatigue levels between females with prelingual and postlingual single-sided deafness. To compare the results, same-sex and age-matched females with bilaterally normal hearing were included as normative data. Materials And Methods: Eighteen female patients (Mean Age: 41,72 SS:13.89, Min Age: 21, Max Age: 58) and eighteen participants with normal hearing were included in the study. Audiologic assessment and Turkish Checklist Individual Strength Questionnaire were performed on 8 prelingual and 10 postlingual patients. The total and four subscales (Subjective experience of fatigue, concentration, Motivation, Physical activity) scores of CIS T were statistically compared in terms of pre- and postlingual SSD and normal hearing group. Results: All participants had left-side single-sided deafness. The duration of hearing loss was from 1 year to 56 years. No statistically significant relation was found between prelingual and postlingual single-sided deaf females according to total scores (p=,705) and physical activity (p=.203), concentration (p=.775), motivation (p=.428), subjective experience of fatigue (p=.805) subscales of Checklist Individual Strength Questionnaire. The correlation between the duration of deafness and CIST scores was also found insignificant. The comparison between normal hearing and hearing loss revealed statistical differences (p<0.05). Conclusion: Although the CIST total and subscale scores are higher than normal hearing normative data, the current preliminary study reveals that females with SSD didn’t have different fatigue levels according to deafness duration and onset. A wide range of hearing loss duration could be the effect of the results. Thus hearing loss duration variability ought to be considered for further studies.

Abstract title:
Complete laryngotracheal separation

Authors and co-authors names:
Gintare Ciburaite (1), Marius Kaseta (2)

Authors and co-authors institutions, country:
1 - Marijampole Hospital, Marijampole 2 - Fi Clinica, Kaunas, Lithuania

Keywords:
laryngeal trauma, laryngotracheal separation, tracheostomy, airway trauma

Abstract text:
Introduction: Severe laryngeal injury is rare – it accounts up to 1 % of all trauma cases and is usually associated with high velocity traumas. Complete laryngotracheal separation (CLS) is the most severe type of laryngeal injury (classification by Schaefer) and if inappropriately managed might promptly lead to airway loss and death. Case report: A 27-year-old male suffered a “clothesline” type injury while riding a motorbike. He was firstly brought to a peripheral emergency department. After arrival, the patient became unstable and was intubated. A presumably stable airway gave the opportunity to order a neck computed tomography scan (CT), however, almost immediately the patient became unstable again, oxygen saturation started dropping and he developed massive subcutaneous emphysema extending to his abdomen. The CT showed massive subcutaneous emphysema, pneumopericardium, pneumothoraces, the endotracheal tube dislodged into the soft tissues below the subglottis. After an urgent tracheostomy, the patient was transported to a tertiary hospital where secondary laryngotracheal anastomosis was performed. The postoperative course was uneventful and the patient was discharged with a tracheostomy tube since both of his vocal cords were in a fixed position. Deglutition remained unaffected. Results: On follow up there were no relevant stenosis or granulation formation at the site of the anastomosis. The patient's only complaint was of a weak voice. Discussion: The first step when managing a laryngeal trauma is to asses and secure the airway. In some cases there might be no time for radiological investigation. In case of CLS urgent tracheostomy is recommended. Unguided intubation or coniotomy are discouraged because these procedures might complete a partial separation or further dislodge the current airway.

Abstract title:
Complex reconstruction in advanced head and neck cancer cases: our center experience

Authors and co-authors names:
Ignas Karnas (1), Otilija Kutanovaitė (2), Saulė Kėkštaitė (3), Linas Senkus (4), Jolita Gibavičienė (5)

Authors and co-authors institutions, country:
Department of head and neck and skin cancer surgery, National Cancer Institute, Vilnius, Lithuania (1-5)

Keywords:
head and neck, cancer, reconstruction

Abstract text:
Head and neck cancer is often diagnosed in advanced stages. There are few reasons for this delay: patient social status, no screening programs or tests available to diagnose the disease in early stages, lack of symptoms in early stages for some specific head and neck subsites (e.g. hypopharyngeal carcinoma). If possible, surgery is one of the mainstay treatment options for head and neck cancer patients. Head and neck cancers involve critical structures associated with speaking, swallowing and appearance. Removing these structures may result in tissue loss, function deficit and appearance disfigurement. Flap reconstruction is needed for more than 50% of these patients. Reconstruction of composit defects (muscle, skin, bone) is acquired using microvascular free flap surgery. National Cancer Institute is leading head and neck cancer center in Lithuania with over 1000 patients treated in our department yearly.

Abstract title:
Cone beam computed tomography (CBCT) in diagnostics of sinonasal disease: a literature review

Authors and co-authors names:
Mantas Balseris (1)

Authors and co-authors institutions, country:
Department of ENT, Vilnius University Hospital Santaros clinics - 1

Keywords:


Abstract text:
Cone beam computed tomography (CBCT) is a low radiation dose imaging diagnostic method which can be used in ENT practice for diagnostics of sinonasal disease. This diagnostic method is different than conventional CT in terms of its x-ray beam movement, parameters and the time of the procedure. In this presentation we are going to discuss the advantages and disadvantages of CBCT and compare it with conventional CT. Cone beam computed tomography image quality is almost the same as conventional CT with the concordance between the two imaging techniques of 97%, while the average effective dose of radiation of CBCT being almost 42%k less than conventional CT. A few studies indicate that CBCT is valid diagnostic method for the identification of relevant sinonasal anatomical structures. The significantly lower dose of radiation of CBCT is the greatest advantage of the device, therefore it could be more suitable choice for pre-operative imaging and recurrent sinonasal disease monitoring. Some studies have shown that CBCT could also be used with multiple neuronavigation systems performing endoscopic sinus and skull base surgery. The main disadvantages of this method are low density resolution of soft tissue imaging and reportedly lower contrast resolution. While conventional CT is still recommended in patients with complicated and extended sinonasal disease, CBCT is faster and applies less radiation to the patient with almost the same imaging resolution, therefore could be the better choice in routine pre-operative sinonasal disease diagnostics and patient monitoring.

Abstract title:
Congenital laryngeal stenosis in Kaunas Clinic

Authors and co-authors names:
Lukas Vitkauskas, Rūta Pribuišienė

Authors and co-authors institutions, country:
1- ENT Department of Lithuanian university of health sciences (LUHS), 2- ENT Department of Lithuanian university of health sciences (LUHS)

Keywords:
laryngeal stenosis; congenital; laryngomalatia

Abstract text:
The aim: to assess clinical and demographic aspects of congenital laryngeal stenosis in Kaunas Clinic of LUHS. Methods: Retrospective analysis of 33 cases of congenital laryngeal stenosis (CLS) under 18 year treated in Kaunas clinic of LUHS during 2015-2020. Causes of CLS, demographic and clinical data, diagnostics and management were analysed. Results. There was no statistically significant difference between CLS among male and female (p>0.05). The most cases (72.7 %) were city residents (p<0.05). The mean age of CLS was 2.8 months, moda – 1 month (43.3 %). Stridor was most common (75.8 %) in comparison to other symptoms: tachypnea (16,7 %), desaturation (25%), hoarseness (3%). Endoscopy was the most common method used for diagnostics in 78.8 % of cases (p<0.05). Radiologic methods to clarify extension of CLS was used only in 12.1 % (n=4) of cases. After endoscopy CLS was confirmed in 63,6 % (n=21) cases. Last 12 cases (36,4 %) was diagnosed as primary laryngeal stenosis and other congenital laryngeal defects (6 cases each, 18,2 %). Laringomalacia (54,5 %, n=18) was the most common CLS (p<0.05). The non-surgical treatment was used in most of cases (81,8 %, n=27) (p<0.05). Surgery was performed in 18,2 % (n=6) of cases. Endolaryngeal surgery was performed in 6.1% of the cases. In 12.1% of cases tracheostomy was made. Conclusions CLS was mostly diagnosed in 1 month-old babies with stridor. The most common cause of CLS was laryngomalacia. In two-thirds of cases of CLS was confirmed by fibroendoscopy. Conservative treatment was reliably used more often in patients with CLS. Only 20% of patients required surgical treatment. Two-thirds of them underwent tracheostomy

Abstract title:
Conversational artificial intelligence bots in healthcare

Authors and co-authors names:
Evaldas Kateiva

Authors and co-authors institutions, country:
Department of Ear, Nose, and Throat Diseases, Republican Vilnius University Hospital, Vilnius, Lithuania.

Keywords:
Conversational artificial intelligence bots chatbots

Abstract text:
Conversational artificial intelligence bots are considered to be ground-breaking technologies in customer relationships. With exceptional growth in artificial intelligence, chatbots have begun to rule various industries. One major contribution of a chatbot is in healthcare. Possible applications in healthcare: clinical documentation, diagnostic assistance, medical education, streamlining literature review, patient education, task automation. Also, chatbot benefits the healthcare industry by improving patient engagement, ability to easily set up appointments, taking care of common queries, gather patient data, keep patients informed, recommend health and wellness programs, record medical notes and patient feedback. Each technology has benefits and drawbacks. The risks associated with them are: incomplete check and assessment, incorrect diagnosis, user privacy and data hacking, inadequate human interaction, absence of empathy, genuine emotions, and accountability, cannot manage exceptions, failure of trust. Healthcare chatbots are transforming the medical industry by providing a wide range of benefits, nevertheless setting expectations is a crucial first step before using chatbots in healthcare industry. Despite the many difficulties in identifying the complexities of chatbot use in healthcare, efforts must be made to approach this area both ethically and professionally.

Abstract title:
COVID-19 INFECTION AND BENIGN PAROXYSMAL POSITIONAL VERTIGO: A CASE REPORT AND REVIEW OF THE LITERATURE

Authors and co-authors names:
Domas Turčinas, Aistė Paškonienė MD

Authors and co-authors institutions, country:
Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Keywords:
Benign paroxysmal positional vertigo, COVID--19

Abstract text:
Introduction: Benign paroxysmal positional vertigo (BPPV) is a vestibular disorder characterized by brief episodes of rotary vertigo triggered by specific head positions or movement relative to gravity. BPPV is the most common cause of peripheral vertigo, with its prevalence being 2.4%. It manifests mostly in middle-aged and elderly people, with women being more affected. Due to its benign nature, this disorder is frequently treated only by repositioning maneuvers but there are cases in which it is treatment-resistant. During the SARS-COV-19 pandemic cases of intensified BPPV were observed. We report a female patient with treatment-resistant benign paroxysmal positional vertigo after a COVID-19 infection. Case presentation: A 44 - year old female patient presented to her general practitioner with complaints of severe attacks of circular dizziness and nausea, typically occurring when lying in bed, driving, doing physical activities, or swiftly turning the head to the side. The diagnosis of benign paroxysmal positional vertigo was established. The patient was treated with Tab. Cinnarizinum et Dimenhydrinatum 20/40mg and Tab. Bromasepamum 1.5mg. The symptoms subsided for a period of time, yet after being diagnosed with SARS-COVID-19, the symptoms returned and aggravated. The patient started experiencing vertigo, “incoherently moving” sight while driving, and nausea. The diagnosis of anterior semicircular canal canalolithiasis was established based on straight-back head-hanging maneuver, while the Dix-Hallpike maneuver provoked vertical nystagmus. Betahistine 24mg was added to the treatment. Head magnetic resonance imaging (MRI) was without pathological findings. The laboratory value of vitamin D was within the normal range. The Epley and modified Yacovino repositioning maneuvers did not alleviate the symptoms, furthermore provoked nausea. The patient is still under treatment but the BPPV is ruled treatment-resistant. Conclusion: This case report presents a treatment-resistant benign paroxysmal positional vertigo post-COVID-19 infection. In various literature, there is proof that this condition is rare but possible. However, due to the known SARS-COVID-19 neurotropic nature, we suggest that patients with BPPV should be thoroughly assessed after being diagnosed with SARS-COVID-19.

Abstract title:
Customization of the VoiceScreen app for different phone models

Authors and co-authors names:
A. Aleksaitė, V. Uloza

Authors and co-authors institutions, country:
Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Keywords:
Voice Screening; microphones; smartphones; acoustic characteristics; AVQI;

Abstract text:
Objective:  To compare the results of acoustic characteristics of voice obtained from voice recordings simultaneously using different software smartphone models in a clinical setting. Methods: A study group of 29 subjects with normal voices was asked sustain the vowel /a/ and to read aloud a standard text. Voice samples from each subject were simultaneously recorded in an ordinary clinical environment using an internal (bottom) microphones of five different smartphones (namely: iPhone 12 Pro, iPhone 13 Pro Max, Xiaomi Redmi Note 5, iPhone 12 Mini, Samsung Galaxy S10+) at a 30.0 cm distance from the mouth, keeping at about 90° microphone-to-mouth angle. Data of different acoustic characteristics were obtained (AVQI, cpps, hnr, shPerc, shDb, ItasSlope, ItasTreadTilt). The acoustic characteristics of voice estimated with “VoiceScreen” app from voice recordings were compared between different smartphone models. Results: One-way ANOVA showed that differences among acoustic characteristics results obtained from voice recordings recordings done with different smartphone microphones were not statistically significant. Conclusion. The acoustic characteristics measures obtained from used smartphone microphones voice recordings and estimated with “VoiceScreen” app are comparable between different smartphone software systems.  

Abstract title:
DEVELOPMENT OF CI PROGRAM IN LITHUANIA

Authors and co-authors names:
Eugenijus Lesinskas (1, 2), Daumantass Stumbrys (3) Vija Vainutienė (2)

Authors and co-authors institutions, country:
1 - Vilnius University, Faculty of Medicine , 2 - Vilnius University Hospital Santaros Clinics, 3- Vilnius University, Faculty of Philosophy, Institute of Sociology and Social Work, Vilnius, Lithuania

Keywords:
Cochlear implantation; social integration, results

Abstract text:
The aim of this research was to evaluate dynamics of the number of implantations in children andadults and to assess social integration challenges of parents raising children with cochlear implantsin Lithuania. Presentation is based on research which was funded by a grant (No. S-MIP-17-111)from the Research Council of Lithuania. All children and adults implanted in Lithuania in 1998-2023 were calculated using data from hospitals (Vilnius Santaros Clinics, Kaunas Clinics),manufacturers and state institutions (National Health Insurance Fund). Cochlear implantation inLithuania is implemented since 1998. In the 1’st of May 2023 there were 534 CI patients implantedin Lithuania. Dynamics of the number of children and adults, age of adult CI recipients andmpact of the pandemic on implantation. Total number of adult CI recipientsm makes 32% of all theCI patients (n- 174).

Abstract title:
Difficult cases and misdiagnoses in laryngology

Authors and co-authors names:
Aurelija Vegiene (1)

Authors and co-authors institutions, country:
1- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Keywords:
hoarseness, hanging, laryngeal trauma, vocal cord paralysis

Abstract text:
Complications in survivors after typical hanging have not been well characterized because of the high mortality rate. Case Presentation: We present a patient with bilateral vocal cord paralysis following typical hanging. A 25-year-old woman with depression attempted suicide by hanging. She was in a coma and was transported to one of university hospitals in our country. Emergency endotracheal intubation was carried out. After few days of mechanical ventilation, she was extubated. After extubation, her voice was hoarse and stridor was heard. Vocal cord paralysis became apparent by laryngeal fiberscopy, and a tracheotomy was carried out. It didn’t resolved in more than half a year after injury. There were made bilateral posterior cordotomies. Later on the breathing through the larynx became even worse. In next surgeries diagnosis was changed. It was not paralysis, it was misdiagnosed trauma of the arytenoids following scarring and immobility of the vocal folds. Conclusion: Although vocal cord paralysis after typical hanging is rare, there is a need for adequate assessment of the airways in survivors of typical hanging as a differential diagnosis of airway edema after extubation, trauma of the cartilages of the larynx.

Abstract title:
DYSPHAGIA SEVERITY AFTER SURGERY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Authors and co-authors names:
Tomas Balsevičius, Guoda Vaitukaitienė, Rūta Pribuišienė, Lukas Vaidelis

Authors and co-authors institutions, country:
Lithuanian University of Health Sciences

Keywords:
Obstructive sleep apnea, dysphagia, pharyngeal surgery, Palate Post–Operative Problems Score.

Abstract text:
The aim of the study. To evaluate the severity of dysphagia symptoms after surgery for obstructive sleep apnea (OSA) and to compare them with a control group of healthy subjects. The suitability of the Palate Post–Operative Problems Score (PPOPS) questionnaire for use in clinical practice was also assessed. Methods. A total of 50 healthy controls and 157 patients, aged from 16 to 65 (mean 40.38 ± 11.16) years old, who underwent pharyngeal surgery at the Department of Otorhinolaryngology of Lithuanian University of Health Science between 2018 November 1st and 2019 October 30th were examined for dysphagia symptoms. The severity of dysphagia was assessed using the Visual Analogy Scales (VAS), Dysphagia Screening Questionnaire (DAQ), and PPOPS. Results. In both, the study group and control group, the mean VAS scores for dysphagia symptoms were less than 3 points, thus indicating mild symptom severity. As compared to the controls, a higher VAS score for „gagging/ coughing when swallowing“ and „foreign body sensation in the throat“ and higher PPOPS score were found in the study group patients. When comparing subgroups of patients who underwent Radiofrequency surgery (RF), Palatoplasty surgery (PP) or TE surgery, higher VAS scores for „foreign body sensation in the throat“ after PP and TE and higher VAS scores for „gagging/ coughing when swallowing“ after TE were detected. Same, increased PPOPS scores were detected for RF, PP and TE patients when compared to controls. Conclusions. Late dysphagia symptoms after surgery for OSA are mild, regardless of the type of pharyngeal surgery. Nevertheless, the VAS scores for “foreign body sensation in the throat“ and „gagging/ coughing when swallowing“ were generally higher in operated patients when compared to the controls. More pronounced dysphagia complaints were detected after PP and TE surgery comparing with patients undergoing RF surgery. PPOPS questionnaire showed to be a useful and sensitive tool to detect postoperative dysphagia and is a suitable tool for usage in daily clinical practice.

