Background/Aim. Cholesteatoma is characterized by progressive growth with the erosion of surrounding bone due to pressure effects, enzymatic activity and activation of osteoclasts. The aim of this study was to examine the expression levels of tumor necrosis factor (TNF)-alpha receptor 2 (TNF R2) and interleukin-1 (IL-1) in chronic otitis media (COM) with and without acquired cholesteatoma and correlate them with the degree of bone destruction. Methods. The study included 178 patients of both sexes, aged 5?75 years, who underwent microsurgical treatment for COM, with and without cholesteatoma at the Ear, Nose and Throat Department, University Clinical Center of Republika Srpska (UCC RS), Banja Luka from 2015 to 2018. Based on cholesteatoma presence, the patients with COM were divided into two groups: with cholesteatoma (CCOM) (n = 97) and without cholesteatoma (COMWC) (n = 81). Samples of cholesteatoma perimatrix in the CCOM group and tympanic cavity inflamed mucosa in the COMWC group were collected intraoperatively. Intraoperative exploration of the middle ear included the status of the ossicular chain, individual ossicles, osseous walls of the external auditory canal (EAC) and tympanic cavity. Expression levels of TNF R2 and IL-1 were investigated by immunohistochemical analysis of tissue samples obtained during ear surgery. Results. The correlation between the level of osteodestruction and the presence of cholesteatoma was significant (p < 0.01). Elevated expression levels of TNF R2 and IL-1 were most frequent in CCOM patients with osteodestruction. The probability of osteodestruction of EAC and tympanic cavity walls was significantly higher in patients with high TNF R2 expression (p < 0.05). With respect to IL-1 expression levels, no significant correlation with the described pathomorphological changes was observed. Correlation between TNF R2 and IL-1 expressions and ossicular chain destruction was significant (p < 0.01). Conclusion. Cholesteatoma presence and elevated expression levels of TNF R2 and IL-1 in COM patients are significantly correlated. Expression levels of TNF R2 and IL-1 in acquired cholesteatoma tissue have a potential clinical significance for the occurrence of bone destruction compared to expression levels in inflamed mucosa of the tympanic cavity.

Introduction. The inflammatory mediators play a central role in the pathogenesis of the inflammatory process of the middle ear and cholesteatoma from the aspect of initiating and maintaining the inflammatory response to infection and lesion. The aim of the study was to examine if the presence of acquired cholesteatoma could predict pathomorphological changes of the tympanic cavity mucosa in relation to the control tissue of the inflamed middle ear mucosa and to examine and compare the expression levels of tumor necrosis factor-alpha (TNF-a), interleukin-1 (IL-1) and matrix metalloproteinase 9 (MMP-9) with pathomorphological changes in the middle ear mucosa in chronic otitis media (COM), with and without acquired cholesteatoma (AC). Methods. The immunohistochemical study included 178 patients of both sexes, aged 5 to 75, who underwent microsurgical treatment of COM from 2015 to 2018. Patients were divided into two groups based on the presence or absence of AC of the middle ear: 97 with cholesteatoma (CCOM) and 81 without cholesteatoma (COM). Samples of the perimatrix of AC and inflamed middle ear mucosa were taken intraoperatively. The condition of the tympanic cavity mucosa was examined by otomicroscopy exploration intraoperatively. The expression levels of TNF-a, IL-1 and MMP-9 were determined by immunohistochemical analysis. Results. The difference in the percentage distribution of patients according to the condition of the tympanic cavity mucosa between both groups was statistically significant (p <0.01) where in the COM group the highest frequency was 43.2% of patients with mucosal hypertrophy, and in the CCOM 56.7% with granulations. With highly positive expression of TNF-R2 and IL-1, a higher probability of the presence of mucosal hypertrophy and granulations can be expected, and with highly positive expression of MMP-9 the presence of granulations. Conclusion. Acquired middle ear cholesteatoma is a statistically significant predictor of the occurence of mucosal hypertrophy and granulations in the tympanic cavity in relation to the control tissue of the inflamed middle ear mucosa. The high expression of TNF-R2, IL-1 and MMP-9 shows a statistically significant association with the presence of granulations and mucosal hypertrophy in acquired middle ear cholesteatoma which may have clinical significance in the evaluation and prognosis of the disease.

The otogenic intracranial complications are rare manifestations in modern era of antibiotics. An early antibiotic therapy often covers typical clinical signs and symptoms for each complication. A sigmoid sinus thrombosis is often associated with other intracranial complications, as in this case, an epidural abscess. We are presenting a case of 12-year-old girl with the sigmoid sinus thrombosis and epidural abscess as complications of chronic infection to the middle ear with cholesteatoma. In the active phase of chronic inflammation of the middle ear she was treated with the antibiotic therapy that covered early symptoms of intracranial complication development. A humid attic perforation of the tympanic membrane with protrusion of choleastoma and evident signs of bony wall destruction to the external auditory canal was noticed by performing routine otomicroscopy and otoendoscopic examination. Assuming intracranial complication, magnetic resonance imaging (MRI) of the endocranium was undertaken. The MRI showed inflammatory changes of both middle ears with intracranial complications: the right sigmoid sinus thrombosis and epidural abscess of the same side. During the surgery we have noticed an extensive middle ear cholesteatoma with significant destruction of the bony tissue and purulent collection between sigmoid sinus changed with granulation and respective dural segment of the posterior cranial cavity. Timely diagnosis, multidisciplinary approach with an adequate choice of the antibiotic therapy and surgical technique have a crucial prognostic significance.

