MEDICINSKI GLASNIK

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270 Medicinski Glasnik, Volumen 6, Number 2, August 2009 (14). Konzervativno liječenje, pored antibiotika, kortikosteroida i simptomatske terapije, podrazumijeva i postupke kojima se prevenira nastanak eksplozivnih i implozivnih sila za koje se pretpostavlja da su bitan faktor u nastanku pneumolabirinta - mirovanje, antiemetici, sedativi, položaj glave u blagoj elevaciji, regulisanje stolice (6). Eksperimentalno, kod zamoraca, utvrđeno je kako se, nakon resorpcije zraka, funkcija labirinta u potpunosti povratila (4, 5). U unutrašnjem uhu, zrak se može kretati ovisno od položaja glave, a što se može vidjeti na CT snimcima visoke rezolucije (13). Stoga je za dijagnostiku pneumolabirinta ključna pretraga CT-om sa tankim slojevima (od 1 do 1,5 mm debljine), radi boljeg kontrasta u prikazivanju odnosa zrak-kost, nego nuklearna magnetna rezonanca (MRI) (7). Rano otkrivanje pneumolabirinta i perilimfatične fistule, rani početak terapije, bilo konzervativno ili hirurški, kao i niz drugih postupaka i preporuka u njihovom tretmanu, jako su važni u liječenju teških oštećenja sluha i prevenciji mogućih teških komplikacija. U ovom slučaju od velike koristi bila bi rano započeta konzervativna terapija (odmah nakon ozljeđivanja) antibioticima, kortikosteroidima, uz regulaciju probave, mirovanja, blagu elevaciju glave, antitusika, antiemetika, te praćenje audioloških parametara kao što su tonalna audiometrija, BERA (engl. brain steam auditory evoked potentials), timpanometrija. ZAHVALE/IZJAVE Komercijalni ili potencijalni dvostruki interes ne postoji. LITERATURA 1. Mafee MF,Vaslvassori GE, Kumar A, Yannisas DA, Marcus RE. Pneumolabyrinth. A new radiologic sign for fracture of the stapes footplate. Am J Otol 1984; 5:374-5. 2. Scheid SC, Feehery JM, Willcox TO, Lowry LD. Pneumolabyrinth: A late complication of stapes surgery. Ear Nose Throat J 2001; 80:750-3. 3. Isaacson JE, Laine F, Williams GH. Pneumolabyrinth as computed finding in poststapedectomy vertigo. Ann Otol Rhinol Laryngol 1995; 974-6. 4. Yanagihara N, Nishioka I. Pneumolabyrinth in periliymphatic fistula: report of tree cases. AmJ Otolaryngol 1987; 8:313-8. 5. Nakashima T, Kaida M, Yanagita N. Round window membrane rupture and inner ear damage due to barotrauma. Acta Otolaryngol Suppl. 1992; 493:57-62. 6. McGee MA, Dornhoffer JL. A case of barotrauma-induced pneumolabyrinth secondary to perilyphatic fistula. Ear Nose Throath J 2000; 76:456-9. 7. Nishizaki K, Yamamoto T, Akagi H, Ogawa T, Masuda Y. Pneumolabyrinth: imaging case of the month. Am J Otol 1998; 19:860-1 8. Lyos AT, Marsh MA, Jenkins HA, Coker NJ. Progressive hearing loss after transverse temporal bone fracture. Arch Otolaryngol Head Neck Surg 1995; 121:795-9. 9. Meyerhoff WL, Marple BF. Perilymphatic fistula. Otolarygol Clin North Am 1994; 27:411-26. 10. Goodhill V. Sudden deafens and round window rupture. Laryngoscope 1971; 81:1462-74. 11. Sheridan MF, Hetherington HH, Hull JJ. Inner barothrauma from scuba diving. Ear Nose Throath J 1999; 78:181. 12. Pullen FW, Rosenberg GJ, Cabeza CH. Sudden hearing loss in dives and flyers. Laryngoscope 1979; 9:137-38. 13. Kobayashi T, Sakurada T, Ohyama K. Inner ear injury caused by air intrusion to the scala vestibuli of the cochlea. Acta Otolaryngol 1993; 113:725-30. 14. Lao WW, Niparko JK. Assesment of changes in cochlear function with pneumolabyrinth after middle ear trauma. Otol Neurotol 2007; 28:1013-7. 15. Lo S-H, Huang Y-C, Wang P-C. Pneumolabyrinth associated with perilymph fistula. Chang Gung Med J 2003; 26:690-94. 16. Nomura Y. Perlymph fistula: concept, diagnosis and management. Acta Otolaryngol (Suppl) 1994; 514:52-4. 17. Nomura Y, Okuno T, Hara M, Young YH. ”Floating” labirynth. Pathophysiology and treatment of perilymph fistula. Acta Otolaryngol 1992;112:186-91. Pneumolabyrinth \enad Hodžić Department for Ear, Nose, Throat and Maxillofacial Surgery, Cantonal Hospital Zenica, Bosnia and Herzegovina ABSTRACT Computed tomography (CT) revealing pneumolabyrinth after temporal bone fracture is a rare clinical finding. Accompanying symptoms are: vertigo, hearing loss and very often perilymphatic fistula. This paper presents a case of a