Abstract title:
EFFECT OF CYBERKNIFE TREATMENT OF VESTIBULAR SCHWANNOMA ON INNER EAR FUNCTION

Authors and co-authors names:
Nejc Steiner, MD; prof. Saba Battelino, MD, PhD; prof. Roman Bošnjak, MD, PhD

Authors and co-authors institutions, country:
Otorhinolaryngology and Cervicofacial Surgery Clinic, University Medical Centre Ljubljana, Slovenia Faculty of Medicine, University Ljubljana, Slovenia

Keywords:
Cyber Knife, Vestibular Schwannoma, Pure tone average, Caloric testing

Abstract text:
Objectives To evaluate the effect of CyberKnife stereotactic radiosurgery for the treatment of vestibular schwannoma (VS) on hearing and vestibular function.   Materials and methods Database of regular follow-up VS patients between 2014 and 2019 was analyzed. Patients who underwent treatment with CyberKnife were evaluated 1 month before and 6 months after the radiosurgery. Pure tone average (PTA) and level of lateral semicircular canal paresis obtained with caloric testing were analyzed.   Results 30 patients with VS treated with CyberKnife radiosurgery were included in the study. Hearing preservation rate post treatment was 75 %. The mean post-treatment bone conduction PTA (63,12 ± 27,51 dB) did not increase significantly (p=0,068) comparing with the mean pre-treatment bone conduction PTA (59,03 ± 27,29 dB). Post-treatment caloric testing showed statistically significant increase (p=0,020) in the mean lateral semicircular canal paresis (54,74 ± 41,17 %) compared with the mean pre-treatment paresis (38,28 ± 36,33 %).   Conclusion Good post-treatment hearing preservation makes stereotactic CyberKnife radiosurgery a promising treatment option for opportune VS patients with tumor size up to 25 mm.

Abstract title:
Electroporation in ENT&HNS

Authors and co-authors names:
Arnoldas Morozas (1), Justinas Ivaska (1 )

Authors and co-authors institutions, country:
Department of experimental, preventive and clinical medicine, State Research Institute Centre for Innovative Medicine - 1

Keywords:


Abstract text:
Electroporation is a technique that has gained attention in the field of head and neck surgery for its potential applications in various aspects of treatment. Electroporation involves the application of short, high-voltage electrical pulses to cells or tissues, which transiently disrupts the cell membrane and creates nanopores, allowing for enhanced uptake of therapeutic agents . In head and neck surgery, electroporation has been investigated for multiple purposes, including gene therapy, targeted drug delivery, and tumor ablation. Electroporation has been explored for the targeted delivery of chemotherapeutic agents in head and neck cancer treatment. By applying electroporation after intratumoral injection of chemotherapy drugs, local drug concentration can be significantly increased, improving treatment efficacy while minimizing systemic toxicity. Clinical studies have shown promising results in terms of tumor response rates and overall survival in patients with head and neck squamous cell carcinoma Additionally, electroporation has been investigated for tumor ablation in head and neck surgery. Irreversible electroporation (IRE) has emerged as a minimally invasive technique for focal tumor destruction. By applying high-voltage pulses to tumor tissue, IRE induces irreversible damage to the cell membrane, leading to cell death. Clinical studies have shown favorable outcomes in terms of tumor control and preservation of critical structures in head and neck tumors, including those located near vital structures such as major blood vessels or nerves To sum up: electroporation holds promise as a valuable tool in head and neck surgery. Its applications in targeted drug delivery, and tumor ablation offer opportunities for improved treatment outcomes and reduced morbidity. Further research and clinical studies are warranted to optimize electroporation techniques, validate its efficacy, and assess long-term outcomes in head and neck surgery.

Abstract title:
Etiological profile of hearing loss amongst Lithuanian pediatric cochlear implant users

Authors and co-authors names:
Vaiva Mickeviciene (1), Jekaterina Byckova (2), Violeta Mikstiene (3), Eugenijus Lesinskas (4)

Authors and co-authors institutions, country:
1 - Center of Ear, Nose and Throat, Vilnius University hospital, Santaros klinikos, Vilnius, Lithuania 2 - Center of Ear, Nose and Throat, Vilnius University hospital, Santaros klinikos, Vilnius, Lithuania 3 - Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania 4 - Center of Ear, Nose and Throat, Vilnius University hospital, Santaros klinikos, Vilnius, Lithuania

Keywords:
Congenital CMV infection; Etiology; GJB2; Hearing loss

Abstract text:
Congenital sensorineural hearing loss is a heterogeneous disorder and its etiological profile varies between populations. Pathogenic variants of GJB2 gene are the major cause of non-syndromic hearing loss. Congenital cytomegalovirus infection (cCMV) is the most important prenatal etiological factor causing hearing loss and other disorders. Perinatal events, syndromes, postnatal infections or traumas are less common. Causes of the remaining one third of hearing loss cases are unknown. The aim of the study was to determine the etiological profile of hearing loss in pediatric cochlear implant users in Lithuanian population. `material and methods: The data of 122 children (70 male / 52 female; aged 7.6 ± 3.3 years) cochlear implant users were analysed. Medical records of all children recruited in Santaros klinikos (Vilnius, Lithuania) were analysed to identify prenatal, perinatal, or postnatal risk factors based on the adapted list proposed by the Joint Committee of Infant Hearing. Genetic counselling and testing according to the scheme were performed to 101 children. DNA of 117 children was extracted from the DBS on Guthrie cards and CMV DNA detected using real time PCR. Results: non-syndromic hearing loss was diagnosed in 65 cases (53.3%), 58 of which were GJB2 gene associated; syndromic hearing loss was diagnosed to 8 children (6.6%). Perinatal (prematurity, low birth weight, hypoxia, hyperbilirubinemia, sepsis, ototoxicity, and meningitis) and postnatal (meningitis) risk factors were associated with hearing loss in 16 (13.1%) and 4 (3.3%) study participants respectively. CMV DNA was detected in 12 samples (9.8%). The cause of hearing loss remained unknown only for 17 (13.9%) children. Conclusions: The major cause of HL in the current study was GJB2 gene alterations. Only 14% of the cohort had congenital hearing loss of unknown origin.

Abstract title:
Evaluation of Tonsillectomy Patients and Factors Related to Immediate Tonsillectomy

Authors and co-authors names:
Renata Viksne (1), Karolina Polikarpova (2), Ksenija Jenbajeva (3)

Authors and co-authors institutions, country:
1 - Department of Otorhinolaryngology, Daugavpils Regional Hospital, Vasarnicu street 20, Daugavpils, Latvia. Department of Doctoral Studies, Riga Stradins University, Dzirciema street 16, Riga, Latvia. 2, 3 - Faculty of Medicine, Riga Stradins University, Dzirciema street 16, Riga, Latvia.

Keywords:
Complications; Peritonsillar Abscess; Tonsillectomy; Tonsillitis.

Abstract text:
Background: The most common indication for tonsillectomy is infection. Despite the widespread use of antibiotics, immediate tonsillectomies are as frequent as elective tonsillectomies. We conducted a retrospective cohort study with the aim to characterize tonsillectomy patients and identify factors related to the development of complicated cases of tonsillitis and consecutive immediate tonsillectomies in the Latvian population. Materials and methods: We analyzed the data of 493 patients who were hospitalized from January 1, 2019, to November 30, 2020, for elective or immediate tonsillectomy due to recurrent tonsillitis, with or without exacerbation and complications. We performed a statistical analysis with the SPSS 22.0 software. The statistical significance was set as p<0.05. Results: The patients included 216 (43.8%) men and 277 (56.2%) women. The mean age at the time of hospitalization was 35.48 ± 14.24 years (ranging from 16 to 87 years). Of the studied patients, 213 (43.2%) underwent elective tonsillectomy, 269 (54.6%) had immediate tonsillectomy, and 11 (2.2%) refused surgery. The patients who underwent elective tonsillectomy were younger (mean age of 31 years) than those who underwent immediate tonsillectomy (mean age of 33 years) (p=0.004). Peritonsillar abscess was more common in smokers than in nonsmokers (72.1% vs. 27.9%, p<0.001). Smokers had immediate tonsillectomy more often than nonsmokers (76.2% vs. 23.2%, p<0.001). Patients who underwent elective tonsillectomy had the shortest period of antibiotic therapy (p<0.001). The patients who had immediate tonsillectomy had longer hospitalization times than those who had elective tonsillectomy (mean of 3.36 (IQR 2-4) vs. 2.41 days (IQR=2-3). A statistically significant association was found between the duration of hospitalization and the WBC counts and CRP levels; patients with high WBC counts and CRP levels had longer hospital stays (p<0.001). There were no statistically significant associations found between BMI and the number of immediate tonsillectomies performed (p=0.948) or the duration of hospitalization (p=0.226). Conclusion: Immediate tonsillectomies were associated with patients of an older age, smokers, and longer hospitalization and antibacterial treatment periods. Unilateral peritonsillar abscess was the most common complication of tonsillitis, which resulted in immediate tonsillectomy.

Abstract title:
Evaluation of Vestibulo-Ocular Reflex by Video Head Impulse Test: an Otosurgeon's Perspective.

Authors and co-authors names:
Irina Arechvo (1,2)

Authors and co-authors institutions, country:
Department of Ear, Nose and Throat Diseases, Republican Vilnius University Hospital, Vilnius, Lithuania (1); Medical Diagnostic and Treatment Center, Vilnius, Lithuania (2)

Keywords:
saccades; vestibular gain; vestibulo-ocular reflex; video head impulse test; otitis media; labyrinthine fistula; otosclerosis

Abstract text:
The aim of this study was to evaluate gain and refixation saccades (covert and overt) using a video head impulse test (vHIT) in patients with different otosurgical pathology. This was a retrospective chart review of patients with chronic otitis media with and without cholesteatoma and otosclerosis. The vHIT is thought to be a suitable method for evaluating semicircular canal function in patients with different otological diseases as it is not influenced by middle ear pathology.

Abstract title:
Extended indications for endonasal endoscopic surgery: 30 years in review.

Authors and co-authors names:
Saulius Vaitkus(1), Justinas Vaitkus(2)

Authors and co-authors institutions, country:
1- Department of Otorhinolaryngology, Lithuanian University of Health Sciences 2- Department of Otorhinolaryngology, Lithuanian University of Health Sciences

Keywords:
endonasal endoscopic surgery

Abstract text:
Extended indications for endonasal endoscopic surgery: 30 years in review. Endonasal endoscopic surgery is a minimally invasive surgical technique performed through the nose using an endoscope. Since its introduction it has become an established technique for the treatment of various nasal, sinus and skull base conditions. Notable advancement in surgical techniques, instrumentation, image-guided navigation, incorporation of multidisciplinary approach let us expand the indication for endoscopic surgery even further. Some of the expanded indications for endonasal endoscopic surgery include: sinonasal and skull base tumors, orbital pathologies, CSF leaks. During the 30 years of practice in endoscopic endonasal surgery there was performed about 6000 surgeries. Annually, ENT department performs 132 cases of dacryocystorhinostomies, 76 cases of inverted papilloma, 6 cases of orbital decompression, 30 cases of advanced sinus surgery, 56 cases of CFS leaks, 6 cases of lateral recess sphenoid surgeries, 15 cases of choanal atresia, 18 cases of osteomas, 21 cases of vascular benign tumors, 15 cases of malignant paranasal tumors, 2 cases of intrasellar, extrasellar pituitary tumors, 5 cases of craniopharyngiomas. Advancements and progress in endoscopic endonasal surgery have contributed to improved patient outcomes, reduced morbidity, and expanded treatment options. The diverse applications of endonasal endoscopic surgery, is highlighting its role in managing both benign and malignant conditions affecting the nasal, sinus, and skull base regions. As technology continues to advance, it is likely that further refinements and innovations will continue to enhance the field of endoscopic endonasal surgery.

Abstract title:
First experience in Latvia with platelet rich fibrin (PRF) membrane tympanoplasty

Authors and co-authors names:
Ligita Kupica (1), Gunta Sumeraga (2)

Authors and co-authors institutions, country:
1 - Children’s Clinical University Hospital, Latvia, ORCID 0000-0003-4752-9035 2 - PhD Dr.Med., Rīga Stradiņš University Hospital, Latvia, ORCID 0000-0002-2781-8991

Keywords:
PRF, tympanoplaty

Abstract text:
Introduction: Conventionally myringoplasty is a relatively long surgery requiring general anaesthesia. There is a need for faster and less invasive methods, especially in the paediatric practice. PRF membrane tympanoplasty is a novel procedure with the potential to replace conventional myringoplasty. Objectives. Test and introduce a new tympanoplasty method in otorhinolaryngology. Materials and methods. We performed PRF tympanoplasty on 6 patients from Children Clinical University hospital with residual tympanic membrane perforation longer than 3 months after tympanostomy tube removal. To make a PRF membrane, we use a Couchroun centrifuge and patented A-PRF vacutainers to get PRF membrane. Then the myringoplasty procedure was done under general anaesthesia but without harvesting any additional tissues and avoiding other further cuts. The total surgical time, full-time staying in the hospital, and the healing of the tympanic membrane after 2 weeks were registered and compared with average results from conventional tympanoplasty. Results. From December 2022 till now enrolled 6 patients - 2 girls, 4 boys. Mean age 10,4 (6 -14) years. Average size of the defect (from total tympanic membrane size) – <25% - 4; 25-50% - 3. Length of the operation – 15 minutes. Discharge from hospital after surgery – median 1,4 hours. After the follow at 1 month in the two patient the defect of the tympanic membrane was fully healed, in the three patients partial improvement, in one without improvement. No complications related to the procedure noticed. Conclusion. The first results of PRF membrane tympanoplasty showed encouraging results suggesting the possible replacement of conventional tympanoplasty with the minimally invasive PRF graft procedure.

Abstract title:
Functional endoscopic sinus surgery in children with chronic sinusitis

Authors and co-authors names:
Idiev Z.Z., Abdukayumov A.A.

Authors and co-authors institutions, country:
Republican Specialized Scientific and Practical Medical Center of Pediatrics

Keywords:


Abstract text:
The aim of study was to improve diagnosis and surgical treatment of chronic rhinosinusitis in children, taking into account the therapeutic and diagnostic capabilities of modern video endoscopy.    Materials and methods. We examined 120 children aged 3 to 18 years (boys - 69 girls - 51) with chronic rhinosinusitis. The examination included the collection of complaints and anamnesis of patients, general ENT examination, video endoscopy of the nose and nasopharynx using a set of endoscope video systems, radiography of the paranasal sinuses or multislice computed tomography were also performed.    Results and discussion. As a result of the examination, 65 patients (54.1%) were diagnosed with adenoid growths of the II-III degree, 39 (32.5%) - various types of deviated nasal septum, 16 (13.3%) - acute and chronic sinusitis, was mainly chronic maxillary ethmoiditis. Of these: 7 (5.8%) patients had a purulent form, 4 (3.3%) had a cystic form, 3 (2.5%) had a purulent-polypous form, and 2 (1.7%) had a polyposis. After preliminary preparation for surgical intervention, all patients under general anesthesia underwent a one-stage adenotomy with correction of nasal septal deformity and functional endoscopic sinus surgery, where the possibilities of video endoscopy and video archiving were used to the maximum.    It should be noted that in comparison with traditional methods (posterior rhinoscopy, digital examination) in the diagnosis and surgical treatment of adenoid hypertrophy, video endoscopy showed high information content and confidence.    Functional endoscopic sinus surgery has made it possible to visually assess the condition of the mucous membrane and all the walls of the sinus during the surgery, which can be difficult with traditional methods of surgery. In parallel, the state of the middle nasal passage was examined and the natural fistula of the excretory openings was expanded. In addition, surgical treatment under video endoscopy made it possible to successfully coagulate bleeding vessels during the surgery without any special technical difficulties, which made it possible to completely eliminate intra- and possible postoperative bleeding.     Thus, the use of functional endoscopic sinus surgery in the treatment of children with chronic rhinosinusitis is the method of choice, which makes it possible to obtain the necessary information about the pathological conditions of the nasal cavity and paranasal sinuses, which is undoubtedly successful in the rehabilitation of such a contingent of patients.

Abstract title:
IDENTIFICATION OF BACTERIAL MICROFLORA ON THE SURFCAE OF ADENOIDS USING 16S rRNA GENETIC SEQUENCING

Authors and co-authors names:
Oļegs Sokolovs-Karijs (1,4) , Monta Brīvība (3) , Rihards Saksis (3) , Gunta Sumeraga (1) , Angelika Krūmiņa (2)

Authors and co-authors institutions, country:
1. Riga Stradiņš university, department of otolaryngology , Riga, Latvia 2. Riga Stradiņš university, department of infectology , Riga, Latvia 3. Latvian university, Biomedicine study center , Riga, Latvia 4. AIWA Clinic , Riga, Latvia

Keywords:
Adenoids, Microbiome, 16s rRNA sequencing, bacteria

Abstract text:
Background: adenoid hypertrophy is a common condition in young children that isassociated with recurrent rhinosinusitis, otitis media with effusion and obstructive sleepapnea. Bacterial colonization is considered one the main causes of adenoid tissueenlargement. Recent advances in culture-independent, genetic bacterial studies provide amore detailed look at the types of bacterial microorganisms forming colonies on the surfaceof adenoid vegetations. Aim of the study: to identify bacterial genus, phylum, and diversity on the surface ofadenoid vegetations using culture-independent molecular techniques.Materials and methods: 21 adenoid samples were investigated using amplification andsequencing of the V3-V4 hypervariable region of the bacterial 16S rRNA gene. Results: Genus-level analysis shows a prevalence of dental microflora (Veillonela andFusobacterium) as well as Streptococcus, Prevotella, Haemophilus and Moraxella cattarhalis.Phylums-level analysis shows a domination of Firmicutes, followed by Proteobactria,Bacteroidota, Fusobacteriota and Actinobacteriota. Conclusions: our study shows a significant proliferation of dental microflora on theadenoid surfaces as well as Streptococcal, Prevotella and Haemophilus abundance. Whilecolonization by Streptococcus spp. and Haemophilus spp. is common knowledge,proliferation of dental microflora on the adenoid surfaces is yet to be investigated.

