Dokoska, Marija
Preferred name
Dokoska, Marija
Official Name
Dokoska, Marija
Main Affiliation
Email
marija.dokoska@medf.ukim.edu.mk
21 results
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Item type:Publication, Importance of CT imaging in pediatric cochlear implantation: Emphasis the significance of the BCNC width.(2022-07-27); ; ; Introduction: Cochlear Implantation (CI), in the past more than 30 years, has become a standard of care for children with profound sensorineural hearing loss. As it became a routine intervention, requests for pre-op images have increased in the work-up for candidates. The optimal protocol for radio-diagnostics has not yet been defined. CT and MRI are complementary methods and both being used for this purpose. An absent cochlear nerve (CN) is the only absolute contraindication to cochlear implantation and MRI is a gold standard for CN detection. Some authors have reported the relationship between cochlear bony nerve canal (BCNC) stenosis and CN hypoplasia and aplasia. Objectives: The aim of this study was to stress out the importance of CT by evaluating the width of the bony cochlear nerve canal (BCNC) in children with congenital sensorineural hearing loss (SNHL) and “normal" findings on thin section temporal bone CT. Materials and methods: The width of the BCNC was retrospectively evaluated in two groups of patients. The study group included 11 children with congenital, bilateral SNHL who underwent cochlear implantation from July to December 2019. Eleven children aged 3-10 years, with no sensorineural hearing loss were taken as controls. Axial sections of their CT scans were used to measure the width of the BCNC. Results: From the obtained results, the width of the BCNC in children with bilateral, profound sensorineural hearing impairment range from 1.0 to 2.3 mm with mean value of 1.5 ± 0.3 mm and is significantly smaller than in the control group. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, COCHLEAR IMPLANTATION AND VERTIGO- A CASE REPORT(SHMSHM / AAMD, 2020-08-31); ; ABSTRACT Introduction: Cochlear implantation (CI ) is a standard of care for the patients with moderate to severe sensorineural hearing loss in the past more than 20 years. Postoperative vertigo it’s one of the well-known complications and has a considerable impact of patient life. Children really suffer from this complication, usually in milder form and almost never long-term vertigo. The aim of presenting this case is to pint out the need to examine the vestibular function in each patient preoperatively. Case report: A 9-year-old child, with recurrent episodes of vertigo appearing for the first time 6 years after the implantation. Vestibular assessment function was done with caloric irrigation bitermal test that showed asymmetry between two labyrinths. Romberg showed deviation on the right side. Haed impuls test was positive on the right side and Dix –Hallpike’s maneuver test was negative. There was no neurological signs and symptoms. Every next episode of vertigo was milder than the previous one and he well responded to standard vestibular therapy with Beathistine or Sulpiride. Vertigo did not affect implant performance, Conclusion: Patients which are candidates for CI it’s necessary to be informed about possibility and quality of postoperative vertigo. Implementing a protocol for preoperatively evaluation of the vestibular function of specially designed questionnaires and objective tests for assessment of the vestibular function should be standard procedure for each patient who is candidate for CI. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, COMPARATIVE STUDY BETWEEN JODOFORM-VASELINE NASAL PACKING AND MEROCEL HEMOX 10 cm AFTER THE SEPTO-TURBINOPLASTY OR RHINOSEPTOPLASTY PROCEDURE(European Rhinologic Society, 2019-04-04); ; Background: The purpose of our study was to compare Merocel (Merocel Hemox 10 cm) and Jodoform-Vaseline cotton tampons (JVT) after a rhinoseptoplasty procedure in efficiency and patient comfort. Methods: We carried out a prospective study of 53 patients who had undergone surgery between 01/2018 and 01/2019. GroupA, packed with Merocel was composed of 29 patients, and GroupB packed with JVT was composed of 24 patients. A standard scale ranging from zero (no symptoms) to 5 (most severe symptoms) was used to assess subjective symptoms. To compare the usefulness of materials we evaluated the after-surgery bleeding and bleeding after nasal pack removing, discomfort of the patient at 12h and after 72h, discomfort during removing nasal pack. Secretions and crusts were evaluated 1 week and 2 weeks after surgery in both groups. Results: A total of 53 patients were enrolled in the study, 37 women and 16 men; age range 15-42 with a mean age of 34 years. After removing of the nasal pack in the GroupA, in 27 cases no bleeding was present, and in 2 cases