Davcheva chakar, Marina

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Davcheva chakar, Marina

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marina.davcheva.chakar@medf.ukim.edu.mk

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Speech Perception Outcomes after Cochlear Implantation in Children with GJB2/DFNB1 associated Deafness
(AVES Pub., 2014)
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Emilija Sukarova-Stefanovska
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Valentina Ivanovska
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Ilija Filipche
Background: Cochlear implants (CI) for the rehabilitation of patients with profound or total bilateral sensorineural hypoacusis represent the initial use of electrical fields to provide audibility in cases where the use of sound amplifiers does not provide satisfactory results. Aims: To compare speech perception performance after cochlear im-plantation in children with connexin 26-associated deafness with that of a control group of children with deafness of unknown etiology. Study Design: Retrospective comparative study. Methods: During the period from 2006 to , cochlear implantation was performed on 26 children. Eighteen of these children had un-dergone genetic tests for mutation of the Gap Junction Protein Beta 2 (GJB2) gene. Bi-allelic GJB2 mutations were confirmed in 7 out of 18 examined children. In order to confirm whether genetic fac-tors have influence on speech perception after cochlear implantation, we compared the post-implantation speech performance of seven children with mutations of the GBJ2 (connexin 26) gene with seven other children who had the wild type version of this particular gene. The latter were carefully matched according to the age at cochlear implantation. Speech perception performance was measured before cochlear implantation, and one and two years after implantation. All the patients were arranged in line with the appropriate speech percep-tion category (SPC). Non-parametric tests, Friedman ANOVA and Mann-Whitney’s U test were used for statistical analysis. Results: Both groups showed similar improvements in speech per-ception scores after cochlear implantation. Statistical analysis did not confirm significant differences between the groups 12 and 24 months after cochlear implantation. Conclusion: The results obtained in this study showed an absence of apparent distinctions in the scores of speech perception between the two examined groups and therefore might have significant implica-tions in selecting prognostic indicators of speech perception follow-ing cochlear implantation. (Balkan Med J 2014;31:60-63)
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The Pillars of the Nose-Crura Shortening for Over Projected Nose
(Scientific Foundation SPIROSKI, 2019-12-15)
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Petreska-Dukovska, Vesna
The over projected nose, commonly referred to as the "Pinocchio" nose is a significant challenge to the rhinoplasty surgeon. Firstly, we speak about a very large nose, and secondly, we speak about the correction of nasal cartilages (alar and triangular). Surgical correction of the over projected nose is the most difficult and least predictable component of rhinoplasty surgery.
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ВЕРБАЛНА И АУДИТИВНА ПЕРЦЕПЦИЈА КАЈ ЛИЦА СО СЛУШЕН АМПЛИФИКАТОР И КОХЛЕАРЕН ИМПЛАНТ
(Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2012)
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Ѓорѓеска Билјана
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Јовановска Мира
Verbal and auditory (hearing) perception is a subjective experience of one acoustic stimulus of different form and origin (tone, noise, speech, murmur, roar). These perceptions include reception of hearing stimulus, signals and acoustic signs, their processing and retaining (storing). Ability for auditory and verbal perception in a hearing disabled person is much lower or fully disabled. It depends on the level and type of hearing disability and type of amplification. The aim of this paper was to define the level of improvement of hearing and verbal perceptions in hearing disabled persons. A total of 31 patients were included in the study from the University Clinic for Ear, Nose and Throat in Skopje, with a diagnosis of severe bilateral hearing disability. After being diagnosed, they were included into a rehabilitation program and tested, with hearing aids. After six months period, the results of the conducted test for development of auditory perception-Lip Profile (listening progress) showed an insignificant improvement of auditory and verbal perception comparing to the period when the subjects were without hearing aids. Due to the minor improvement, the same patients were included into a treatment with insertion of a Cochlear implant. Conclusion: After six months - period of rehabilitation treatment there was a significant improvement of auditory and verbal perception in comparison with the period when patients had hearing aids.
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Assessment of Speech Development in Children with Cochlear Implants in Republic of Macedonia Using Monosyllabic-Troche Polysyllabic Test (Closed-Set)
(ID Design 2012, 2013-03-27)
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Background: Electric stimulation of the auditory nerve via cochlear implants has made a great impact on treatment of sensory deafness. Advanced signal processing and stimulation paradigms have led to continuously improved results in speech understanding. Consequently, indication criteria have been extended to patients with profound and severe-to profound hearing loss and limited speech understanding with conventional acoustic amplification. Aim: The aim of this study was to present speech development in subjects with pre-lingually sensorineural hearing loss implanted with a cochlear implant in Republic of Macedonia. Methods: The study included 31 subjects of both sexes and pre-lingual sensorineural hearing impairment. The average age of the implanted patients was 100.4 ± 74.1 months. The speech perception after cochlear implantation was evaluated using the Monosyllabic-Throche Polysyllabic test (MTP) with closed-set words without the aid of lip-reading. The patients should be able to point-to or clearly repeat the pictured words (or objects). Subjects were followed-up in a period of 6, 12 and 24 month post-implantation. Results: Cochran’s Q-test showed a significant difference in identification of monosyllabic,disyllabic and polysyllabic words in patients with cochlear implant during the analyzed period of 24 months. McNemar’s test confirmed that 24 months after implantation the subjects significantly better identified monosyllabic, disyllabic and polysyllabic words in comparison with the time interval at 12 and 6 months. Also, there was a substantial improvement 12 months after cochlear implantation in comparison with the interval at 6 months.
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Concurrent genetic and standard screening test for hearing reduction
(Macedonian Pharmaceutical Association, 2020)