Abstract title:
Impact of stenting during endonasal dacryocystorhinostomy: relativity of necessity

Authors and co-authors names:
Dr. Ekaterina Kondratishko (1), Dr. Sofija Korņilova (2), Dr. Maksims Mukans (3), Prof. Aleksejs Derovs (4), Prof. Ģirts Briģis (5)

Authors and co-authors institutions, country:
1 - Department of Doctoral Studies, Riga Stradiņš University, Riga, Latvia, 2 - Faculty of Residency, Riga Stradiņš University, Riga, Latvia, 3 - Statistics Unit, Riga Stradiņš University, Riga, Latvia, 4 - Department of Internal Diseases, Riga Stradiņš University, Riga, Latvia, 5 - Department of Public Health and Epidemiology, Faculty of Public Health and Social Welfare, Riga Stradiņš University, Riga, Latvia

Keywords:
endoscopic dacryocystorhinostomy, endo-DCR, stenting, epiphora, dacryocystitis

Abstract text:
Endonasal dacryocystorhinostomy (endoDCR) is one of surgical treatments for distal nasolacrimal duct obstruction (NLDO). Stenting during endoDCR is standard procedure to prevent rhinostomy closure. The average period between placement and evacuation of the stent, based on information from literature review, is three months. To decrease the risk of lacrimal drainage system infection, granulation formation and lacrimal point laceration, it is preferred to evacuate stent as soon as possible. Meanwhile, there are yet no clear guidelines for post-operative management and evidence for use of stents, even though it directly influences surgical treatment outcomes. The aim of this study was to evaluate potential impact on treatment results in patients who underwent endoDCR with “gold standard” stenting, stenting for shorter period and no stenting at all. This is a retrospective cross-sectional study of patients who underwent endoDCR at two medical centers in Riga (Jugla and AIWA Clinic) by the same surgeon between January 2013 and December 2022. Research population included adult patients with epiphora over 6 months, evidence of distal NLDO and performed endoDCR surgery. Exacerbates chronic dacryocystitis preoperatively was treated with systemic and topical antibiotics and non-steroid anti-inflammatory drugs (NSAID). This research demonstrates the results after evacuating stent after 1 month and no stent implantation. Out of 272 operated patients, in 66 (24.3%) patients the stent was placed for 3 months (control group, I) and 154 (56.6%) - for 1-month (II group), 52 (19.1%) patients had surgery done without stenting (III group). 10 patients had re-operation due to stoma closures, 6 (9,1%) patients in group I, 3 (1.9%) in group II and 1 (1.9%) in group III (p=0,027). 76 patients had simultaneous nasal surgery to improve endoscopic surgical access to tear sac: 14 (21.2%), 53 (34.4%) and 9 (17.3%) respectively (p=0,022). Reoperation rate due to stoma closure was higher in the group I, presumably due to most of the control group was operated according to the gold standard in the beginning of the praxis. Simultaneously it coincided with lower technical support and lower experience of the surgeon. Preliminary results indicate that stent use does not affect the operation's outcome. Stenting conditions in endo-DCR, as well as other factors, is an area for further prospective study of our scientific group.

Abstract title:
Independently provided nurses appointments in East-Tallinn Central Hospital ENT-centre

Authors and co-authors names:
Anu Tammemäe, Maila Rikken

Authors and co-authors institutions, country:
1. Anu Tammemäe, RN, clinical nurse specialist - Centre of Ear, Nose and Throat Diseases, Surgery Clinic, East –Tallinn Central Hospital, Tallinn, Estonia 2.Maila Rikken, RN, advanced practice nurse specialist - Centre of Ear, Nose and Throat Diseases, Surgery Clinic , East –Tallinn Central Hospital, Tallinn, Estonia

Keywords:
Independent nursing care service; Team-work; Patient education; ENT

Abstract text:
East-Tallinn Central Hospital (ETCH) is the oldest health care institution in Estonia consistently providing medical services since 1785. Today we have 6 clinics – Diagnostic, Eye, Nursing, Surgery and Women´s Clinic, Clinic of Internal Medicine, Clinic of Medical Rehabilitation Care. ENT Centre (Ear-Nose- Throat) is the smallest centre in Surgery Clinic. We have 11 ENT- doctors, 20 nurses, 4 nurse aids, 2 speech therapists. We provide surgical care for adults and children from age 2, outpatient doctors  appointments, independently provided nurses appointments, voice therapy.  Starting from 2004 ENT Centre independently provided nurses appointments for patients with 3 nurses. First appointments were hearing evaluation (audiometry), hearing aid fitting procedure and hearing evaluation of newborn . Today we have 6 different nurses´ appointments.  Today independent nurses appointment are provided by 9 nurses and we have added 4 services - Health advice  in case of Dizziness, vertigo and balance disorders, rhinomanometry tests, pre operation consultations and clinic appointments for BAHA patients. In the year 2022 our centre provided 3716 independent nurses appointments. Hearing evaluation.  Audiometry nurse's appointment. For patients ages 6 and above:  Otoscopy; pure tone audiometry; bone conduction testing; speech testing; tympanometry; acoustic reflex testing, determination of loudness discomfort level Patient education about hearing hygiene (how to clean ears properly, usage of earphones, how not keep ones hearing in fit). For patients ages 3–5: play audiometry. Nurse´s appointment 5 days a week. A referral letter from a general practitioner or specialist is necessary for the appointment.We offer fee-based appointments for patients without a referral letter. Customized Hearing Aid Fitting Procedure. Audiometry nurse's appointment. For adult patients. The fitting and installation of hearing aids and hearing evaluation; Choosing Hearing Aid for patient; taking impressions of ears by the need; programming the hearing aid and patient education (care for your hearing aids. You will also need to learn how to replace the batteries and clean your hearing aids). Nurses´ appointment 5 days a week. A referral letter from ENT specialist is necessary for the appointment. Health advice in case of dizziness, vertigo and balance disorders. Conducting of balance tests for adult patients. BPPV (Benign Paroxysmal Positional Vertigo) treatment: positioning tests Dix- hallpike and Roll test.; treatment maneuvers – Eply, Semont, Lembert /BBQ Roll). Balance function rehabilitation: teaching exercises and training together with patient, evaluation of patients skills in performing these exercises, evaluation of dynamics – repeated appointments. Nurses´ appointment 4 times a month. A referral letter from ENT specialist is necessary for the appointment. Hearing tests for newborn, older babies and children. Audiometry nurse's appointment. Main goal is an early ascertainment of hearing loss. Children´s screening tests - otoacoustic emission (AOAE) test and automated auditory brainstem response (AABR) test for babies. Nurse´s  appointment once a week. A referral letter from ENT specialist or pediatrician is necessary for the appointment. Clinic appointments for Cochlear BAHA (Bone Anchored Hearing Aid) patients. Audiometry nurse's appointment for children and adults. After BAHA implantation. The fitting and installation of sound processor according to hearing test results, patient education (usage and care for hearing aid), technical aid. Nurse´s appointment as required. A referral letter from ENT specialist is necessary for the appointment.   Rhinomanometry test. Patient education how to collaborate during the test. Interpretation of test result and notification a doctor. Nurse´s  appointment once a week. A referral letter from ENT specialist is necessary for the appointment. Pre-operation consultations. Patient and family members preparation for the operation: requirements for patient before general anesthesia, personal medications admission before operation. Assessment of blood test and co-operation with doctor. Introduction to pain treatment after the operation. Nurse´s  appointment once a week. A referral letter from ENT specialist is necessary for the appointment.   In ETCH a nurse can provide independently appointments if licenced by the Board. Minimum requirements to get a licence are:   higher education in nursing, nurse -specialist education (clinical nurse specialist, advanced practice nurse specialist  ); work experience in clinical practice at least 2 years, mandatory advanced training courses 120 (AH) during past 2 years

Abstract title:
Infra-temporal fossae tumors: Description of endoscopic endonasal surgery approach, surgical anatomy and report of illustrative cases.

Authors and co-authors names:
Saulius Vaitkus(1), Silvija Ryškienė(2)

Authors and co-authors institutions, country:
1- Department of Otorhinolaryngology, Lithuanian University of Health Sciences 2- Department of Radiology, Lithuanian University of Health Sciences

Keywords:
Infra-temporal fossae, tumors, endoscopic surgery.

Abstract text:
The infratemporal fossa is a space located inferior and posterior to the maxilla (upper jawbone) and deep to the zygomatic arch (cheekbone). It is an anatomical region within the skull, specifically in the temporal bone area. The infratemporal fossa is bounded by various structures and contains important neurovascular structures. While the infratemporal fossa is traditionally approached through external approaches, such as lateral skull base surgery, there have been advancements in minimally invasive techniques that allow access to this region using an endoscopic endonasal approach. Infratemporal fossa tumors can occasionally be managed through endoscopic surgery, particularly when the tumor extends into the skull base or involves adjacent structures. However, the feasibility and appropriateness of this approach depend on the specific characteristics of the tumor and the expertise of the surgical team. The selection of patients for endoscopic endonasal surgery depends on various factors, including tumor characteristics (size, location, extent), patient anatomy, and the expertise of the surgical team. Tumors located in the medial and posterior infratemporal fossa is more suitable for endoscopic endonasal surgery. These techniques are often used for benign tumors, such as schwannomas, or selected cases of malignancies, where the tumor's size and extension are favorable for this approach. Endoscopic endonasal surgery involves accessing the infratemporal fossa through the nasal passages and creating a corridor to reach the tumor using visualization and specialized instruments to remove the tumor while preserving surrounding structures and minimizing trauma. This approach requires a multidisciplinary team, including neurosurgeons and radiologists. Collaboration among these specialists is crucial for preoperative planning, intraoperative decision-making, and postoperative care. It's important to note that endoscopic endonasal surgery for infratemporal fossa tumors is a specialized technique performed by experienced surgical teams. The selection of the surgical approach depends on various factors, and not all cases are suitable for this minimally invasive approach. Each patient's situation should be evaluated on an individual basis, considering factors such as tumor characteristics, surgical expertise, and patient anatomy.

Abstract title:
Is endoscopic diving technique effective in the surgical treatment of functioning pituitary adenomas? A prospective randomized study

Authors and co-authors names:
Donata Sukyte-Raube (1)

Authors and co-authors institutions, country:
Department of Ear, Nose and Throat. Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania - 1

Keywords:
endoscopic endonasal pituitary surgery; endocrinological remission; radiological remission, endoscopic diving technique, endoscopic sellar hydroscopy

Abstract text:
Objective/hypothesis: Endoscopic diving technique (EDT) is an effective, cheap, and easy to perform surgical tool to ameliorate remission rates in functional pituitary adenomas after the endoscopic endonasal transsphenoidal surgery. Study design: prospective randomized. Methods: This prospective randomized study was performed in Vilnius University hospital Santaros clinics in 2021-2023 after the approval from Lithuanian Bioethics Committee (No. 2021/6-1362-836). This study enrolled 68 patients (19 – 77 years) with functioning pituitary adenomas who met the inclusion criteria. Patients were randomly attributed to either EDT (patients who underwent endoscopic hidroscopy at the end of the endoscopic endonasal transpterygoidal tumor removal) or non-EDT (endoscopic hydroscopy was not performed) groups. Patients were followed up to 2 years after the surgery and the endocrine and radiologic remission was evaluated 3 and 6 months postsurgery and 1-2 years later. Data analysis included evaluation of surgical complications and their rates as well as subjective evaluation of the surgeon after each surgery: the benefit of the EDT, duration of the surgery and the amount of water used (in the EDT group). Results: 68 patients with functioning pituitary adenomas were enrolled in this prospective study: 41 of them were attributed to the EDT group and remaining 27 – to the non-EDT group. Groups did not differ neither based on the age (p<0.05) nor the tumor invasion (p<0.05). The hormonal profile of tumors distributed as follows: growth hormone-secreting adenomas (36.8%), prolactin-secreting adenomas (29.4%), adrenocotricotropic-secreting adenomas (26.5%), functional gonadotroph adenomas (2.9%), plurihormonal secreting adenomas (2.9%), and thyrotropin secreting adenomas (1.5%). Significantly more adrenocotricotropic-secreting adenomas were found in the EDT group compared to non-EDT group (14 versus 4, respectively, p=0.012), other types distributed statistically similarly between the groups. Data analysis demonstrated that the endocrine remission was more frequent in the EDT group; however, the difference was not significant. On the other hand, 3, 6 months and 1-2 years after the surgery significantly less radiologic relapses were observed in the EDT group: radiologic remission in the EDT group 3 months post surgery – 85.4% vs non-EDT group - 63.0% (p=0.043); 6 months post surgery – 80.5% vs 51.9% respectively (p=0,017); 12-24 months after the surgery – 65.9% vs 37.0% respectively (p=0,026). Complication rates were statistically similar between the study groups and EDT did not carry any additional complication risk to patients (4.9% of post-operative complications in the EDT group vs 3.7% in the non-EDT group (p=1.00). Conclusions: The use of the endoscopic diving technique after the endoscopic transsphenoidal surgery was associated with better endocrine and radiologic remission rates in functional pituitary adenoma patients. Frequency of complications was statistically similar between the study groups; however, subjectively, EDT was advantageous in improving tumor visualization, elevating displaced sellar diaphragm and reducing venous hemorrhage. Keywords: endoscopic endonasal pituitary surgery; endocrinological remission; radiological remission, endoscopic diving technique, endoscopic sellar hydroscopy.

Abstract title:
LABORATORY AND INSTRUMENTAL ANALYSIS OF INDICATORS IN CHRONIC TONSILLITIS COMBINED WITH HYPERKINETIC TICKS

Authors and co-authors names:
Zarina Egamberdieva

Authors and co-authors institutions, country:
Assistant of the Department of Otorhinolaryngology Tashkent Pediatric Medical Institute Tashkent, Uzbekistan

Keywords:
chronic tonsillitis, children, hyperkinetic ticks, streptococcus,ASL-O, B-hemolytic streptococcus

Abstract text:
Chronic tonsillitis occupies one of the first places among ENT diseases. Despite the achievements of modern medicine, the proportion of chronic tonsillitis does not decrease. The problem in otorhinolaryngology remains the initial contamination of ENT organs with conditionally pathogenic microflora. In the absolute majority (94.4%) of patients with CT, the microflora of the palatine tonsils is represented by microbial associations, which include Streptococcus pyogenes, Staphylococcus aureus, Streptococcus pneumoniae, as well as hemolytic streptococci of groups B, C, G, and F. [1]Ticks are the most common pathology in childhood, although their prevalence in the general population, according to various data, ranges from 3 [4] to 21% [5]. At the same time, it is known that some patients do not go to the doctor because of the insignificant severity of ticks [6]. Among school-age children, ticks are observed in 11–20%, and the prevalence of Tourette's syndrome is 5-7 cases per 10,000 children [7].The study aimed to conduct a comparative laboratory and instrumental characterization of patients with chronic tonsillitis with and without hyperkinetic ticks.We examined 64 children aged 7 to 18 years with chronic tonsillitis from 2020 to 2022 in inpatient conditions at the clinical base of the Tashkent Pediatric Medical Institute.All the examined children were admitted to the hospital with chronic tonsillitis, a toxic-allergic form. Of these, 40 (62.5%) were diagnosed with grade 1 TAF, and 24 (37.5%) had grade 2. When divided into the examined groups, it was found that, in patients of the main and comparative groups, the frequency of toxic-allergic form 1 and toxic-allergic form 2 did not significantly differ.In chronic tonsillitis with ticks, along with the presence of beta-hemolytic streptococcus group A, against the background of normative indicators of leukocytes, ESR, CRP, and RF, an increased level of ASL-O is detected.Chronic tonsillitis with ticks is characterized by the absence of organic lesions in brain structures. However, the presence of changes in the form of convulsive readiness is recorded.The seeding of B-hemolytic streptococcus was the same for both study groups, which means that the toxins of hemolysin, streptolysin, and hyaluronidase have the character of internal intoxication, but their effect on internal organs is individual.

Abstract title:
Laryngopharyngeal reflux diagnosis with pepsin salivary test

Authors and co-authors names:
Šiupšinskienė Nora (1), Bajorinienė Rasa (2)

Authors and co-authors institutions, country:
Hospital of Lithuanian University of Health Sciences Kauno Klinikos – 1, Republican Siauliai Hospital – 2

Keywords:


Abstract text:
Introduction: Since pepsin is only produced in the stomach, so it is a specific biomarker for gastric reflux and can be detected in all kinds of reflux contents, such as saliva, sputum, and even tears. With the introduction of the commercially available rapid lateral flow medical device for the detection of pepsin, the value of the pepsin saliva test in the clinical setting has increased. Objectives: To identify salivary pepsin in patients with clinically suspected laryngopharyngeal reflux (LPR) versus healthy controls and to assess relationships between positive pepsin test and person’s sociodemographic and clinical findings. Methods: In this prospective study, 40 consecutive adult patients with clinically suspected LPR based on their reflux-related symptoms and findings, as well as 17 healthy adult controls evaluated at the outpatient department of Lithuanian University of Health Sciences Hospital Kaunas Clinics, were selected. All participants were assessed using an original questionnaire for sociodemographic data, as well as the Lithuanian version of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) for LPR. The results of RSI>13 and RFS≥7 were considered abnormal. Samples of saliva/sputum for all the participants were investigated for the presence of pepsin with a non-invasive rapid lateral flow pepsin test (Peptest, RD Biomed Limited, UK). Results: Pepsin test was positive for most patients (72.5%) with suspected LPR unlike healthy ones (5.8%) (p<0.001). A stepwise logistic regression analysis revealed that five out of 23 investigated sociodemographic and clinical factors (posterior commissure hypertrophy, abnormal RFS, lingual tonsil hypertrophy, troubled breathing or choking episodes, and heartburn) were significantly related to the positive pepsin test results. Conclusions: Salivary peptest is non-invasive and simple LPR diagnostic tool that together with the RSI and RFS could be recommended for everyday clinical practice.

Abstract title:
Laser treatment of epistaxis in hereditary haemorrhagic telangiectasia. How we do it.

Authors and co-authors names:
J.Jurusaite (1), D.Sukyte-Raube (1)

Authors and co-authors institutions, country:
Department of Ear, Nose and Throat. Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania - 1

Keywords:
Diode laser; epistaxis; HHT; nasal endoscopy.

Abstract text:
Hereditary Haemorrhagic Telangiectasia (HHT) is a rare genetic disease characterized by an angiogenesis disorder that consists of vascular malformations in mucocutaneous tissues, internal organs and the central nervous system. Recurrent epistaxis is the most common clinical symptom and occurs in up to 95% of patients. Severity of epistaxis increases with age. Different methods of epistaxis magament are available: repeated tamponade, electrocautery, sclerotherapy, septodermoplasty and laser procedures. Diode laser is currently promising for patients suffering from HHT epistaxis. The aim of this report is to share our experience with the diode laser in this field. We use a modified contact method that allows us to affect the telangiectatic node through all layers. This method is safe, effective, gives us better results and helps avoid repeated interventions for 2-3 years.