there was present bleeding. In the GroupB in 19 cases no bleeding was present, and in 5 cases there was present bleeding. In the GroupA overall average discomfort score was 2, and in the GroupB overall average discomfort was 3. We noticed statistically significance reduction of nasal secretions and crusts at 1 week after surgery. The difference is not statistically significant 2 weeks after surgery. Difference in discomfort related to nasal packing is statistically significant (p < 0.05) regarding the pain during packing removal, the general satisfaction and the pressure. Conclusions: Merocel Hemox 10 cm was easily implanted and removed, causing patients less discomfort during the first days after surgery. The nasal mucosa was better preserved with Merocel than with JVT. This type of material can be used in rhino-septoplasty or septoturbinoplasty. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, INTRIGUING VASCULAR ENCOUNTER: ANEURYSM ALONG AN ABERRANT SYSTEMIC ARTERY TO THE LUNG- RADIOLOGY CASE STUDY(Macedonian Association of Anatomists and Morphologists, 2024-05-02); ; ; ; Systemic arterial supply to the lungs from an aberrant artery is a rare congenital anomaly, and the occurrence of an aneurysm along this aberrant vessel is an even rarer phenomenon. We present a detailed case study of a 69-year-old male diagnosed with a fusiform aneurysm of an aberrant systemic artery supplying the right lower lobe. Accurate diagnosis was achieved through CT angiography, enabling precise visualization of the anomalous artery and the aneurysmatic dilatation. In this unique case, a 69-year-old male presented with persistent cough, chest/back pain, dyspnea, prompting medical attention. Ultrasonography revealed an atypical dilation of the inferior vena cava (IVC), measuring up to 3.5 cm, alongside a distinct sub-hepatic vascular structure. Doppler imaging indicated a discernible signal, prompting further investigation through CT angiography. Notably, during imaging, features suggestive of intra-lobar sequestration were observed, indicating a potential connection between the vascular anomalies and eventual respiratory symptoms. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, EVALUATING CHRONIC RHINOSINUSITIS AS A COMORBID DRIVER IN COPD(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2025-07-18); ; ; Introduction: Chronic rhinosinusitis (CRS) is increasingly recognized as a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD), particularly under the framework of the “united airways” model, which emphasizes shared inflammatory mechanisms across the upper and lower respiratory tract. Aim: To evaluate inflammatory biomarker profiles among COPD patients with and without CRS, and to assess differences across distinct COPD phenotypes—non-exacerbators (NE), frequent exacerbators (E), and asthma-COPD overlap (ACO). Material and methods: A cross-sectional study was conducted on 36 COPD patients at a university clinic in Skopje, including 21 with CRS and 15 patients without CRS. All participants underwent clinical phenotyping, nasal endoscopy, sinus CT, and serum biomarker analysis (IL-4, IL-5, IL-6, IL-8, CRP, leukocytes). Statistical comparisons were made using Mann–Whitney U and Kruskal–Wallis tests. Results: CRS was predominantly found in patients with the ACO phenotype (71.4%, p = 0.0006). No statistically significant differences were observed in systemic biomarkers (IL‑4, IL‑5, IL‑6, IL‑8, CRP, leukocytes) between COPD patients with and without CRS. IL‑5 and IL‑6 were undetectable. Similarly, inflammatory profiles did not significantly differ among COPD phenotypes. Conclusion: CRS appears disproportionately represented in the ACO phenotype, likely due to shared type‑2 inflammatory pathways. However, conventional systemic biomarkers lack the sensitivity to detect upper airway involvement or differentiate COPD phenotypes. These findings highlight the need for comprehensive airway assessment and more specific biomarkers in future studies to better understand the interplay between CRS and COPD. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, BONY COCHLEAR NERVE CANAL IN CHILDREN WITH BILATERAL PROFOUND SENSORINEURAL HEARING LOSS–A PILOT STUDY(Faculty of Medicine- Skopje, Ss Cyril and Methodius University in Skopje, 2021-11-30); ; ; Introduction:The aim of this study was to evaluate the width of the bony cochlear nerve canal (BCNC) in children with congenitalsensorineural hearing loss(SNHL)and "normal" findings on thin section temporal boneCT.Materialand methods:The width of the BCNC was retrospectively evaluated in two groups of patients. The study group included 11 children (22 bone canals) aged 2-12 years, withcongenital, bilateral SNHLwho underwent cochlearimplantation (CI)from July to December 2019and no abnormalities of the inner ear were detected on their preoperative CT scans. Eleven