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Shukarova Stefanovska, Emilija
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Reduction of hearing is the most common sensory impairment among newborns with an incidence of 1-3 per 1000 births. Introduction of an Auditory Newborn screening program allows early identification of hearing impairment. Mainly, congenital hearing loss in early childhood is a result of genetic changes. Due to high frequency of GJB2 pathogenic variants, its molecular characterization among sensorineural hearing reduction cases is already conducted as a routine analysis in many countries. The aim of this study is to show our initial results in the effort to determine whether genetic screening along with the standard hearing screening in newborns is justified. Otoacoustic emission (OAE) method was conducted in 223 newborns at risk of hearing impairment. Among them, 7 did not pass the test in both ears while 9 exhibited one-sided hearing loss. In all 7 children with indication of profound bilateral deafness, the diagnosis was confirmed using auditory brainstem response. Genetic screening of GJB2 gene was performed in 6 of them. Genetic analysis of GJB2 revealed homozygous state of the most common pathogenic variant 35delG in 3 (50%) of the analyzed infants. In the remaining 3 no pathogenic variant was determined. The results indicate that performing auditory OAE together with genetic screening is justified. In newborns who have not passed the hearing screening test and have profound hearing loss, without other syndrome traits, screening for mutations of GJB2 gene should be conducted. Genetic screening enables establishment of early definite diagnosis for deafness and helps in conducting adequate therapy providing timely rehabilitation and social inclusion of deaf child.
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Adenoid Vegetations - Reservoir of Bacteria for Chronic Otitis Media with Effusion and Chronic Rhinosinusitis
(Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences, 2015)
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Beti Zafirovska
Introduction: Otitis media and rhinosinusitis are commonly encountered illnesses in pediatric population. Literature reports have documented the association between the occurrence of these two conditions and even their almost identical microbiological findings. Until recently, the key factor in the association of these two conditions was considered to be the hypertrophic adenoid tissue, but within the past few years there have been evidences in the literature about the presence of bacterial biofilms on the adenoids suggesting biofilms to be also responsible for both conditions, chronic otitis media with effusion and chronic rhinosinusitis. Aim: The aim of this study was to make a microbiological analysis of the adenoid tissue specimens taken from patients with chronic otitis media with effusion and chronic or recurrent rhinosinusitis and to determine their potential for biofilms formation. Methods: After the surgical intervention, adenoidectomy, microbiological evaluation and analysis of the adenoid tissue specimens taken from 20 patients were made. Having in mind the disease history, chronic otitis media with effusion was diagnosed in all 20 patients and chronic rhinosinusitis in 9 patients. Results: The results obtained from the microbiological analyses showed many potentially pathogenic bacteria in the adenoids that were almost identical with the most common organisms incorporated in the etiopathogenesis of both conditions, in chronic otitis media with effusion and in chronic rhinosinusitis. In 7 (35%) patients Haemophylus influenzae was isolated, in 6 (30%) Streptococcus pneumoniae, in 4 (20%) Moraxella catаrrhalis, in 2 (10%) patients Staphylococcus aureus and in 1 (5%) patient Streptococcus pyogenes - group A was isolated. One bacterium was isolated from all adenoid vegetations, except in one case when two bacteria (Haemophylus influenzae and Staphylococcus aureus) were concurrently isolated. Conclusion: Our results have shown that the key role in adenoid vegetations in chronic otitis media with effusion and chronic rhinosinusitis is not only the mechanism of rhinopharyngeal obstruction, but also the presence of bacterial strains with a large potential for formation of biofilms adhered to their surface, especially in cases with symptoms of chronic otitis media with effusion and chronic rhinosinusitis that were resistant to antibiotic therapy.
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Noise induced sleep disturbance in adult population: Cross sectional study in Skopje urban centre
(Institute od Immunobiology and Human Genetics, Faculty of Medicine, University "Ss Kiril and Metodij", Skopje, 2009-09-15)
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Vera Petrova
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Aim. To evaluate sleep disturbance caused by environmental noise in residents of Skopje urban centre and to quantify the probability for sleep disturbance related to night-time noise exposure. Methods. Cross sectional study with noise measurements for determination of noise exposure indicator Lnight. A randomised sample was selected from adult population and directly interviewed with questionnaire for assessment of sleep disturbance. Results. 510 questionnaires were collected and the response rate was 72%, 8% of the population sample reported a high level of sleep disturbance and 18% reported a moderate level of sleep disturbance. The most frequent sources of noise were neighbourhood and road traffic. The most disturbed age group were individuals 51-65 years old, who were significantly more disturbed (p=0.010) than the age group of 41-50 years old. Differences in sleep disturbance were significant only for the group exposed to Lnight ≥ 56 dBA (Wald = 4.31; p = 0.04). Exposure to Lnight above 56 dBA had OR = 2.2 (95% CI 1.1 - 4.7) or double significant increase probability for sleep disturbance, compared with control group of subjects exposed to Lnight ≤ 45 dBA. Conclusion. Night time noise exposure above the established limit values significantly increased the risk for sleep disturbance. These findings induce necessity for reducing noise exposure, especially during night-time and for taking preventive measures.
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COCHLEAR IMPLANTATION AND VERTIGO- A CASE REPORT
(SHMSHM / AAMD, 2020-08-31)
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Duma-Vasovka ,Irena
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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.
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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)
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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).
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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)
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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.

Davcheva chakar, Marina

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