Abstract title:
Leucocyte telomere length and related genes in patients with laryngeal squamous cell carcinoma

Authors and co-authors names:
Paulius Vaiciulis 1, Alvita Vilkeviciute 2, Rasa Liutkeviciene 3, Vykintas Liutkevicius 1, Greta Gedvilaite2, Akvile Aleksaite1, Virgilijus Uloza1

Authors and co-authors institutions, country:
1Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania. 2Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania. 3Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Keywords:
LTL, laryngeal cancer, TERT, TRF1, survival rate

Abstract text:
Introduction: Telomeres represent specialized DNA structures located at the ends of chromosomes. These structures and related genes are essential for chromosome integrity and genomic stability. Meta-analysis revealed that the short telomeres were related to increased overall cancer risk. However, there are studies in which data are controversial. Aim. To determine the associations of relative LTL and telomere-related gene polymorphisms (TERT (rs2736098), TERT-CLPTM1L (rs401681), TRF1 (rs1545827, rs10107605), TNKS2 (rs10509637, rs10509639)) with laryngeal squamous cell carcinoma development and the 5-year survival of the LSCC patients. Methods: This case-control study consisted of 300 patients with LSCC: 289 (96.3 %) males and 11 (3.7 %) females with a median age of 62.8 (SD 8.8) years and 369 healthy subjects: 357 (96.7 %) males and 12 (3.3 %) females with a mean age of 62.5 (SD 14.3) years. The LSCC patient and control groups were adjusted by age and gender. DNA samples of the represented population were extracted from peripheral venous blood. The real-time polymerase chain reaction method was used to measure telomere length and telomere-related gene polymorphisms. Statistical analysis was performed using „IBM SPSS Statistics 20.0“. Results: No significant differences in relative LTL between the LSCC and control groups were revealed. Comparative analysis of relative LTL in patient subgroups according to LSCC differentiation grade (G) revealed statistically significantly shorter relative LTL in LSCC subgroup G3 compared with G1 (p=0.033) and G2 (p = 0.023). We performed analyses of the 5-year survival rate of LSCC patients and the LTL distribution of short and long telomeres. We found statistically significant differences of LTL on the 5-year survival rate of patients p=0.041 short LTL shows the worse survival. Our results showed that the TERT rs401681 C/T genotype was associated with an approximately 30% decreased odds of developing LSCC in the codominant p=0.010 and overdominant p=0.013. C/T+T/T genotypes were also associated with approximately 30% decreased odds of developing LSCC in the dominant model p=0.021. We found significant impact of TRF1 rs1545827 CT allele distribution p=0.037 and worse survival on 5-year patient survival. Conclusion: Relative LTL may not be related to LSCC development. Carriers of the C/T and T/T genotypes of TERT rs401681 have a lower probability of LSCC development. Shortened relative LTL and TRF1 rs1545827 CT allele negatively influences the 5-year survival rate of LSCC patients. 

Abstract title:
Long-Term Effects of Otitis Media in Children on Speech Perception in Noise

Authors and co-authors names:
Samet KILIÇ, Didem TURKYILMAZ

Authors and co-authors institutions, country:
1- Department of Audiology, Trakya University Faculty of Health Sciences, Edirne, Turkey; 2- Department of Audiology, Hacettepe University Faculty of Health Sciences, Ankara, Turkey

Keywords:
otitis media, speech in noise, otitis media in children, long term effects

Abstract text:
Otitis media (OM) is a common childhood ear infection that affects the middle ear, the space behind the eardrum that contains the small bones (ossicles) that transmit sound from the eardrum to the inner ear. OM can cause fluid buildup and inflammation in the middle ear, which can lead to hearing loss and other auditory problems. One possible reason for this is that OM can cause damage to the tiny hair cells in the inner ear that are responsible for transmitting sound signals to the brain. This damage can result in a permanent loss of hearing sensitivity, particularly in the high-frequency range where many speech sounds occur. Children with a history of OM may also have trouble processing speech signals that are degraded by background noise, which can make it harder for them to understand what is being said. This study compares the speech perception in noise among normal-hearing children with a history of otitis media and their peers without a history of otitis media. This study includes 42 children and adolescents ranging in age from 8 to 17 years old (12.92 ± 2.58; 22 female). It consisted of 21 children with a history of otitis media (study group) and 21 children without a history of otitis media (control group). Speech in noise abilities of participants were evaluated with Hearing In Noise Test (HINT) and compared between groups. Mann-Whitney U non-parametric test was used to compare the results between groups. A significant difference was found between the HINT scores of the study and control groups (p>0.05). The study group's results were lower than the control group. Early diagnosis and treatment of OM are important for minimizing the long-term effects on speech perception and other aspects of development. Treatment options may include antibiotics, pain relievers, and surgical procedures, depending on the severity and cause of the ear infection. Regular hearing tests and follow-up care are also crucial for monitoring the child's hearing and addressing ongoing issues.

Abstract title:
Middle Ear Adenoma: Case Report

Authors and co-authors names:
Dr.Beatrise Rozenfelde 1,6 Dr.Arturs Barščevskis 1,2, Dr.Jūlija Starinska 5, Dr.Edīte Kreitāle 3, Dr.Tatjana Zablocka 4.

Authors and co-authors institutions, country:
1. Riga Stradiņš University, Riga, Latvia 2. Pauls Stradins Clinical University Hospital, Department of Otorhinolaryngology, 3. Pauls Stradins Clinical University Hospital, Department of Radiology, 4.Pauls Stradins Clinical University Hospital, Department of Pathology, Riga, Latvia 5. Daugavpils Regional Hospital, Department of Surgery, Daugavpils, Latvia 6. Ziemeļkurzemes Regional Hospital, Department of Otorhinolaryngology, Ventspils, Latvia

Keywords:
neoplasm, neuroendocrine adenoma, middle ear,

Abstract text:
Introduction:Middle ear neuroendocrine adenomas are very rare neoplasms, accounting for lessthan 2% of all middle ear and inner ear tumours. This diagnosis occurs over a wideage range more often patients aged 14-80 years old, the prevalence between the sexesis equal, and is not characterized by specific symptoms or findings. The most frequentcomplaints are ear fullness and unilateral hearing loss.Despite diagnostic imaging being widely available nowadays, diagnosis can bechallenging due to non-specific findings and the rare occurrence. The surgeon can stillbe surprised by the intraoperative findings and the results of histological examinationsin the postoperative period.Middle ear adenoma (MEA), also known as neuroendocrine adenoma of the middleear (NAME) or middle ear adenomatous tumour (MEAT), is a benign glandulartumour of the middle ear that includes cytomorphological and immunohistochemicalfeatures with neuroendocrine and mucinous differentiation.Case report: A 48-year-old woman turned to an otorhinolaryngologist with complaints ofdiscomfort and a feeling of fullness in her right ear. During the examination, the righttympanic membrane is retracted, dull, greyish, the light reflex is missing. The lefttympanic membrane is grey, shiny, with a distinct light reflex. Pure tone audiometryand tympanometry were performed, without pathological findings.After one month, the patient undergoes a CT scan of the pyramids. Following the CTscan, the patient repeatedly consults an otorhinolaryngologist. She complains of apersistent feeling of fullness in the right ear; the patient denies new complaints.Surgical therapy is appointed. Right ear surgery was performed - excision of theformation, revision of the tympanic cavity and tympanoplasty with a flap ofm.temporalis fascia and cartilage perichondrium.The result of histological examination (haematoxylin-eosin staining method): Thesent material contains a mass consisting of glands located close to each other,confluent in places with round-shaped basophilic cells. CKAE1/3 positive,chromogranin positive, synaptophysin positive, Ki67 positive 2-3%. Themorphological and immunohistochemical picture is consistent with an adenoma withneuroendocrine differentiation.MRI examination after surgery; conclusion: Content in the upper part of the righttympanic cavity, in the mastoid cells, without a change if compared to the previousMRI examination before surgery.Pure tone audiometry and tympanometry were performed.Pure tone audiometry after surgery showed a sensorineural hearing loss at 2KHz8KHz of 40-70dB.Tympanometry showed type B findings in the right ear.Conclusions:- In this case report, we present the details of a rare case of neuroendocrineadenoma of the middle ear. Middle ear neuroendocrine adenomas areextremely rare neoplasms, accounting for less than 2% of all middle ear andinner ear tumours.- Patients with middle ear adenoma usually present with nonspecific clinicalfindings usually unilateral hearing loss and ear fullness. A diagnosis is oftendelayed due to the rearity of this tumor, and biopsy is usually needed to reacha definite diagnosis. In most cases, such as in ours, cholesteatoma is the firstsuspect.- The differential diagnosis of middle ear adenoma is broad and includescarcinoid tumor, schwannoma, teratoma, meningioma, congenitalcholesteatoma, and paraganglioma of the middle ear.- Tumours of the middle ear has previously been described by many namesincluding neuroendocrine adenoma of middle ear (NAME), middle earadenomtous tumour (MEAT) carcinoid tumour of the middle ear.- A pathological examination is required to differentiate middle earneuroendocrine adenoma.- Preoperative radiological findings does not always correlate withintraoperative findings and clinical symptoms. ENT surgeons should keep anopen mind and be prepared to change their plan during surgery according tointraoperative findings.- Surgical treatment is main therapy, adjuvant radiotherapy and chemotherapy isnot recommended.- Taking into account the number of recurrences described in the literature,which is around 15%, it is not excluded that the patient in our case will needrepeated surgical treatment, provided that radical surgery is not performed.- CT of the pyramids in this particular case, along with the diagnostics of smallmiddle ear lesion would be more informative. The radiological signs of smalllesions can be very similar; the more common lesions can be differentiated bytheir location. It should be noted that the radiological diagnosis of smalllesions is not simple and often depends on the knowledge and attention of theinvolved physician.- MRI examination in the cholesteatoma programme is considered aninformative examination even in the case of small lesions.- Considering the rare occurrence of adenomatous formations of the middle ear,it can be concluded that the successful diagnosis of these formations is a teameffort, which can be implemented in close cooperation between anotolaryngologist, a radiologist and a histologist.

Abstract title:
Minimally invasive interventions in laryngeal diseases

Authors and co-authors names:
Marius Polianskis 1,2. Arnoldas Morozas 1,2.

Authors and co-authors institutions, country:
(1) Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University. (2) Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santaros Clinics.

Keywords:
office-based laryngology, vocal fold palsy, spasmodic dysphonia, TruBlue laser.

Abstract text:
Technological and research advancements offer otolaryngologists opportunities to help patients by decreasing the scope of intervention and time spent in healthcare facilities. We would like to share our experience with minimally invasive laryngeal interventions in VULSK.  Different conditions can be managed with minimally invasive techniques. Unilateral vocal fold palsy symptoms could be decreased early with an injection of Hyaluronic acid into the vocal fold. Injections could be performed in the operating room or the office with the benefit of no general anesthesia-related risk.    Spasmodic dysphonia is a rare condition that causes involuntary spasms in vocal fold muscles. Botulinum toxin injections into vocal or vestibular folds are one of the most common treatment options. These procedures could be safely performed in an outpatient setting with good cooperation from the patient.  With advancements in laser technology, a new 445 nm laser with a wavelength that is absorbed by hemoglobin is introduced. It is really useful in conditions like recurrent respiratory papillomatosis - which has a lot of blood vessels. We present first cases of our clinic experience and future possibilities of outpatient procedures for the patients.  In conclusion the field of minimaly invasive procedures in laryngology promises exciting opportunities for otolaryngologists and their patients.  

Abstract title:
Mobile Virtual Reality-based System for Evaluation of Subjective Visual Vertical in Otoneurological Practice

Authors and co-authors names:
Tautvydas Klėgėris, Ingrida Ulozienė, Milda Totilienė

Authors and co-authors institutions, country:
Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Keywords:
Otoneurology, virtual reality, verticality, perception

Abstract text:
Introduction The subjective visual vertical (SVV) test evaluates subject’s perception of verticality and its deviations from the true earth’s gravitational vertical. It is a sensitive test of vestibular function and condition of central multisensory integration which is responsible for processing afferent inputs from various receptors of spatial orientation. Therefore the SVV reflects both peripheral and central vestibular function. Multiple sclerosis (MS) patients show significant deviations of the SVV most likely due the altered central integration of sensory inputs. Most prior studies measure SVV in upright head possition, therefore we aim to investigate possible SVV misperception during lateral head tilts for MS patients. Head tilts of 30 degree create conditions of noisy vestibular and somatosensory inputs needing higher degree of central integration thus we expect to find larger deviations of SVV for these patients and further confirm the importance of peripheral and central components for spatial orientation. Aim To measure the subjective visual vertical for multiple sclerosis patients in both upright and head tilt conditions and to evaluate its correlations with course of the disease. Methods The study group consists of MS patients with relapsing remitting form who are included in the study during the exacerbation of disease. Healthy volunteers without vestibular and neurological impairments will form the control group. The SVV is measured utilizing a portable virtual – reality based system QUEST 2 which enables to perform the test in static and dynamic conditions as well as during 30 degree lateral head tilts. Systematic errors during head tilt, i.e., A-effect and E-effect were also measured (E-effect is a typical SVV response during head tilts of ± 30°). Statistical analysis is performed using IBM SPSS 27.0. The Nonparametric Mann-Whitney U or Kruskal-Wallis tests were applied to compare quantitative data among independent groups. In all of the tests, the differences and relationships were considered statistically significant if P<0.05. Results Currently, 14 MS patients and 14 controls are enrolled in the study. SVV misperception was significantly higher in upright head position with dynamic conditions for MS patients. SVV misperception did not differ in static upright testing between MS and control groups. SVV misperception was significantly higher during lateral head tilts when compared to upright testing for both groups, but did not differ between groups. We found bilateral E – effect for 100% of the control group participants. The presence of A – effect was found on at least one of the tests (static or dynamic) for 8 (57%) MS patients: 3 bilateral and 5 unilateral Conclusions/discussion Upright SVV testing in dynamic conditions is more sensitive than static testing for detection of abnormalities in verticality perception for MS patients which is in line with previous data. Asymmetrical and noisy vestibular and proprioceptive signals lead to higher SVV errors during head-tilted SVV testing. MS patients did not show significantly higher misperception of verticality during lateral head tilts compared to healthy controls – opposite to our hypothesis. The presence of pathological A – effect could be potentially helpful for detecting central lesions with the SVV test. We conclude that clinicians should focus on the side to which the SVV deviates rather than the magnitude of perceptual errors when testing SVV in head tilt conditions.

Abstract title:
Morphological differences between an adult and pediatric acquired cholesteatoma

Authors and co-authors names:
Kristaps Dambergs (1,2), Gunta Sumeraga (1), Māra Pilmane (3)

Authors and co-authors institutions, country:
1 - Department of Otorhinolaryngology, Rīga Stradiņš University, Latvia; 2 - Children’s Clinical University Hospital, Latvia; 3 - Department of Morphology, Institute of Anatomy and Anthropology, Rīga Stradiņš University, Latvia.

Keywords:
Cholesteatoma, cytokines, remodelling factors, Ki-67, transcription factor.

Abstract text:
Introduction. The aim of this study is to compare proliferation marker Ki-67, transcription factor NFκβ, pro- and anti-inflammatory cytokines IL-1 and IL-10, remodelling factors MMP-2, MMP-9, TIMP-2, TIMP-4, in a cholesteatoma’s matrix and perimatrix in an adult and pediatric population.             Materials and Methods. Tissues were obtained from 19 adults and 21 children during cholesteatoma surgery. Tissues were immunohistochemically stained for Ki-67 and NFκβ, IL-1, IL-10, MMP-2, MMP-9, TIMP-2, TIMP-4. The slides were analysed by light microscopy using a semi-quantitative method. Non-parametric statistical analysis – Kruskal – Wallis’s test was used to detect statistical differences between groups.             Results. Ki-67 mean number was occasional (0/+) and NF-κβ – few to moderate (+/++) positive cells in both groups. A few to moderate (+/++) IL-1 and IL-10 factor positive cells were observed in adult and pediatric groups. Mean values of MMP-2 positive cells were a few to moderate (+/++), MMP-9 – occasional (0/+), TIMP-2 – a few (+), TIMP-4 – moderate to numerous (++/+++) in both groups. Similar positive correlations were found in both groups between the following: Ki-67 in perimatrix and NF-κβ in perimatrix (r=0.538 adults, r=0.641 children), IL-1 in matrix and IL-1 in perimatrix (r=0.583 adults, r=0.718 children), IL-1 matrix and IL-10 matrix (r=0.820 adults, r=0.734 children), IL-1 matrix and IL-10 perimatrix (r=0.777 adults, r=0.781 children), IL-1 perimatrix and IL-10 perimatrix (r=0.600 adults, r=0.697 children), IL-10matrix and IL-10 perimatrix (r=0.839 adults, r=0.748 children), MMP-2 in matrix and perimatrix (r=0.626 adults, r=0.918 children), MMP-9 in matrix and perimatrix (r=0.635 adults, r=0.682 children) and TIMP-2 in matrix and perimatrix (r=0.697 adults, r=0.708 children).   Conclusions. The appearance of tissue factors in cholesteatoma do not depend on the patient’s age. Similar average values of IL-1, IL-10 and their strong intercorrelations in both groups, prove the same mechanism against the inflammation regardless the age. The increased MMP-2 and TIMP-4 suggest the presence of intensive remodulation in non-age depending cholesteatoma. The elevation of Ki-67 and NF-κβ (compared to control group) and their intercorrelation prove hyperproliferative activity of cholesteatoma’s cells regardless the age.

Abstract title:
Motion sickness. How motion disorders the body?

Authors and co-authors names:
Aistė Paškonienė 1 2, Jelizaveta Kogan 1 2

Authors and co-authors institutions, country:
1) Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University. 2) Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santaros Clinics.

Keywords:
motion sickness, kinetosis, sensory conflict, nausea

Abstract text:
Motion sickness (kinetosis) is common complex syndrome that occurs as a physiological reaction to real or percepted motion. It covers a wide spectrum of clinical presentations with nausea, vomiting and dizziness being the most common symptoms. Kinetosis can be experienced by any individual with healthy labyrinthine function. The risk depends on the individual susceptibility, strength and duration of the provocative factor. Physiologically vestibular, somatosensory, and visual afferents provide information about body posture and body movements  with three afferent pathways complementing each other. In case of motion sickness a mismatch of sensory information occurs. The most current explanation of motion sickness is based on the sensory conflict theory. Treatment methods covers nonpharmacological (habituation training, behavioral modifications, acupressure and use of ginger) and pharmacological measures. Pharmacological treatment includes groups of anticholinergic, antihistaminic and sympathomimetic drugs. Since prevention of motion sickness is more important than treatment, it is recommended to start a therapy before symptoms starts to develop. The discomfort caused by motion sickness negatively affects the patient's well-being and quality of life, based on that it is essential to apply right measures at the right time.