patients (22 bone canals), aged 3-10 years, in whomno sensorineural hearing loss hadbeen diagnosed were taken as controls and CT scan of the temporal bone wasperformed for another reason -suspected acute mastoiditis, chronic otitis media, or perforation of the tympanicmembrane. Axial sections of their CT scans wereused to measure the width of the BCNC.Results:BCNC width values in patients with bilateral, profound sensorineural hearingloss rangedfrom 1.0 to 2.3 mm and the mean value was1.5±0.3 mm. In patients with normalhearing, the values for the canal width werehigher,with mean value of 2.1±0.3 mm.Conclusion: The resultsobtained showed thatthe width of the BCNC in children withbilateral, profound sensorineural hearing impairment wassignificantly smaller than in the controlgroup with normal hearing for p <0.05 (t-test=6.62912, p=0.000000). - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Impact of socioeconomic status on the occurrence of complications after cochlear implantation - A case study(Institute of Sensory Organs, 1 Mokra Street, Kajetany, 05-830 Nadarzyn, Poland, 2018-06-27); INTRODUCTION Cochlear implantation is a powerful tool for helping children with severe to profound sensorineural hearing loss gain the ability to hear, achieve age-appropriate reading skills, and develop communication skills equal to those of their hearing counterparts. Although it’s a reliable and safe procedure cochlear implantation surgery, like any other surgical procedures, has some minor and major complications. Major complications are those that are require surgery whereas minor complications are those that can be medically treated. The overall rate of complications among cochlear implant patients ranges from 6% do 20%. According to the time of appearance can be classified as immediate (< 1 week) or delayed (≥1 week) events. One of the quite worrying and potentially devastating are the postoperative wound infections after cochlear implantation. Because of the risk of the implant infection in this cases, which can lead to device removal with loss of the implant function, every effort must be made to prevent this infections, or if they occur to be timely and appropriately treated which will enable salvage of the implant and its function. AIM Тo emphasize the importance of socioeconomic status as risk factors for the occurrence of postoperative wound infection after cochlear impantation. MATERIALS AND METHODS We report the case of 4-year-old child with delayed postoperative surgical wound infection. The one appeared 14 days after the cochlear implantation (postoperatively). Anamnestic data obtained from the mother indicates that after discharging from the hospital the child was repeatedly itchy the wound. On examination a half of the surgical wound was reddish with mild discharge and starting dehiscence at one point. The swab obtained from the wound was positive for Vancomycin resistant-Enterococcus faecium. RESULTS An outpatient medical care with antiseptic dressing, topical and oral antibiotics was started immediately. Because of no response, even worsening of the local status, 7 days after a revision surgery was required. With the employment of timely and appropriate intraoperative wound debridement and re-suture the healthy edges without using a flap, the implant was salvaged. DISCUSSION/CONCLUSIONS As reported in the literature, in children from families with lower socioeconomic background incidence of complications is higher comparing to the children that come from families with higher income level. The reason for this can be poor hygienic conditions and habits, as well as negligent care of the parents. Тhis case is just another(one more) confirmation that the socioeconomic status can represents a possible risk factor for the occurrence of postoperative complications in children after CI surgery. Specially in an environment where because of financial barriers, access to the cochlear implantation is limited, special attention should be paid to the socioeconomic status of the candidates for CI. This indicates that a special approach in pre-operative preparation and postoperative care in the candidates for cochlear implantation with lower socio-economic back-ground is needed. Involvement of a motivated social workers in the care of the cochlear implant children is necessary for additional support and education if this group of parents and children, in order to prevent and reduce the negative impact of the socioeconomic background of the CI surgery outcomes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Microscopic techniques of cholesteatoma surgery(2023-10); ; Cholesteatoma of the middle ear or/and mastoid is an erosive process defined by trapped squamous epithelium that produces and accumulates desquamated keratin debris with/without a surrounding inflammatory reaction. Due to its