fifteen-year old boy with clinical discomfort after falling down from a height. Pneumolabyrinth was diagnosed by CT scan of the temporal bone and it had remained unrecognized for almost two weeks. The patient was treated conservatively. As the hospital treatment started too late the final result of this injury was complete and permanent hearing-loss of the impaired ear. Key words: pneumolabyrinth, temporal bone fracture, hearing loss, perilymphatic fistula Original submission: 25 February 2009; Revised submission: 01 April 2009; Accepted: 19 April 2009; CASE REPORT Sphenochoanal polyposis Ivana Pajić-Penavić 1 , Davorin \anić 1 , Ljubica Fuštar-Preradović 2 1 Department of Otorhinolaryngology Head and Neck Surgery, 2 Department of Pathology and Cythology; General Hospital “Dr. Josip Benčević” Slavonski Brod, Croatia Corresponding author: Ivana Pajić-Penavić, Department of Otorhinolaryngology Head and Neck Surgery General Hospital “Dr. Josip Benčević’’ Andrije Štampara 42, 35 000 Slavonski Brod, Croatia Phone: +385 35 445 643 E-mail: ivana.pajic-penavic@sb.t-com.hr Original submission: 04 December 2008; Revised submission: 09 February 2009; Accepted: 04 May 2009. Med Glas 2009; 6(2): 271-273 ABSTRACT The reports of sphenochoanal polyps in the literature are relatively rare. Computed tomography and nasal endoscopy contribute in diagnosis of sphenochoanal polyps. Simple polypectomy which partialy leaves a polyp inside the sphenoid sinus increases the risk of a relapse. Using powered instrument-assisted endoscopic sinus surgery we surgically removed sphenochoanal polyp in a ten year old boy. We wide opened the orifice of sphenoid sinus and removed the cystic polyp part from sphenoid sinus. At the annual follow-up examination, this patient remains free of signs of polyp recurrence. Key words: spenochoanal polyposis, endoscopic surgery, computed tomography (CT scan) INTRODUCTION Choanal polyps are rare benign mucous tumors of the nose and the paranasal sinus which grow from the sinus orifice and spread through nasal meatus into choanae and nasopharynx . They make 3-6 % of all the polyps of the nose (1). Based on the origin of the polyp’s petiole, polyps are divided into the three types: antrochoanal (originating in the maxillary sinus), ethmoidochoanal (originating from the etmoid sinus) and sphenochoanal (originating from the sphenoid sinus) (2). Polyps whose source is in the orifice or in sphenoid sinus are distinctly rare (2,3). They were first described by Zuckerkandl in 1892 (4,5). Clinically, the glistening and pale masses are identical to typical nasal polyps; careful inspection using endoscopy can disclose a stalk leading to the sinus of origin (6). It must be emphasized that the stalk of antrochoanal polyp can be easily visualized but it is very difficult to visualize sphenoid orifice in children even without polyps. In case of sphenochoanal polyp only stalk from sphenoethmoid recess can be seen. In general, the diagnosis of choanal polyps is established by nasal endoscopic examination and CT (3,6). In this paper we presented a case of endoscopic treatment of a ten year old male with the sphenochoanal polyp. CASE REPORT Case report The patient was a 10-year old male, with symptoms of heavy respiration through his nose, with incessant frontal rhinorrhea, purulent mucous discharge with occasional snoring. He had been adenoidectomised three years earlier in another hospital due to heavy respiration through the nose. After the operation he showed no postoperative improvement. Using a front rhinoscopia, an abundance of mucous and purulent secretion was found in both nasal cavities. Physical examination by endoscope revealed an intranasal pearly 271
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