Abstract title:
Multidisciplinary approach to skull base tumors

Authors and co-authors names:
Justinas Vaitkus (1), Karolis Bareikis (2)

Authors and co-authors institutions, country:
(1) Department of Otorhinolaryngology, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas Lithuania. (2) Department of Neurosurgery, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas Lithuania.

Keywords:
Skull base, tumors, team approach, endonasal surgerey, open surgery

Abstract text:
Skull base tumors are a diverse group of neoplasms that arise in the complex anatomical region at the base of the skull. Due to the intricate anatomy and proximity to critical structures, these tumors pose unique challenges in terms of diagnosis and management. In recent years, there has been a growing recognition of the importance of a multidisciplinary approach in the evaluation and treatment of skull base tumors. This presentation aims to explore the significance of a multidisciplinary approach and its impact on patient outcomes.

Abstract title:
Nasal cryotherapy in pediatric care: experience of VUL SK Pediatric ENT department

Authors and co-authors names:
Gabrielė Žakienė (1)

Authors and co-authors institutions, country:
1- Pediatric ENT department, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.

Keywords:
cryosurgery, cryotherapy, chronic rhinitis.

Abstract text:
Pediatric nasal and throat diseases are common conditions in childhood that can cause discomfort and disrupt daily activities. Traditional treatment methods, such as medication or surgical interventions may have side effects or be ineffective in children with chronic rhinitis. Cryotherapy is a minimally invasive procedure that uses nitrous oxide or liquid nitrogen as a cooling agent and induces necrosis by freezing the tissue. It works by inducing scarring and direct destruction of mucosa and submucosal tissue. Cryosurgery has been used successfully in a variety of specialties and also can be used in the management of pediatric nasal and throat diseases. It has a number of advantages, including ease of use, minimal infection rate, no bleeding intraoperatively and usually does not require surgical incision or anesthesia. According to the studies, it is a safe, comfortable, cost-effective procedure and readily accepted by patients, has a positive safety profile attributed to the limited depth of penetration, minimizing the potential impact on surrounding bone and cartilage. It does not only provide a scaffold for tissue repair and optimal healing, but also minimizes the potential of damage to larger blood vessels. Minor effects include post-procedural pain and discomfort, headache and palate numbness. Cryotherapy significantly and clinically improves chronic rhinitis symptoms and quality of life with outcomes that are durable through 24 months after treatment, reducing the need for further treatment or surgical intervention. In summary, pediatric cryosurgery is an effective alternative to traditional treatment methods for pediatric chronic rhinitis, especially when turbinate reduction surgery is debatable in children. Although cryotherapy appeared safe and efficacious, low-quality evidence made strong that further research and long-term monitoring would be beneficial to validate the efficacy of cryosurgery in pediatric populations.

Abstract title:
Odontogenic Rhinosinusitis

Authors and co-authors names:
Regimantas simuntis(1), Saulius Vaitkus (2), Žygimantas Vaitkus (3)

Authors and co-authors institutions, country:
1- Department of Oral and Maxillofacial Surgery 2- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lietuva. 3- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lietuva.

Keywords:
odontogenic, rhinosinusitis

Abstract text:
Odontogenic rhinosinusitis is a condition characterized by inflammation and infection of the maxillary sinuses that originates from dental infections. Research in the field of odontogenic rhinosinusitis focuses on several key areas to improve understanding, diagnosis, and treatment of the condition. By focusing on these research areas, our aim is to enhance understanding of odontogenic rhinosinusitis and improve diagnostic accuracy, treatment outcomes, and overall patient care. Aim is to evaluate the importance (role) of diagnostic radiology tests and questionnaires in optimizing the treatment of odontogenic rhinosinusitis. 200 patients with chronic rhinosinusitis (odontogenic and rhinogenic origin) were selected and divided into two groups regarding radiologic examinations (periapical (DPA), panoramic (DPR) and computed tomography (CT)) and completed the SinoNasal Outcome Test 22 (SNOT-22) questionnaire. SNOT-22 was filled before and 3 months after the treatment. The study comparing the ability of different specialists to identify the dental cause of maxillary sinusitis using various imaging techniques demonstrated that CT views evaluated by experienced radiologists and surgeons had the highest diagnostic accuracy, with AUC values of 0.958 and 0.859, respectively. The sensitivity and specificity of CT in identifying the dental cause of maxillary sinusitis were found to be up to 94.6%. Regarding the symptoms and health-related quality of life (HRQL) in patients with odontogenic and rhinogenic sinusitis, utilizing the SNOT-22 questionnaire identified that the presence of malodor is the most characteristic symptom of OMS (p=0.01). However, the total SNOT-22 score did not differ significantly between the OMS and RS groups. Reevaluating SNOT-22 after treatment showed that 77.1% of patients with chronic odontogenic rhinosinusitis experienced full resolution of symptoms after eliminating the dental cause. For the remaining 22.9% of patients, persistent symptoms indicated the need for sinus surgical treatment. This study emphasizes the importance of accurate diagnosis using diagnostic radiology tests and questionnaires in determining the dental cause of maxillary sinusitis. The findings also shed light on the differences in symptom patterns and HRQL between patients with OMS and RS, with malodor being a notable characteristic of OMS. Eliminating the dental cause through appropriate treatment can lead to symptom resolution, and the presence of malodor can be an indicator of treatment success.

Abstract title:
Osteoarthritis of the head of the stapes in the course of otosclerosis

Authors and co-authors names:
Agnieszka Wiatr (1), Kazimierz Niemczyk (2) Robert Bartoszewicz(2), Kamila Szpak (3), Maciej Wiatr (1)

Authors and co-authors institutions, country:
1 - Department of Otolaryngology Jagiellonian University Medical College 2 - Department of Otolaryngology, Head and Neck Surgery of the Medical University of Warsaw 3 - University Hospital of Krakow

Keywords:
otosclerosis, Scanning Electron Microscopy, stapes overload changes

Abstract text:
Introduction: Hearing loss is a disease of heterogeneous etiology. Over 6% of the world's population lives with a hearing impairment that can adversely affect development, education and overall health. One of the related causes of acquired hearing impairment is otosclerosis. Otosclerosis is a primary disease of multifactorial etiology, the essence of which is the process of bone tissue remodeling in various areas of the temporal bone. The presence of otosclerotic foci in the oval window immobilizes the base of the stapes, disturbing the process of conducting vibrations to the inner ear and changing the distribution of forces during vibrations, leading to overload changes in the articular surfaces in the auditory ossicles. Aim: Analysis of the degree of damage to the surface of the stapes head as a component of the incus-stapes joint in the course of otosclerosis.     Material and method: The analysis included 31 patients operated on due to otosclerosis in the years 2020-2021 (Group 1) and 5 patients operated on due to a acoustic neurinoma (control group). The study was carried out using Scanning Electron Microscopy with a variable vacuum in the range of 0.3 - 0.6 Torr. The analysis of the chemical composition was carried out using the Raymond Gauvin correction procedure (Variable Pressure method), measuring two spectra at two different CO2 pressures and then extrapolating the maximum values ​​of individual peaks to zero gas pressure. Results: The bone tissue forming the stapes heads was identified in both groups as hydroxyapatite with a predominance of calcium hydroxyphosphate with a Ca/P ratio of 1.667 - 1.691. In group 1, in all preparations obtained from patients diagnosed with otosclerosis, in contrast to the control group, various types of damage to the surface of the bone tissue of the stirrup head were observed. Conclusions: Analysis of the stapes head using SEM in patients with otosclerosis compared to the control group did not reveal differences in chemical composition and the presence of otosclerotic foci. Immobilization of the base of the stirrup by otosclerotic foci leads to overloads in the incus and stapes joint and ultimately to the remodeling of the articular surface of the stapes head.

Abstract title:
Otitis Externa Management in Primary Care: Are We Over-Prescribing Oral Antibiotics?

Authors and co-authors names:
Sabina Dranova, Mohamad Nazmi Nordin, Naveen Goddard, Tom Robson, Misha Verkerk, Viktoria Grammatopoulou

Authors and co-authors institutions, country:
ENT Department, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK

Keywords:
ENT, Otitis externa, GP

Abstract text:
Aim The NICE Clinical Knowledge Summary (CKS) strongly recommends against the use of systemic antibiotics for uncomplicated Acute Otitis Externa (OE), unless there is an extension outside the ear canal. From our initial audit cycle, overprescribing oral antibiotics for OE remains an issue. This study aims to compare the assessment and initial management of OE referred to our Emergency Clinic, against an acceptable standard. Method Retrospective analysis of a single cohort; adults (16 years and above) with OE with or without Pinna Cellulitis, Necrotising Otitis Externa or concurrent Otitis Media, who were referred to our Emergency Clinic, were included. Three cycles of analysis were done, with interventions introduced in between cycles. Interventions include distributing electronic and physical infographic summaries of NICE CKS guidelines in OE management and delivering targeted teaching to GP trainees during the GP Regional Teaching Day. Results The percentage of patients who had ear swabs taken for culture and sensitivity by the GP improved from 21% (first cycle) and 14% (second cycle) to 30% in the third cycle. The percentage of patients who receive inappropriate oral antibiotics improved from 33% (first cycle) and 52% (second cycle) to 22% in the third cycle. Conclusions Interventions implemented led to positive outcomes; the better practice of taking ear swabs by the GP in case of initial treatment failure, and a reduction in the rate of inappropriate oral antibiotics given for OE. Continuous guided training and teaching are essential to ensure a high-quality practice assessing and managing primary care OE.   

Abstract title:
Paranasal sinus mucoceles – a case series review of Republican Vilnius University hospital ENT department

Authors and co-authors names:
Svajūnas Balseris (1), Giedrius Strazdas (1)

Authors and co-authors institutions, country:
Republican Vilnius University Hospital, Lithuania - 1

Keywords:


Abstract text:
Mucoceles of the paranasal sinuses are slowly growing, locally expansive epithelial lesion with osteolytic features that can involve surrounding structures such as the orbit and intracranial cavity. Commonly mucoceles form secondary to obstruction of a sinus outflow tract or from mucosal gland entrapment from chronic infection, inflammation, iatrogenic trauma, external trauma, or neoplasm. Symptoms usually arise from the nasal obstruction or compression of surrounding structures. Mucoceles should be remembered in the differential diagnosis of intranasal tumors. Computed tomography and magnetic resonance imaging are helpful in making the diagnosis. Endoscopic sinus surgery may be a viable treatment for paranasal sinus mucoceles and external approach is rarely necessary. We have reviewed the management of 21 patients with 22 mucoceles of paranasal sinus in ENT department of Republic Vilnius University Hospital. The diagnosis of mucocele was established on the basis of medical history, physical examination, CT scans of the paranasal sinuses and intraoperative findings. A total of 22 mucoceles of 21 patients – 5 sphenoidal, 4 ethmoidal, 4 frontoethmoidal, 6 frontal, 2 maxillary and 1 middle turbinate.  7 patients developed mucocele following previous sinus surgery and 6 after the sinus fracture. 6 cases had well documented history of the chronic rhinosinusitis with or without nasal polyps and 3 cases unknown etiology.   All patients were treated surgically using endoscopic approach in 16 cases, external approach in 3 cases and combined – external and endonasal endoscopic approach in 3 cases. 2 complications occurred during frontal sinus mucocele surgery – CSF leak. Endoscopic sinus surgery appears as an effective method in majority of well-selected cases of paranasal sinus mucoceles.

Abstract title:
Pilot program of hearing screening newborn: findings from a 2-Year study

Authors and co-authors names:
Inoyatova F.I. (2) Primako V. (1) Nadjimutdinova N.Sh. (3) Abdukayumov A.A. (4) Mahmudov.M.U (5)

Authors and co-authors institutions, country:
1 - Republic Specialized Scientific Practice medical center of Pediatrician. Uzbekistan, Tashkent 2 - Head of program of rehabilitation for children with hearing loss, Republic Specialized Scientific Practice medical center of Pediatrician. Uzbekistan, Tashkent 3 - department of ENT, Republic Specialized Scientific Practice medical center of Pediatrician. Uzbekistan, Tashkent 4 - chief physician Republic Specialized Scientific Practice medical center of Pediatrician. Uzbekistan, Tashkent 5 - department of ENT, Republic Specialized Scientific Practice medical center of Pediatrician. Uzbekistan, Tashkent

Keywords:
screening programs, hearing, newborn

Abstract text:
Untreated hearing loss has a serious impact on a child's speech, intellectual, social and emotional development. Early diagnosis of hearing impairment in children is possible only through audiological screening during a mass examination of newborns. There are 2 approaches to identifying newborns with hearing impairment: examination of hearing in children with risk factors for hearing loss; hearing screening for all newborns. General hearing screening programs exist in a number of countries, including the US, Austria, the Netherlands, Belgium, the UK, and Israel. To date, the average age of detection of congenital hearing loss in Uzbekistan is 3.5 years and older, while the age of children for cochlear implantation is 4.3 years. The need for a general hearing screening for all born children is a requirement of the modern social policy of our state. Efficiency and cost-benefit for health will be evaluated in a pilot project on newborn hearing screening in Uzbekistan in the city of Tashkent. It is expected that such a program will be added to the provisions related to the prevention of hearing pathology in children within the healthcare system of Uzbekistan and will become the National Program of the state as part of the commitment to WHO priorities for the prevention and rehabilitation of severe disabling hearing pathologies. Material and methods: Hearing screening was performed in 104770 newborn in 2021-2022 in Tashkent. Hearing screening testing included transient evoked otoacoustic emission (TEOAE), automatic auditory brainstem response (AABR), or a combination of OAE and AABR. In 2021, a system of a two-stage screening protocol was introduced: the first stage - TEOAE in maternity complexes if the test is not passed - combined screening (TEOAE and AABR), the second stage - the pediatrics center - an audiologist monitoring tracking and conducting an extended hearing test with consultation of deaf teachers and a psychoneurologist with CT and MRI research. In 2022, the protocol was changed and a three-stage screening protocol was introduced: the first stage - TEOAE in maternity complexes, the second stage - TEOAE and AABR in the regional center by an audiologist who also conducts daily tracking at the same time, the third stage - the pediatrics center - an extended hearing test with consultation of deaf teachers and a psychoneurologist with CT and MRI examination - to determine the degree of the form of hearing loss and treatment management. Results: The results for 2021 showed that screening coverage was 80.7%, at the first stage of the protocol, normal hearing was observed in 72.9%, errors were 26.9%, the test failed (hearing pathology) - 0.13%. The results of 2022 showed - screening coverage of 88.4%, at the first stage of the protocol, normal hearing was observed in 88.9%, errors were 10.8%, the test failed (hearing pathology) - 0.21%. We note the moments of 2021 - at the first stage, a combined screening system (OAE and AABR) was introduced in case of failure to pass the test, but experience has shown that only in 3 cases the test was completed, in other cases the newborn was sent to the second stage. Also, the results of 2021 showed that the time of the combined test was extended, the costs increased, the need to replenish consumables and monitor its availability was required. Also, the Stage 2 audiologist was not specifically responsible for screening – screening was an additional responsibility to the main job of the audiologist. Moments of 2022 - at the first stage, combined screening was abandoned if the test was not passed, a three-fold repetition of the OAE was recommended. A specialist audiologist responsible for screening and its monitoring was assigned separately with a separate allocation of staff. Discussion. For Uzbekistan, the introduction of a three-stage newborn hearing screening system turned out to be more effective and led to better results and control over the first stage with higher coverage, lower costs. Despite the higher sensitivity and specificity of AABR, its introduction at the first stage is inappropriate, as this will increase the cost of screening and lengthen the time of the first stage. Also, the inclusion of the second stage at the regional level will allow monitoring the work of regional services for registering children with hearing pathology and maintaining them after the stage of operations and monitoring of hearing aids.

Abstract title:
POST-TONSILLECTOMY HEMORRHAGE RANGE – DO WE NEED AN AGREEMENT/CRITERIA WHAT TO CALL IT?

Authors and co-authors names:
Greta Rokaitė, Lukas Pamerneckis, Rūta Pribuišienė, Tomas Balsevičius

Authors and co-authors institutions, country:
Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania

Keywords:
Tonsillectomy; hemorrhage, incidence

Abstract text:
Authors: Greta Rokaitė1, 6th year, Lukas Pamerneckis1, 5th year Supervisors: Rūta Pribuišienė2, Prof., Tomas Balsevičius2, Prof. 1 Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania  2 ENT department, Hospital of Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania  Background and aim of the study. The occurrence rate of post-tonsillectomy hemorrhage (PTH) varies between 1.5% to 20% according to studies and inclusion criteria. However, there is no agreement on the criteria to classify a case as PTH. To compare frequency of this dangerous complication we need to analyze its range, severity, and management. These data could help to establish criteria of PTH. Therefore, we decided to conduct this study.  Methods and materials. In this retrospective cohort study, a total of 2683 patients who underwent tonsillectomy alone or with adenoidectomy (T&A) at ENT department of LUHS in 2017-2021 were included. From this cohort, 236 patients were hospitalized because of PTH. Information from medical documentation of these patients was retrospectively collected and analyzed. Statistical data analysis was performed using the SPSS 19.0 package.  Results. PTH frequency was 9.5%. After exclusion of patients with spontaneous cessation of bleeding during hospitalization (patients who did not require the use of hemostatic agents in the doctor's office or operating room) and cases with no recurrence of PTH during hospitalization, the frequency of PTH was determined to be 5.6%. Conclusions. The incidence of PTH is based on diagnostics criteria. There is a need to establish a consensus on the precise definition and diagnostic criteria to assign a case as PTH, because otherwise there is a possibility of misinterpretation of the clinical data. Keywords. Tonsillectomy; hemorrhage, incidence.

Abstract title:
Progress in Transoral Laser Microsurgery (TOLMS) for Laryngeal Cancer: An Overview of Recent Literature and the LUHS Department of Otorhinolaryngology's Clinical Experience

Authors and co-authors names:
Evaldas Padervinskis

Authors and co-authors institutions, country:
Department of Otorhinolaryngology, Lithuanian University of Health Sciences.

Keywords:
TOLMS, laryngeal cancer.