Introduction. Matrix metalloproteinase-9 (MMP-9) plays one of the key roles in the migration of inflammatory cells and the destructive behavior of acquired middle ear cholesteatoma. The aim of the study was to determine the expression levels of MMP-9 in chronic otitis media, with and without acquired cholesteatoma, as well as to determine the correlation between them and the pathomorphological changes in the tympanic membrane (TM). Methods. Immunohistochemical study included 178 patients of both sexes, aged 5-75 years, who underwent microsurgical treatment of chronic otitis media (COM) at the Ear, Nose and Throat Department of the University Clinical Center of the Republic of Srpska in Banja Luka from 2015 to 2018. Patients were divided into two groups on the basis of the presence or absence of acquired cholesteatoma: 97 (CCOM) and 81 (COMWC). The samples of the perimatrix of acquired cholesteatoma (n=97) and inflamed middle ear mucosa (n=81) were taken intraoperatively. The presence of retraction and certain types and subtypes of TM perforations were examined by intraoperative exploration. MMP-9 expression levels were determined by immunohistochemical analysis. Results. In the presence of cholesteatoma and highly positive expression of MMP-9, the marginal type of TM perforation was more likely to occur (p<0.01) while in negative expression of MMP-9 in the COMWC group, the central type was more likely to occur (p<0.01). There was a higher probability of the presence of attic subtype of TM perforation in patients with cholesteatoma and moderate positive expression of MMP-9 (p<0.01). There was not a statistically significant contribution of any of the factors in the prediction of the influence on the occurrence of TM retraction. Conclusion. The presence of acquired middle ear cholesteatoma and highly positive expression of MMP-9 are statistically significant predictors of the presence of marginal type and attic subtype of TM perforation. Expression levels of MMP-9 may have potential clinical significance in the development of irreversible pathomorphological changes on TM in middle ear cholesteatoma.

Introduction/Objective. Total thyroidectomy (TT) is frequently performed in head and neck surgery and is considered a relatively straightforward procedure, yet it is still associated with a number of complications. This study aimed to examine the role and significance of TT in the occurrence of postoperative complications in correlation with histopathological (HP) and endocrinological findings. Methods. A cross-sectional study was conducted involving 90 patients in the University Clinical Center of the Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina who underwent the thyroid gland surgery 2022?2024. Preoperatively, hormonal analyses, thyroid ultrasound examination, and endovideolaryngoscopy were performed. TT was performed in all patients. Postoperatively, HP diagnostics, control hormonal tests, and endovideolaryngoscopy were performed. Results. Vocal fold paralysis (VFP) was reported by 11 (12.2%) patients. HP analysis showed that goiter was the leading cause in 37 (41.1%) patients, followed by follicular adenoma in 25 (27.8%) and papillary carcinoma in 18 (20%); other causes were present in the remaining 10 (11%). Regarding endocrinological complications, hypocalcemia was present in 67 (74.4%) patients, and elevated parathyroid hormone levels in four (4.4%) patients. Conclusion. VFP and hypocalcemia represented the most common postoperative complications after TT, particularly in patients with HP-diagnosed goiter, follicular adenoma, or papillary thyroid carcinoma. These findings may help identify older patients who are at increased risk of TT-related complications that could significantly impair their quality of life.

Introduction. Hyperglycemia causes the well-known microvascular complications of diabetes mellitus (DM) such as diabetic retinopathy, polyneuropathy and nephropathy, but it can also affect the inner ear, and hearing loss (HL) can be considered as one of the microvascular complications. The aim of the study was to evaluate association between HL and values of glycated hemoglobin A1c (HbA1c) in patients with diabetes mellitus type 2 (DMT2).Methods. In this retrospective-observational cross sectional study, we included 80 patients divided into two groups: experimental group consisting of 40 patients with DMT2 and control group consisting of 40 patients who were not previously diagnosed with DM. Data were retrieved from electronic medical records of patients treated in outpatient clinic of the Ear, Nose and Throat Department, University clinical center of Republic of Srpska (UCC RS) from 2023 to 2024. Results. Out of 40 patients from experimental group, 15 were males (37.5%) and 25 were females (62.5%). Regarding glycoregulation patterns in experimental group, patients were stratified into three subgroups: HbA1c < 7% (N 17; 42.5%), HbA1c-9% (N 17; 42.5%) and HbA1c > 9% (N 6; 15%). In the experimental group, a significant (p<0.000) greater number of patients had HL, and significant greater number of patients had bilateral HL (N 32; 80%, p<0.05) with predominantly pronounced sensorineural HL (N 36; 90%, p<0.05).Conclusion. Patients with DMT2 had a higher incidence of HL compared to controls. The sensorineural type of HL showed a significantly high prevalence among patients with DMT2. HbA1c levels may be a potentially significant predictor of HL in DMT2.