aggressive growth and invasive nature, cholesteatoma tends to cause extracranial and potentially fatal intracranial complications. Otitis media with cholesteatoma is considered an unsafe ear and currently surgery is the definitive line of management with an aim to create a safe and dry ear by exteriorizing the disease and improving hearing. There are different approaches used worldwide and each surgeon has his own beliefs and conceptions/misconceptions. Two main options in cholesteatoma surgery are the canal wall up and canal wall down mastoidectomy. The quest for better surgical outcome has continued to raise challenges and the choice of the surgical technique is always a matter of debate. Hence otologists are in search of a tailored and more adaptable technique. No single method is optimal in all cases of cholesteatoma, so cholesteatoma surgery should be individualized and the choice of the operative procedure based on the extent of the disease and condition of the ME cleft, the needs of the patient, and the surgeon’s experience. Both canal wall–up and canal wall–down mastoidectomies can be utilized successfully in the management of cholesteatomas as long as the operative techniques are performed correctly and appropriate patient selection occurs. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CT and MRI, importance of preoperative radiological assessment in pediatric cochlear implantation(Europrean Federation of Audiology Societies, 2023-05); INTRODUCTION: Cochlear implantation (CI), in the past more than 30 years, has become a standard of care for children with profound sensorineural hearing loss. As it became a routine intervention, requests for pre-op images have increased in the work-up for candidates. The optimal protocol for radiodiagnostics has not yet been defined. CT and MRI are complementary methods and both being used for this purpose. The presence of a functional cochlear nerve is a key issue in pediatric CI. Cochlear nerve aplasia is the only absolute contraindication for CI and MRI is a gold standard for cochlear nerve (CN) detection. Recently, some authors have reported the relationship between bony cochlear nerve canal (BCNC) stenosis on CT and cochlear nerve deficiency (CND). OBJECTIVES: The aim of this study was to consider the importance of CT in the preoperative assessment of prelingualy deaf children and to determine whether the width of the bony cochlear canal (BCNC) can serve as a reliable predictive factor for the existence of a CND. MATERIALS AND METHODS: A total of 11 children with confirmed diagnosis of prelingual, severe sensorineural hearing loss will be included in this study. In all patients, indication for CI was confirmed and according to the preoperative protocol, high-resolution CT and MR were performed. Reconstructions at a distance of 0.6 mm of the axial plane images from the HRCT of temporal bones were used for measuring the width of the BCNC. The cochlear nerves were evaluated on axial and sagittal - oblique T2 - MRI images and classified as normal, hypoplastic or aplastic. CND is diagnosed if the cochlear nerve is absent (aplasia) or very thin i.e. smaller than the adjunct facial nerve in the internal auditory canal on MRI (hypoplasia). Two factors were reviewed retrospectively: presence of inner ear anomalies and the relationship between BCNC stenosis on CT and the existence of CND on MRI. RESULTS From a total of 22 temporal bones analyzed (22 ears in 11 patients), inner ear malformations were detected in 6 ears from 3 patients (27.27%). All three children had a bilateral malformation, in one it was Michel deformity and in two it was IP2 (incomplete partition 2). BCNC diameter ranged from 0.1mm to 2.33mm with a mean value of 1.46±0.6mm. CND was recorded in 4 of 22 ears and all were associated with stenosis of the BCNC. In a total of three ears with a stenotic canal, we obtained a normal finding for the cochlear nerve on MR. CONCLUSION: Radiological evaluation is integral in surgery planning. The optimal protocol for radio-diagnostics has not yet been defined. CT and MRI are complementary methods and both being used for this purpose. Children with BCNC stenosis on CT have a high incidence of CND on MRI. A narrowed BCNC on CT can be an indicator for the selection of children who are candidates for CI and need to be additionally referred for MRI. So, when its feasible use both imaging methods, but when not narrow BCNC on CT it’s a reliable indicator for mandatory MRI. KEYWORDS: CT, MRI, bony cochlear nerve canal, cochlear nerve, pediatric cochlear implantation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Bony Cochlear Nerve Canal as a Predictor for Cochlear Nerve Status in Prelingually Deaf Children(Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences/ Sciendo, 2023-03); ; ;
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