Abstract text:
Abstract: Transoral Laser Microsurgery (TOLMS) has emerged as a promising treatment modality for early-stage laryngeal cancer, offering a minimally invasive approach with reduced morbidity and improved functional outcomes. My oral presentation aims to evaluate the current status of TOLMS in the management of laryngeal cancer, highlighting its advantages, technical considerations, and potential challenges.   In the lecture I will focused on a comprehensive review of the literature on TOLMS in laryngeal cancer, on its indications, surgical technique, oncological outcomes, and functional results and  expanding role of TOLMS in more advanced disease stages and the integration of this modality with other treatment options, such as radiotherapy and chemotherapy shortly . In the literature  TOLMS is a reliable and effective treatment option for early-stage glottic and supraglottic cancer, with comparable oncologic outcomes to traditional approaches, such as open surgery and radiotherapy. The minimally invasive nature of TOLMS results in reduced postoperative morbidity, quicker recovery times, and improved voice and swallowing function. Technical considerations for successful TOLMS include adequate exposure of the surgical field, precise control of laser parameters, and a thorough understanding of the relevant anatomy. Challenges in performing TOLMS include limited exposure in cases with unfavorable anatomy and the potential for inadequate resection margins in larger tumors. The role of TOLMS in advanced laryngeal cancer is still evolving, with encouraging results in selected cases of T3 and T4 tumors. Further studies are needed to better define the indications and optimal treatment algorithms for these patients. Additionally, the integration of TOLMS with other treatment modalities, such as radiotherapy and chemotherapy, offers the potential for organ preservation and improved outcomes in advanced disease. In conclusion, TOLMS has established itself as a valuable tool in the treatment of early-stage laryngeal cancer, offering minimally invasive management with favorable oncologic and functional outcomes. Continued advancements in surgical techniques and multidisciplinary approaches will help to further expand the possibilities of TOLMS in laryngeal cancer treatment.  

Abstract title:
Progress in Transoral Laser Microsurgery (TOLMS) for Laryngeal Cancer: An Overview of Recent Literature and the LUHS Department of Otorhinolaryngology's Clinical Experience

Authors and co-authors names:
Evaldas Padervinskis

Authors and co-authors institutions, country:
Department of Otorhinolaryngology, Lithuanian University of Health Sciences.

Keywords:
TOLMS, laryngeal cancer.

Abstract text:
Abstract: Transoral Laser Microsurgery (TOLMS) has emerged as a promising treatment modality for early-stage laryngeal cancer, offering a minimally invasive approach with reduced morbidity and improved functional outcomes. My oral presentation aims to evaluate the current status of TOLMS in the management of laryngeal cancer, highlighting its advantages, technical considerations, and potential challenges.   In the lecture I will focused on a comprehensive review of the literature on TOLMS in laryngeal cancer, on its indications, surgical technique, oncological outcomes, and functional results and  expanding role of TOLMS in more advanced disease stages and the integration of this modality with other treatment options, such as radiotherapy and chemotherapy shortly . In the literature  TOLMS is a reliable and effective treatment option for early-stage glottic and supraglottic cancer, with comparable oncologic outcomes to traditional approaches, such as open surgery and radiotherapy. The minimally invasive nature of TOLMS results in reduced postoperative morbidity, quicker recovery times, and improved voice and swallowing function. Technical considerations for successful TOLMS include adequate exposure of the surgical field, precise control of laser parameters, and a thorough understanding of the relevant anatomy. Challenges in performing TOLMS include limited exposure in cases with unfavorable anatomy and the potential for inadequate resection margins in larger tumors. The role of TOLMS in advanced laryngeal cancer is still evolving, with encouraging results in selected cases of T3 and T4 tumors. Further studies are needed to better define the indications and optimal treatment algorithms for these patients. Additionally, the integration of TOLMS with other treatment modalities, such as radiotherapy and chemotherapy, offers the potential for organ preservation and improved outcomes in advanced disease. In conclusion, TOLMS has established itself as a valuable tool in the treatment of early-stage laryngeal cancer, offering minimally invasive management with favorable oncologic and functional outcomes. Continued advancements in surgical techniques and multidisciplinary approaches will help to further expand the possibilities of TOLMS in laryngeal cancer treatment.

Abstract title:
Rare skull base tumors: diagnosis and treatment

Authors and co-authors names:
Saulius Vaitkus (1), Justinas Vaitkus (1), Karolis Bareikis (2)

Authors and co-authors institutions, country:
1. Department of Otorhinolaryngology, LUHS KC, Kaunas, Lithuania 2. Department of Neurosurgery, LUHS KC, Kaunas, Lithuania

Keywords:
skull base, tumors, rare tumors, skull base tumors

Abstract text:
Rare skull base tumors are a heterogeneous group of neoplasms that originate in the complex anatomical region. These tumors are characterized by their low incidence and unique clinical presentation, posing challenges in accurate diagnosis, effective treatment, and assessment of prognosis. This oral presentation aims to review rare skull base tumors, identification and management.

Abstract title:
SECONDARY BENIGN PAROXYSMAL POSITIONAL VERTIGO AFTER VESTIBULAR NEURITIS: A CASE REPORT AND REVIEW OF THE LITERATURE

Authors and co-authors names:
Domas Turčinas, Aistė Paškonienė

Authors and co-authors institutions, country:
Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Keywords:
Benign paroxysmal positional vertigo, vestibular neuritis

Abstract text:
Introduction: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness and recurrent peripheral vertigo, with paroxysmal, spontaneous-resolving episodes of vertigo, which are triggered by specific head positions. The peak incidence of primary or idiopathic BPPV is greatest among middle-aged women. One of the causes of secondary BPPV is vestibular neuritis (VN). Secondary BPPV after VN is observed in younger patients and is often associated with treatment-resistant forms, with persisting symptoms of posterior semicircular canalolithiasis. We present a case of a male patient with treatment-resistant secondary BPPV after VN. Case report: A 21-year-old patient presented to a general physician complaining of a sudden attack of prolonged continuous vertigo while lying in bed, and imbalance during walking. The patient was diagnosed with vestibular neuritis and received treatment with prednisolone, betahistine, and B vitamins. After a few months a positive supine roll test and Dix-Hallpike maneuver, with both provoking right peripheral nystagmus, confirmed the diagnosis of secondary posterior and horizontal benign paroxysmal positional vertigo. Repositional maneuvers proved to be beneficial for a short period of time, afterwards the symptoms deteriorated. The patient experienced brief vertigo attacks and issues in focusing the eyes, with a slight left nystagmus a rotary component. MRI of the head showed no pathological findings. Due to the vestibular dysfunction, issues in focusing the eyes, and recurring BPPV, the treatment was initiated by administering tab. Cinnarizinum et. Dimenhydrinatum. Additionally, modified repositional maneuvers and vestibular rehabilitation were continuously applied for 12 months. Due to the long-term treatment, the symptoms have improved but have not gone away completely. Conclusion: In this case report we present a young patient with a treatment-resistant secondary benign paroxysmal positional vertigo after vestibular neuritis. Due to the possibility of BPPV after vestibular neuritis, we suggest a thorough examination of patients after being diagnosed with VN to prevent a late diagnosis.

Abstract title:
Sentinel lymph node biopsy in OCSCC

Authors and co-authors names:
Dariusz Kaczmarczyk1,2, Antoni Bruzgielewicz3, Dawid Zagacki4, Ali Movarekh5

Authors and co-authors institutions, country:
1 - Department of Oncological Physiotherapy, Medical University of Lodz, Poland 2 - Head and Neck Cancer Unit, Copernicus Memorial Hospital, Lodz, Poland 3 - Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland 4 - International Doctoral School, Medical University of Lodz, Poland 5 - Student Scientific Circle of Head and Neck Neoplasms Surgery, Medical University of Lodz, Poland

Keywords:
SLNB, OCSCC

Abstract text:
ObjectivesThe objective of the study was to evaluate the value of sentinel lymph node biopsy in the oral cavity cancer. Methods245 patients were enrolled into the study, 109 women and 136 men. Each patient presented a tumor in T1N0M0 stadium. A day before the surgery, lymphoscyntygraphy was performed. During the operation, after tumor excision using gamma-ray detector sentinel lymph node was resected. In 46 patients SLNB and elective neck dissection I-III (END I-III) were performed, in 199 cases only SLNB. Each sentinel node was examined histologically and cytokeratin staining was done. Histological finding of sentinel lymph node and other lymph nodes were compared. ResultsThe group age was between 41 to 93 years with the mean of 64,5 years old. In 24 cases there were metastases to the sentinel lymph node confirmed thus resulted in the change of nodal state to N1. In 221 patients there were no metastases present in the sentinel lymph node which allowed to avoid overtreatment in these patients.ConclusionsSentinel lymph node biopsy is a good tool to state the clinical advance of nodal metastases. It allows saving lymph structures of the neck when nodal metastases are not confirmed.

Abstract title:
Sinonasal glomangiopericytoma in a patient with an unclear etiology of hypophosphatemia

Authors and co-authors names:
Reinis Jansons (1,2); Ingus Vilks (1,2), Gunta Sumeraga (1,2)

Authors and co-authors institutions, country:
1 - Pauls Stradins Clinical University Hospital 2 - Riga Stradins University

Keywords:
FESS, Oncology, Rhinology

Abstract text:
Background: Sinonasal glomangiopericytoma is a rare tumor that arises in the nasal cavity or paranasal sinuses from mesenchymal pluripotent pericyte cells of the blood vessel walls. It is a benign tumor with a low to moderate malignization potential. The epidemiology of sinonasal glomangiopericytoma is not well-defined, but it is considered a rare tumor, accounting for less than 0.5% of all sinonasal tumors. It is more common in adults, with a mean age of diagnosis in the fifth decade of life. Glomangiopericytoma has also been linked to causing oncogenic osteomalacia.  Herein, we describe a clinical case of a 30 year old female patient diagnosed with glomangiopericytoma with a history of hypophosphatemia and multiple bone fractures at Pauls Stradins Clinical University Hospital (PSKUS). Case presentation: A 30 year old woman presented to the PSKUS out-patient clinic with a suspected tumor in her left nasal cavity, arising from ethmoidal cells growing into the olfactory plate, cranial part of the nasal septum, and the cranial margin of middle nasal turbinate, discovered during a head MRI performed due to the patient’s unclear etiology of hypophosphatemia, multiple fractures of spine, pelvis, and humerus. The patient had complaints about frequent episodes of epistaxis and crusting. Three years prior to the discovery of the tumor, the patient had been seen in an emergency setting experiencing severe epistaxis, but after cauterization and achieved hemostasis, was discharged. However, this time, an endoscopic examination was performed and diffuse crusting of the nasal cavity was observed. In the left common meatus a well defined mass of pathological tissue was discovered, obstructing the nasal passage. A decision was made to proceed with an endoscopic tumor biopsy. Prior to the surgery, a nasal cavity CT scan with intravenous contrast series was obtained. During the surgery, a relatively well demarcated tumor arising from ethmoid cells was discovered and a decision to proceed with an immediate resection was made. The tumor was radically resected and sent for histological analysis. The pathology report identified a benign glomangiopericytoma sinonasal tumor. The patient was discharged 3 days after the surgery. On a 3 month follow up, the patient had no further nasal complaints, there were no signs of residual tumor tissue or recurrence of the tumor. Discussion: Herein we describe a case that suggests a more routine use of endoscopic examination, including emergency settings. Physicians as standard practice should thoroughly examine all reasons of epistaxis, particularly, in young patients with no data of hypertension and/or anticoagulant use.

Abstract title:
Spasmodic dysphonia: treatment options and challenges.

Authors and co-authors names:
Aurelija Vegiene (1), Giedrius Endrikas (2)

Authors and co-authors institutions, country:
1,2- Lithuanian University of Health Sciences, Lithuania

Keywords:
functional voice disorder , botulinum toxin injections

Abstract text:
Functional voice disorders (FVD) are caused by insufficient or improper use of the phonation apparatus without either anatomical or neurological abnormalities. Neurologic voice disorders occur as part of an underlying neurologic condition such as Parkinson's disease, multiple sclerosis, myasthenia gravis, or ALS. They can also happen as the result of a stroke. These disorders can affect the strength of the muscles of the voice box, and impact the control of the voice. Many of these neurological disorders affect the body systemically, but patients will often complain of dysphonia before other symptoms develop. The otolaryngologist can therefore be the first physician to diagnose such neurological conditions. This impacts speech to varying degrees and results in strained and strangled voice quality. While there is currently no cure for such disorders, voice therapy and chemodenervation with botulinum toxin (BT) injections remain the base of management. Surgery also may be performed in some cases. However BT injections are used to treat spasmodic dysphonia and essential tremor. While BT injections may show vocal improvement, results can depend on several factors such as the general health of the patient, onset and severity of the condition, dosage, interval between injections and experience of the practitioner. While many studies have documented the efficacy of botulinum toxin for improving vocal symptoms, this review aims to discuss some of those studies.

Abstract title:
Spectroscopic colour analysis of intranasal endoscopy images for objective diagnosis of nasal mucosa diseases

Authors and co-authors names:
A.K.Krievina [1], E.Eliasa-Vigante [1,2], S.Konuhova [1,2], K.Peksis [1,2], U.Rubins [3], J.Spigulis [3]

Authors and co-authors institutions, country:
1 - University of Latvia Faculty of Medicine, Riga, Latvia 2 - ENT clinic "Headline", Riga, Latvia 3 - Institute of Atomic Physics and Spectroscopy, Biophotonics Laboratory, University of Latvia, Riga, Latvia

Keywords:
nasal mucosa, intranasal endoscopy, spectroscopy, colour analysis

Abstract text:
Introduction Pathological processes cause the nasal mucosa to change its structure and composition, the presence of different cells, changes in chemical composition, dilation or constriction of blood vessels - all these change the colour of the mucosa. The otorhinolaryngologist makes a subjective diagnosis by examining the patient with an anterior rhinoscopy. Diseases of the nasal mucosa are common in ENT practice, with an average of one in three patients presenting to a specialist with a complaint of a disease of the nasal mucosa or symptoms caused by it. Colour vision varies between people, so some non-invasive method of objective examination is needed to clarify the diagnosis. Aim of the study To determine whether spectroscopy can be used to quantify changes in the nasal mucosa from images and videos obtained during nasal endoscopy on the surface of the inferior nasal turbinates in different diseases of the nasal mucosa: acute rhinosinusitis, chronic inflammation (vasomotor or other cause), chronic hyperplastic and allergic nasal mucosa. Materials and methods The study participants (66 in total, 36 healthy or control group, 10 chronic hyperplastic, 9 chronic inflammatory, 10 acute rhinosinusitis, 5 allergic) underwent anterior nasal endoscopy in ENT clinic “Headline”, prepared and stored the material in video format. The Karl Storz TP 200 endoscope system with a video camera was used to acquire the material. The videos were then analysed on a computer using Matlab software. The analysis algorithm consists of manually selecting the region of interest (inferior nasal turbinate), segmenting the image, and then averaging the pixels in [RGB] and [L*a*b] colour scales. Results Generally positive values of [a, b] depend largely on the degree of inflammation of the nasal mucosa. The results of the study showed that [a] values were higher in chronic inflammatory and acute rhinosinusitis (35+/-3), while [a] values were slightly lower in chronic hyperplastic nasal mucosa (24+/-3), compared to the control group (27+/-4). Conclusions There is a large statistical spread in the control group. Spectroscopic analysis can distinguish between healthy and inflamed nasal mucosa. Chronic inflammation and acute rhinosinusitis have higher [a] values. Chronic hyperplastic nasal mucosa has lower [a] values. Slightly higher [b] values for allergic mucosa, but the number of participants in this group was too small for the group results to be considered conclusive. This study is a pilot study which is planned to be continued.

Abstract title:
Speech outcomes with tracheoesophageal prosthesis

Authors and co-authors names:
Lekt. m.dr. K. Pribuišis, doc. m. dr. E. Padervinskis

Authors and co-authors institutions, country:
Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Keywords:
Laryngeal cancer, Tracheoesophageal prosthesis

Abstract text:
Introduction. Laryngeal carcinoma remains the most common malignant tumor of the upper respiratory tract worldwide and approximately 60% of patients present with advanced disease (stage III or IV) at the initial workup. Total laryngectomy is a widely used surgical procedure that is usually reserved for the treatment of advanced laryngeal cancer when the patient is not eligible for conservative techniques or in case of their failure. Loss of voice has a major impact on the quality of life of laryngeal cancer patients. Therefore, it is important to provide laryngectomee patients with reliable voice and speech rehabilitation options. Research objectives. To determine if the quality of speech generated by using voice prosthesis is comparable to the speech after organ preserving surgery, i.e. partial laryngectomy. Materials and methods. The study applied auditory perceptual and acoustic analysis to 18 speech samples from patients who underwent total laryngectomy with speech rehabilitation by implantation of voice prosthesis and 11 patients after partial laryngectomy. Same patients were asked to fill out a self-reported Speech Handicap Index questionnaire to determine how they perceive their speech impairment. Results. Auditory perceptual and acoustic evaluation results were not statistically significantly different between the total and partial laryngectomy groups (p=0.576 and p=0.526). Patients after total laryngectomy self-reported greater speech handicap than patients after partial laryngectomy (p=0.009). Conclusion. Speech after total laryngectomy is comparable to speech after partial laryngectomy on the auditory perceptual and acoustic levels. On the other hand, patients after total laryngectomy self-report greater speech handicap.

Abstract title:
Submucosal Minimally Invasive Lingual Excision (SMILE) for Obstructive Sleep Apnea: surgical technique and personal experience.

Authors and co-authors names:
Tomas Balsevičius, Tomas Jakštas

Authors and co-authors institutions, country:
Lithuanian University of Health Sciences

Keywords:
Submucosal minimally invasive lingual excision, Obstructive sleep apnea, Coblation.

Abstract text:
Submucosal minimally invasive lingual excision (SMILE)  is a technique for treating tongue base obstruction in Obstructive sleep apnea (OSA)  patients. While invasive tongue base procedures are mucosal destructive, leading to significant postoperative pain,  SMILE technique provides a mucosal sparing approach while allowing aggressive tongue base tissue removal. SMILE  technique is a version of the of tongue base reduction using coblation through a midline lingual incision approach. Coblation technology removes hypertrophic tongue base musculature tissue at a low temperature, resulting in less tissue destruction and edema. Side effects of bleeding, edema, pain, infection, and dysfunction are minimized, and pilot results of SMILE surgery are favorable.

Abstract title:
SURGERY ON PATULOUS EUSTACHIAN TUBE

Authors and co-authors names:
Eugenijus Lesinskas (1)

Authors and co-authors institutions, country:
1 - Vilnius University, Faculty of Medicine, Institute of Clinical medicine

Keywords:
Patulous eustachian tube, tuboplasty, injection, hyaluron

Abstract text:
The aim of this instructional course is to introduce an options of conservative and surgical treatmentof of the clinical condition, which is described as patulous Eustachian tube. Patulous Eustachiantube dysfunction (PETD) is thought to result from a longitudinal concave defect in the mucosalfunctional valve, usually in the anterolateral wall of the Eustachian tube (ET). Diagnostic methodsof this entity are discussed. Technics and results of the main surgical treatment methods arepresented (tympanic membrane (TM) manipulation, Eustachian tube (ET) injection, plug surgery,shim surgery, tuboplasty and ET closure). Surgical videos of various surgical treatment modalitiesare demonstrated. The surgical treatment results of 10 patients are commented.

Abstract title:
SURVIVAL OF PATIENTS WITH LARYNGEAL AND HYPOPHARYNGEAL CANCER AFTER SURGICAL, RADIATION AND CHEMORADIATION TREATMENT IN 2019 - 2022

Authors and co-authors names:
Mantas Žemaitaitis(1), Paula Venckutė(2), Evaldas Padervinskis(1)

Authors and co-authors institutions, country:
(1)Lithuanian University of Health Sciences, Academy of Medicine, Department of Otorhinolaryngology (2)Lithuanian University of Health Sciences, Academy of Medicine

Keywords:
laryngeal and hypopharyngeal cancer treatment, survival

Abstract text:
Introduction: Head and neck cancers are neoplasms arising principally from the mouth (oral cavity), voice box (larynx), throat/upper gullet (pharynx), salivary glands, nose and sinuses, and primary bone tumors of the jaw. Each year there are approximately 900 000 new cases and over 400 000 deaths of head and neck cancers worldwide and they accounted for 5.7% of all cancer-related deaths [1,2]. The most significant documented risk factor for the development of cancer of this region is smoking. Additionally, it appears that tobacco and alcohol consumption have a synergistic effect [1]. Patients with SCC of larynx or hypopharynx usually undergo surgical resection or radiation therapy (RT) with or without chemotherapy [3]. The purpose of this study was to assess and compare the survival of patients with larynx and hypopharynx cancer after surgical, radiation and chemoradiation in Hospital of Lithuanian University of Health Sciences Kaunas Clinics Otorhinolaryngology and Oncology departments in 2019 - 2022.     Aim: To assess the survival of patients with laryngeal and hypopharyngeal cancer after surgical radiation and chemoradiation treatment   Objectives: To calculate the time from diagnosis to the treatment for patients who have been diagnosed with larynx or hypopharynx cancer in 2019 – 2022. To determine the survival rate of patients with larynx or hypopharynx cancer after surgical, radiation and chemoradiation treatment. To compare survival rates with surgical, radiation and chemoradiation treatment. Methods: The research data was obtained retrospectively. Our inclusion criteria were all patients who were treated in Otorhinolaryngology and Oncology departments, Lithuanian University of Health Sciences Kaunas Clinics from larynx and hypopharynx cancer with surgical treatment, radiotherapy or chemoradiotherapy in 2019-2021.Information about deaths was obtained from Institute of Hygiene. 2023.01.01 was the last date for which mortality information was included. The data was analyzed using IBM SPSS 27.0   Results: The survival rate of patients with larynx and hypopharynx cancer after surgical, radiation and chemoradiation treatment was calculated and compared with the literature. Assesed time from diagnosis to treatment start and its impact on survival. All data will be provided on site at the time of presentation.

Abstract title:
Swallowing disorders in an elderly stroke patient: A case report

Authors and co-authors names:
Fatma Esen AYDINLI (1), Önal İNCEBAY (2), Elif TUNÇ SONGUR (3), Ferit UZUN (4)

Authors and co-authors institutions, country:
1- Speech&Language Pathology Department Hacettepe University, Faculty of Health Science. 2-Speech&Language Pathology Department Hacettepe University, Faculty of Health Science. 3-Speech&Language Pathology Department Hacettepe University, Faculty of Health Science. 4-Speech&Language Pathology Department Hacettepe University, Faculty of Health Science.

Keywords:
swallowing disorders, elderly, stroke

Abstract text:
Title of abstract: Swallowing disorders in an elderly stroke patient: A case report Background: Following a stroke, oropharyngeal dysphagia increases the risk of dehydration, undernutrition, aspiration pneumonia, long-term disability, and possibly mortality. Because the prevalence of stroke increases with age, older stroke patients are more likely to develop dysphagia and associated consequences. However, the cause is not necessarily associated with stroke. Objective: We reported the swallowing evaluation and therapy plan of an elderly stroke case experiencing a swallowing disorder. Case report:  A 67-year-old female with hypertension, and type 2 diabetes had a cerebrovascular accident on January 2, 2022. The patient didn’t need to participate in post-stroke rehabilitation due to the fact that she was able to walk independently in the community without help and had clear consciousness, coordination, and cooperation.  Clinical swallowing evaluation showed that the patient had a total oral intake, normal oral motor skills, spontaneous cough, and velar movement in phonation. The gag reflex was absent and velar elevation was symmetric. However, the patient suffered from swallowing difficulty. Therefore, a videofluoroscopic swallow study (VFSS), eating assessment tool (Eat-10), and swallowing quality of life survey (SWAL-QOL) were performed, and swallowing rehabilitation was established based on VFSS and questionnaires. Results: According to VFSS, there was no aspiration or penetration. The laryngeal elevation, on the other hand, was weak, and the swallowing reflex was delayed. Furthermore, the upper esophageal sphincter's opening was shown to be impaired. The EAT-10 scores of the case before and after therapy were reported as 24/40. When the EAT-10 and SWAL QOL scores of the case were compared before and after therapy, there was no change. Although partial improvements are observed in the VFSS results of the case, it can be said that there is no big difference. Discussion: Although traditional swallowing therapy is a well-known effective approach for poststroke swallowing disorders, there weren’t found clinical and instrumental differences in the elderly patient after the rehabilitation. Therefore, we concluded that stroke mightn’t be the only cause of dysphagia in this patient. It will be bear in mind that psychogenic factors may contribute to the swallowing disorder since the patient has a psychological trauma in the detailed medical history.

Abstract title:
The experience of the cochlear implantation in children with Auditory Neuropathy Spectrum Disorder in the Republic of Kazakhstan

Authors and co-authors names:
Mariya Kirillova

Authors and co-authors institutions, country:
University Clinic, Kazakh National University named after Asfendiyarov, Almaty, Kazakhstan

Keywords:
cochlear implantation, Auditory Neuropathy Spectrum Disorder

Abstract text:
The cochlear implantation in Kazakhstan has been carried out under the government program since 2007. The indications for surgery in our country in children are bilateral deafness, bilateral profound hearing loss and Auditory Neuropathy Spectrum Disorder (ANSD). Today about 3,000 people with profound hearing loss have been operated on. Since 2019, the cochlear implantations have been performed bilaterally. We have noticed at the last 3 years the number of patients with ANSD has increased. In Kazakhstan, a children with ANSD get a cochlear implantation only after 6 months of wearing an hearing aids. Since 2020, our clinic has performed 10 cochlear implantations in children with ANSD. Their age category ranged from 2 to 5 years. By the time of the operation, all of them were already using a hearing aids. 7 children had no effect from the use of the hearing aids: a speech development stopped at the level of a simple words. The children focused more on the articulation than on the hearing. In the 3 cases, in children aged 4-5 years, after using the hearing aids, speech intelligibility improved, but it was less than 40 % (when tested with the simple words). The evaluation of the dynamics of the auditory and speech development was carried out 1-2 years after the first fitting of the speech processors. All the children regularly individually studied with the speech therapists and at home with their parents. As a result, it was noted that in 8 cases in the children after the cochlear implantation there was a positive dynamic in the development of the auditory perception and speech. In 2 cases the children had no results after the cochlear implantation.

Abstract title:
THE IMPORTANCE OF EARLY DIAGNOSIS IN THE CASE OF ACOUSTIC NEUROMA: CASE REPORT AND LITERATURE REVIEW

Authors and co-authors names:
Domas Turčinas, Aistė Paškonienė

Authors and co-authors institutions, country:
Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Keywords:
Acoustic neuroma, early diagnosis, surgical treatment

Abstract text:
Introduction: Acoustic neuromas are benign tumors arising from Schwann cells located on the VIIIth cranial nerve in the pontocerebellar corner, near the porus acusticus. They have an incidence rate of 1-2 cases per 100000 people yearly, this constitutes about 6-7% of all intracranial tumors. Risk factors for this tumor include female sex, ionizing radiation, and leisure noise. Early diagnosis of acoustic neuroma is associated with a wider choice of treatment options, as well as a better disease prognosis. We report a female patient with an acoustic neuroma after surgical treatment. Case presentation: A previously healthy 45-year-old female patient presented to an otorhinolaryngologist with a persisting hearing loss, difficulty in perceiving sounds and speech with her right ear, as well as ringing and pain around her right ear with the symptom duration of over one year. Due to magnetic resonance imaging (MRI) scan the diagnosis of an acoustic neuroma of the right pontocerebellar angle was established. Surgical treatment was performed with retrosigmoid craniotomy on the right side. Postoperative complications such as gaze nystagmus, dysarthria, dysphagia, persisting impaired hearing in the right ear, balance, and coordination problems were observed. Conclusion: This case report presents an acoustic neuroma, which was treated surgically. After the removal of the tumor, persisting complications were observed. We suggest that early diagnosis of the tumor is crucial and may lead to better outcomes after the treatment. In cases of acoustic neuromas, appropriate diagnosis, choice of treatment and close follow-up by a team of physicians in multidisciplinary centers are important.

Abstract title:
The importance of sleep endoscopy in choosing the treating method of obstructive sleep apnoe.

Authors and co-authors names:
Lina Jurgaitienė(1), Andrius Savanevičius(2)

Authors and co-authors institutions, country:
Department of Ear, Nose and Throat diseases, Republican Vilnius University Hospital, Vilnius, Lithuania (1,2)

Keywords:
Drug-induced sleep endoscopy; site of OMA collapse; OMA surgical method.

Abstract text:
The aim of the study was to evaluate the importance of DISE{ Drug-induced sleep endoscopy} in determining the exact sites, the severity, the pattern of collapse, the site of vibration in patients with OSA{Obstructive sleep apnea}. The results of diagnostic tests in the awake state do not always correlate with satisfactory surgical results. DISE is safe and useful method in daily practice for detecting collapse of hypopharyngeal and laryngeal sites, the multilevel obstruction and  selecting the treating method. Drug-induced sedation endoscopy is the best option when choosing a surgical method.

Abstract title:
The Importance of the Temporal Bone 3T MR Imaging in the Diagnosis of Menière's Disease

Authors and co-authors names:
Aistė Paškonienė 1 2, Renata Baltagalvienė 3, Givi Lengvenis 3, Vilma Beleškienė 1 2, Justinas Ivaška 1 2, Vėtra Markevičiūtė 4, Vaiva Mickevičienė 5, Eugenijus Lesinskas 1 2

Authors and co-authors institutions, country:
1- Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University. 2 - Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santaros Clinics. 3 - Centre of Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Clinics. 4 - Faculty of Medicine, Vilnius University. 5 - Department of Pediatric Otorhinolaryngology and Ophthalmology, Children's Hospital, affiliate of Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.

Keywords:
Endolymphatic hydrops—Magnetic resonance imaging—Menie`re’s disease.

Abstract text:
Background: The aim of this study was to evaluate endolymphatic hydrops using the 3T temporal bone magnetic resonance imaging (MRI), performed according to the chosen protocol, and determine whether it could be applied as an objective diagnostic tool for Menière's disease. Methods: 105 participants diagnosed with probable (n = 50) and definite (n = 55) Menière's disease were included in this prospective study at Vilnius University Hospital, Santaros Clinics. Audiometry, vestibular function tests, videonystagmography, and computer posturography were performed before MRI. The 3T MRI with gadolinium contrast was performed to evaluate the endolymphatic hydrops. Imaging protocol consisted of 3D-FLAIR and 3D T2DRIVE sequences. Vestibular endolymphatic sac was interpreted as enlarged if occupied more than 50% of the vestibular area. Results: 78.1% of subjects had abnormal MRI findings other than hydrops, and it was more than 90% (50/55) of patients in the definite MD group (p < 0.001). Changes in caloric test were observed in 63.8% of subjects in general, and in 76.4% of patients with a definite Menière's disease. The side of the endolymphatic hydrops observed on MR imaging corresponded to the clinical diagnosis of the Menière's disease based on the results of audiometry (p < 0.001) and unilateral weakness (p < 0.001). Endolymphatic hydrops on MRI and directional preponderance in caloric test were two independent predictors of the definite Menière's disease. Conclusions: Temporal bone 3T MRI with gadolinium contrast is clinically superior to confirm the diagnosis of Menière's disease. Grade II endolymphatic hydrops on MRI, directional preponderance, and unilateral weakness on caloric test were independent predictors for the definite Menière's disease.

Abstract title:
The influence of cholesteatoma structure on the degree of damage to the bones of the skull base and the development of intracranial complications in chronic cholesteatoma otitis media

Authors and co-authors names:
Agnieszka Wiatr (1), Kamila Szpak (2), Katarzyna Job (2), Marta Biel (2), Maciej Wiatr (1)

Authors and co-authors institutions, country:
1 - Department of Otolaryngology Jagiellonian University Medical College 2 - University Hospital of Krakow

Keywords:
chronic otitis media, skull base defect, Scanning Electron Microscopy, cholesteatoma microstructure

Abstract text:
Introduction: Cholesteatoma is an epidermal cyst resulting from the uninhibited growth of keratinized squamous epithelium with the participation of bacterial infection and complex inflammatory processes. Cholesteatoma is diagnosed in 3-6 people per 100,000. people. They are divided into congenital - very rare and acquired. Chronic cholesteatoma otitis media is characterized by a tendency to destroy bone tissue. The slow process of bone destruction and the accompanying middle ear infection can lead to the development of extracranial, intracranial and intracranial complications. Aim: Detailed analysis of the structure of the cholesteatoma tissue acquired in the Scanning Electron Microscope and its impact on the degree of bone tissue destruction of the temporal bone and the base of the skull. Material and methods: An analysis of the collected fragments of pathological tissue of the middle ear with the appearance of cholesteatoma from 10 patients operated on due to chronic otitis media complicated by the transfer of the inflammatory process to the CNS was carried out. The surgical preparation was analyzed in the Scanning Electron Microscope. The degree of cranial base damage was assessed depending on the type of cholesteatoma structure in HRTC, MRI imaging and during surgery. Results:              In the analysis of the cholesteatoma surface in the scanning electron microscope, both regular  and, in most cases, irregular structure of the matrix were observed. Regular cholesteatoma coexisted with statistically significantly less destruction of the skull base (20%) compared to cases of acquired cholesteatoma with irregular structure (80%). The irregular structure of the matrix concerned cases with a short medical history and patients in whom it was the first surgery. In these cases, a much less coordinated proliferation of keratinocytes was observed in the tested preparations compared to acquired cholesteatoma with a regular structure similar to the typical layered structure of the epidermis, in which the pattern of their arrangement is regular. Conclusions: The microstructure of cholesteatoma assessed in SEM in the form of a regular arrangement of layers coexists with reduced destruction of the bony walls of the middle ear. Irregular system (pathognomonic for a process with a short medical history, patients operated on for the first time) is characterized by a tendency to deeper destruction of bone tissue and intracranial complications

Abstract title:
The results of surgical treatment on the quality of life the patients with chronic otitis media

Authors and co-authors names:
Nurmukhamedova F.B.

Authors and co-authors institutions, country:
Nurmukhamedova F.B. (Scientific adviser - MD, Associate Professor Amonov A.Sh.) Tashkent Pediatric Medical Institute Otorhinolaryngology, children's otorhinolaryngology and dentistry

Keywords:
chronic otitis media, treatment, quality of life, COMOT-15, tympanoplasty

Abstract text:
Introduction. For a long time, the success of surgical treatment of COM was associated with factors such as the surgeon's level of preparation, the presence of high-quality optics and modern tools, as well as the nature of the pathological process in the middle ear, the presence of cholesteatoma, and middle ear anatomical features (GAROV E.V., 2017). However, the practice has shown that the development of fundamentally new approaches in the surgery of the middle ear also can increase the efficiency and quality of surgical treatment in patients with COM. Purpose. Comparison of the results of the quality of life depending on the surgical treatment in patients with COM. Materials and methods. The study involved 150 patients with COM (from 18 to 65 years old). In accordance with the type of surgery, patients were divided into 5 subgroups. 1st - which conducted tympanoplasty, the 2nd - sanitizing surgery, 3rd patients with simultaneous tympanoplasty and with sanitation of the ear, 4th - patients with tympanoplasty and ossyculoplasty, 5th - patients after radical surgery of the ear. Results. Data of the total number of points confirm the positive dynamics of the quality of life of patients after all types of surgical treatment except for the 5th group, which performed a radical surgery of the ear. For example, the quality of life after tympanoplasty improved with a reliable decrease in the COMOT-15 points from 48 to 4.25 (p <0.05), with tympanoplasty with ossyculoplasty up to 2.5 points. It should be noted that the score in healthy individuals was up to 5 points. As for the complaint related to the noise in the ear, in all groups, the result is not reliable and indicates that surgical intervention does not affect improvement in this symptom. Patients of the 2nd group - after a sanitizing operation on the ear, they received a reliable difference in the general score, but compared with 1, 3 and 4 groups, they received a non-reliable difference in issues of the concerns of the hearing function (p> 0.05), and these issues are important for patients what should be borne in mind. But the data obtained by us indicate that, according to some indicators, for example, 10, 13, 14 and 15, the questions showed a deterioration in these sales, which indicates that a radical surgery on his ear leads to a greater reduction in the quality of the patient’s life than to surgical treatment. This is a good example of where the otolaryngologist is based on the indications for the radical operation, but the patient evaluates his condition as negative. In this case, it should be concluded that patients of this category must be announced in advance of the expected results of the operation in relation to their quality of life in order to prevent the patient’s dissatisfaction after the surgery. Conclusions. The COMOT-15 questionnaire showed that the type of tympanoplasty with ossiculoplasty leads to a significant improvement in the quality of life of patients, reaching indicators of healthy individuals. The radical surgery of the ear leads to a greater reduction in the quality of the patient’s life than other types of surgical treatment.

Abstract title:
THE STATE OF THE NASAL CAVITY AND PARANASAL SINUSES IN CHILDREN WITH CONGENITAL CLEFT LIP AND PALATE

Authors and co-authors names:
N.E. Makhkamova (1) , D.M. Nabieva (2)

Authors and co-authors institutions, country:
1 - Department of Otorhinolaryngology, Tashkent State Dental Institute of the Republic of Uzbekistan 2 - Department of ENT diseases and audiology of the consultative polyclinic of the TMA multidisciplinary clinic

Keywords:
congenital cleft lip and palate, children, nose, paranasal sinuses

Abstract text:
On the territory of Uzbekistan, the number of children with congenital malformations of the maxillofacial region is increasing. The most common are cleft lip and palate. The severity of anatomical and functional disorders depends on the degree of cleft and the age of the child. In children with congenital cleft lip and palate (CCLP), there are more frequent cases of diagnosing acute sinusitis, rhinitis, tonsillitis and other ENT diseases compared with healthy children [1-3]. There is not enough data on the prevalence of inflammatory pathology of the paranasal sinuses in this group of children, the causes and predisposing factors, examination algorithms have not been developed to prevent the onset of the disease or to detect it at an early stage, which would reduce the duration of treatment and increase its effectiveness. The purpose of the study is to assess the state of the paranasal sinuses and structures of the nasal cavity in children with CCLP. Material and methods: We examined 52 children with CCLP aged 9 to 18 years (main group; 30 boys and 22 girls) and 52 children aged 9 to 18 years (control group; 27 boys and 25 girls) without congenital anomalies of the maxillofacial region. The group of children with CCLP included: 24 children with congenital isolated cleft palate, 17 children with congenital through cleft lip and palate on the left, 11 children with congenital through cleft of the upper lip and palate on the right. All patients were successfully operated on for a congenital defect in the first year of life. Examination of children included the collection of anamnesis and complaints of the patient, routine ENT examination (anterior rhinoscopy, mesopharyngoscopy, otoscopy), endoscopy of the nasal cavity and nasopharynx, and computed tomography of the paranasal sinuses. When collecting anamnesis and complaints, the greatest attention was paid to the absence or presence of episodes of sinusitis of various localization in the anamnesis, frequent and prolonged rhinitis, periodic or persistent difficulty in nasal breathing, discomfort or pain in the projection area of the paranasal sinuses, and cephalic sinuses. Research results: The study revealed that 25 children with CCLP (15 - with a through cleft of the upper lip and palate on the left, 10 - with a through cleft of the upper lip and palate on the right) had a curvature of the septum of the nose. Of these, 9 children with a through cleft lip and palate on the left had a curvature of the nasal septum to the right, and in 6 children with a through cleft of the upper lip and palate on the right, a curvature of the nasal septum was noted to the right. In 2 children with an isolated cleft palate, a pronounced deformity of the nasal septum was noted,, at the same time, the deformed section of the nasal septum was adjacent to the hyperplastic inferior turbinate, in connection with which surgical treatment was performed - submucosal resection of the nasal septum, bilateral vasotomy of the inferior turbinates (note that compensatory hyperplasia of the inferior turbinates was detected in all 32 patients). In 5 patients with an isolated cleft palate, a ridge of the nasal septum was detected on the right throughout the cartilage and bone sections, spreading along the floor of the nasal cavity with moderate hyperplasia of the inferior turbinate on the left. In 3 patients with a through cleft of the upper lip and palate on the left and in 1 with a through cleft of the upper lip and palate on the right, there was slight S-shaped curvature of the nasal septum in the cartilaginous section, predominantly to the left, accompanied by slight hyperplasia of the inferior turbinates. In all children with CCLP, during an endoscopic examination of the nasopharynx, adenoid vegetations of the II-III degree were determined. All patients underwent computed tomography of the paranasal sinuses. In 13 patients with an isolated cleft palate, 8 with a through cleft of the upper lip and palate on the left, and 5 with a through cleft of the upper lip and palate on the right, increased pneumatization of the anterior end of the middle turbinate was noted. In 39 patients ( 13 - with an oxide rabree lip and no one, 11 - a fed rabbit lip and a power supply, 15 - with an isolated ranger of NOBA) When examining children in the control group, deviated nasal septum with signs of vasomotor rhinitis was noted only in 10 patients. During endoscopy of the nasopharynx in 11 children, adenoid vegetations of the II degree were diagnosed. In 15 patients, vitreous edema and cyanosis of the mucous membrane of the nasal cavity, severe hyperplasia of the inferior turbinates were noted, children noted periodic rhinorrhea, tearing of the eyes. These complaints were seasonal in nature, which made it possible to make a diagnosis of allergic rhinitis. In 26 patients, no pathology was detected during anterior rhinoscopy and endoscopy of the nasal cavity and nasopharynx. According to computed tomography of the paranasal sinuses, all 52 children from the control group had satisfactory pneumatization of the paranasal sinuses. Conclusions: in patients with CCLP, in more than 72% of cases, there is a curvature of the nasal septum, accompanied by hyperplasia of the inferior turbinates. In the absence of pronounced differences between the paranasal sinuses of patients with CCLP and healthy children and the degree of pneumatization of the SNP corresponded to the age of the child in both groups, patients with CCLP showed increased pneumatization of the anterior end of the concha.

Abstract title:
The treatment of spasmodic dysphonia and other neurological voice disorders

Authors and co-authors names:
Aurelija Vegienė (1); Giedrius Endrikas (2)

Authors and co-authors institutions, country:
1 - Department of Otorhinolaryngology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania. 2 - Department of Otorhinolaryngology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.

Keywords:
spasmodic dysphonia, botulinum, neurological voice disorder

Abstract text:
Neurological voice disorders is a group of dysphonias that are caused by neurological dysfunction. Many of these neurological disorders affect the body systemically, but patients will often complain of dysphonia before other symptoms develop. The otolaryngologist can therefore be the first physician to diagnose such neurological conditions. This impacts speech to varying degrees and results in strained and strangled voice quality. While there is currently no cure for such disorders, voice therapy and chemodenervation with botulinum toxin (BT) injections remain the base of management. Surgery also may be performed in some cases. However BT injections are used to treat spasmodic dysphonia and essential tremor. While BT injections may show vocal improvement, results can depend on several factors such as the general health of the patient, onset and severity of the condition, dosage, interval between injections and experience of the practitioner. While many studies have documented the efficacy of botulinum toxin for improving vocal symptoms, this review aims to discuss some of those studies.

Abstract title:
The value of CEUS, CT and MRI in assessing thyroid cartilage invasion in patients with laryngeal squamous cell carcinoma

Authors and co-authors names:
Milda Pucetaite (1), Silvija Ryskiene(1), Dalia Mitraite (1), Valdas Sarauskas(2), Saulius Vaitkus (3)

Authors and co-authors institutions, country:
1 – Department of Radiology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania. 2 – Department of Pathology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania. 3 – Department of Otorhinolaryngology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Keywords:
thyroid cartilage, laryngeal cancer, CEUS

Abstract text:
Background: Imaging staging of local laryngeal cancer spread plays an important role in choosing suitable treatment strategy which can affect the quality of life. The main diagnostic radiology exams are contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI), however cross-sectional modalities sometimes might have false-positive results, especially in detection of non-ossified thyroid cartilage invasion. Contrast-enhanced ultrasound (CEUS) has a potential in assessing non-ossified thyroid cartilage invasion. Purpose: to assess the value of CEUS, CECT, MRI in detection of non-ossified thyroid cartilage invasion. Methods: Twenty-three patients with laryngeal squamous cell carcinoma with suspected invasion to non-ossified thyroid cartilage initially had CECT, followed by CEUS and eighteen of the patients also had MRI before surgery. Five patients had more than one possible invasion site. The imaging findings of laryngeal carcinoma were evaluated and compared with the postoperative histopathological findings, which were chosen as a gold standard. The dependence of possible thyroid cartilage invasion on laryngeal carcinoma local and distant spread were evaluated. Results: In total 9 thyroid cartilage invasion sites were detected on histopathological examination.  The sensitivity, specificity, and accuracy in detection of thyroid cartilage invasion were 88.9%, 78.9%, and 82.1% for CEUS, 66.7%, 78.9%, and 75.0% for CECT, and 100.0%, 50.0%, and 61.9% for MRI, respectively. Our study showed that CEUS and CECT are more accurate than MRI (P<0.05), there was no statistically significant difference between CEUS and CECT. Also, there was tendency of false positive results in CEUS and CECT when laryngeal carcinoma was more locally disseminated. Thyroid cartilage invasion did not show dependence on distant spread of disease. Conclusion: CEUS showed high diagnostic value in detection of non-ossified thyroid cartilage invasion comparing with MRI and could be used as a complementary study to CECT especially in less locally disseminated laryngeal cancer.    

Abstract title:
The value of the sentinel lymph node biopsy in the assessment of the spread of tumors of the larynx, oral cavity and oropharynx

Authors and co-authors names:
Jurgita Kupčinskaitė (1), Evaldas Padervinskis (1), Kipras Pribuišis (1), Donatas Vajauskas (2), Gintarė Petreikytė (3), Žygimantas Mickus (3)

Authors and co-authors institutions, country:
1- Department of Otorhinolaryngology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania 2 - Department of Radiology, Nuclear Medicine, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania 3 - Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania

Keywords:
sentinel lymph node, head and neck cancer, occult metastases

Abstract text:
Background: Sentinel nodes (SNs) are the lymph nodes that directly receive lymphatic flow from a primary cancer lesion. The SN concept implies that lymphatic metastasis initially occurs at SNs. Determining the presence of regional metastases is critical for staging, treatment, and prognosis. Metastasis to a single regional lymph node can transform a small stage I tumor to an advanced stage III or even stage IV head and neck cancer. The involvement of cervical lymph nodes can decrease disease specific survival by up to 50 %. Systematic reviews demonstrates a high sensitivity and negative prognostic value of SLNB for the detection of cervical lymph node metastases in patients with oropharyngeal, laryngeal, and oral carcinoma, justifying a place in the diagnostic workup. In this study we investigated the accuracy of sentinel lymph node biopsy (SLNB) in laryngeal, oropharyngeal and oral cancer and whether it can be used in the diagnostic and therapeutic approach.Methods: We retrospectively reviewed 213 patients who had undergone SN biopsy at Lithuanian University of Health Sciences Kaunas Clinics, ENT Clinic. A retrospective study was performed on patients who had undergone SN biopsy from a year 2012 to 2022. The underlying pathology was laryngeal cancer in 183 patients while 16 patients had oral cancer and 15 patients had oropharyngeal cancer. 99mTc nano-coloid was injected into several sites around tumor on the day before surgery. Preoperative localization of SN was determined using conventional lymphoscintigraphy. Intraoperative localization and diagnosis of SN were performed by gamma probe. SNs were surveyed intraoperatively, and neck dissections including at least levels II, III, IV, V and VI were performed.Results: In our study SNB was performed in patients with laryngeal cancer (n=183), oropharyngeal cancer (n=15) and oral cancer (n=16). SN was found in 89% cases with laryngeal cancer (159/182), 100% cases with oropharyngeal cancer (15/15) and 100% oral cavity cancer (16/16). Mean age of the subjects was 61.7 years. Dominant sex was male – 91% (195/213) while female subjects compiled 9% (17/213). Mean amount of 99mTc nano-coloid injected was 109.7 MBq/ml. Dominant site of SN found in laryngeal cancer was level II - 23.8% (n=38), level II in oropharyngeal cancer – 26.6% (n=4) and level I in oral cavity cancer – 18.75% (n=3). In most of the cases in laryngeal, oropharyngeal and oral cavity cancer SNs where found in multiple levels ipsilaterally - 42.13% (n=67), 40% (n=6), 18.75% (n=3) respectively. The sensitivity and negative predictive value of SLNB will be presented on-site.

Abstract title:
Treatment outcomes of deep neck infection: Parapharyngeal, Retropharyngeal and Deep Neck Abscess

Authors and co-authors names:
Dovilė Šiaulytė (1), Tomas Balsevičius (1), Paula Venckutė (1)

Authors and co-authors institutions, country:
1 - Lithuanian University of Health Sciences, Kaunas, Lithuania.

Keywords:
Parapharyngeal abscess; Retropharyngeal abscess; Deep neck abscess; Mortality rate.

Abstract text:
OBJECTIVE: As deep neck infection (DNI) results in significant mortality rates, we designed our study to evaluate treatment outcomes of patients with deep neck infection. MATHERIALS AND METHODS: 98 cases of the adult patients who were treated in LUHS Kaunas Clinics in 2016-2021 because of DNI were reviewed and included in this study. Information about patients gender, age, comorbidities, DNI etiology, treatment before hospitalization and during hospitalization, CRP levels, complications during hospitalization, radiological findings and treatment outcomes were collected and analyzed. RESULTS: Out of 98 patients 58.2% were male and 41.8% were female. The average age in our study was 54.95 (±15.34) years. The mean time from onset of DNI to hospitalization was 4,3 (±2.76) days. Before hospitalization 43.9% of patients didn’t receive any kind of treatment. The average hospitalization time due to DNI was 13.31 (±11.03) days. The highest morbidity due to DNI was found in the age group of 51 to 65 years old. Most common DNI was parapharyngeal abscess (48%). Out of all patients who were admitted to the hospital with DNI 10.2% of patients already had DNI complications. During hospitalization, 20,4% of patients experienced complications from mediastinitis, sepsis, or septic shock. The most prescribed antibiotics were ampicillin/sulbactam (40.8%) and cephalosporins with metronidazole (37.8%). The mean time of antibiotic therapy was 14.37 (±9.23) days. The mean time from hospitalization until surgical treatment was 8 (±16.33) hours. On average 1.66 (±1.21) surgeries per case were performed. The mortality rate in our study was 9.1%. Increased risk of mortality was observed in a group of patients with DNI complications of mediastinitis, sepsis or septic shock, as well as in a group of patients that had high CRP level. Patients that had DNI with complications mortality rate was 40%, whereas it was 1.3% in a group with no complications (p<0.001). The DNI caused mortality rate increased 51.3 times when complications developed. The risk of mortality in patients with DNI and CRP levels above 301 mg/l was 78.9% (sensitivity – 77.8%, specificity – 77.8%). CONCLUSIONS: Deep neck infections have the potential to cause many complications that can be life-threatening so early diagnosis and treatment of DNI is essential in decreasing mortality rates. The treatment outcome of DNI depends on the severity of the infection and immune status.

Abstract title:
Unilateral vestibular hypofunction. Mechanism of vestibular compensation

Authors and co-authors names:
Aistė Paškonienė 1 2, Jelizaveta Kogan 1 2

Authors and co-authors institutions, country:
1) Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University. 2) Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santaros Clinics.

Keywords:
vestibular neuronitis, vestibulopathy, vestibular dysfunction, neuroplasticity, vestibular compensation

Abstract text:
Unilateral vestibular hypofunction is a result of acute unilateral vestibular damage. Epidemiologically an increased incidence of unilateral vestibular hypofunction has been recently observed. Acute unilateral vestibular hypofunction presents as sudden severe vertigo, vegetative symptoms , spontaneous nystagmus directed to a healthy side, impaired VOR and inclination of the head and body towards the affected side during vestibulospinal tests.  Vestibular syndrome made of both static symptoms, observed in a stationary subject and dynamic symptoms seen only when the patient moves his head or body in space. Vestibular compensation is a complex homeostatic process, during which the central nervous system attempts  to adapt to the lost vestibular afference. It is based on the neurologic phenomenon of neuroplasticity and central nervous reorganization, leading to functional rehabilitation and recovery. Vestibular compensation is divided to acute (immediate) and chronic (long-term) and is based on several concepts called restoration, habituation and adaptation. Factors interfering with a vestibular compensation are following: mobility of a patient, use of vestibular suppressants, acute stress, visual dependence and early vestibular rehabilitation. The prevalence of chronic vestibular after acute vestibulopathy remains high, with 80% of patients  reporting decreased  quality of life and interrupted daily activities. Despite the neuroplastical capacities and right treatment vestibular compensation could be incomplete resulting in wide distribution of possible clinical outcomes after acute vestibular hypofunction.

Abstract title:
Vestibulo-Ocular Reflex Measured by Video Head Impulse Test in Patients with Chronic Otitis Media: an Otosurgeon's Perspective.

Authors and co-authors names:
Irina Arechvo (1,2)

Authors and co-authors institutions, country:
1 - Department of Ear, Nose and Throat Diseases, Republican Vilnius University Hospital, Vilnius, Lithuania; 2 - Medical Diagnostic and Treatment Center, Vilnius, Lithuania

Keywords:
VOR, vHIT, cholesteatoma, vestibular dysfunction

Abstract text:
The main aim of the study was to evaluate vestibulo-ocular reflex (VOR) in patients with chronic otitis media with and without cholesteatoma by video head impulse test (vHIT). It was a retrospective case review in tertiary referral center. The gain of VOR and the presence of corrective saccade were examined for the semicircular canals in patients with chronic otitis media. vHIT is a useful tool for evaluating semicircular canal function in patients with chronic otitis media before and after otosurgery.

Abstract title:
Voice feminisation: actuality and challenges.

Authors and co-authors names:
Aurelija Vegiene (1)

Authors and co-authors institutions, country:
1- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania

Keywords:
pitch raising, voice feminization, vocal folds

Abstract text:
Voice feminization for transgender women is a highly complicated, difficult, comprehensive transition process. However, voice feminization should not only consider voice pitch but also consider gender differences in physical, neurophysiological, and acoustical characteristics of voice. The methods used for voice feminisation are classified to surgical and not surgical. Usually it is used combined methods. Therefore, the strategy of voice feminization to overcome gender differences in fundamental frequencies should aim the following two factors of voice simultaneously: pitch in phonation and phonemes in articulation. Strategies for modification of fundamental frequency includes modification surgery of three fundamental principles (tension, length, density of vocal folds). It may be one factor modification surgery or two ant three factor modification surgery through external or endoscopic approaches. From surgeon’s point of view, postoperative outcome depends on how precisely postsurgical vocal folds are symmetrically balanced and how normal regular vibration is generated. Technical problems could induce postoperative dysphonia or insufficient increase of pitch that might be associated with asymmetrical vocal folds level, inappropriate scarred membranous vocal folds, excessive scar formation, tension discrepancy of vocal fold muscle, and distortion of the laryngeal framework. Pitch is the most important feature of voice femininity. It’s reported that a minimum F0 value of 180 Hz required for a voice to be perceived as feminine. An increase in the pitch is not enough to gain femininity and that there is a relationship between the value of the vowel formant frequency and perceptions of gender. Resonance is another vocal characteristic that contributes to the perception of gender, and maybe the second most important acoustic cue. Conclusions. Voice feminization is a very complicated and complexity modulation procedure. It is a comprehensive medical process in which all knowledge of speech science including laryngology, speech language pathology and acoustics must be applied. Voice feminization is a long transition journey that changes a male phonatory system including phonatory organs and pattern to a female phonatory system.