22nd Czech - German ENT Days

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Introduction Ultrasound guided fine needle aspiration (FNA) is the diagnostic tool used routinely for thyroid gland nodules since the 1980s. In about 10-20 % of cases the cytology result is inconclusive. Lately core-needle biopsy (CNB) is becoming more and more popular to diagnose head and neck tumors. From previous studies we can conclude that CNB of thyroid gland is a safe, mini-invasive biopsy method. Methods This is a retrospective study of 5 case reports and literature review of thyroid gland CNB. Results At the Department of otorhinolaryngology in General university hospital in Prague we provide US guided CNB in head and neck since 2018. In the 6-year period (2018-2023) we performed 5 CNB of the thyroid gland (4 females and 1 male). 4 patients were referred to our department by endocrinologist and 1 patient has been referred by hematooncologist. There were no severe complications after the biopsy, one patient complained of oedema in the site of the biopsy. 3 of the 5 biopsies found malignant tumor, 2 biopsies were benign. One of the benign biopsies was false negative. Conclusion The latest data comparisons show that the histology results of thyroid gland CNB are not significantly better than FNA cytology examination. Consequently, CNB is not usually the primary diagnostic tool for thyroid gland nodules. However, as is also demonstrated in our series of cases, CNB proved to be significantly better than FNA to diagnose low differentiated tumors such as lymphomas and anaplastic carcinoma. In conclusion CNB of thyroid gland is a useful auxiliary diagnostic method for some thyroidal tumors.

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Background: Primary hyperparathyroidism is one of the most common endocrine disorders. The standard treatment is surgical removal via a cervical incision. In some cases abnormal parathyroid tissue may be present in the mediastinum and sometimes is necessary thoracic approach. Methods: We retrospective analyzed two groups of patients: 923 cases of primary hyperparathyroidism, operating between years 2008-2013, and 1293 cases operating between years 2018-2023. Surgical thoracic approaches were noted. Results: A total of 2216 cases of primary hyperparathyroidism were studied. The 49 cases ectopic parathyroid adenoma were deep in the mediastinum. The thoracic approaches in the first group (2008-2013) were sternotomy in 22 cases. The thoracic approaches in the second group (2018-2023) were sternotomy (4 cases), video-assisted thoracoscopy (21 cases) and robotic-assisted thoracoscopy (2 cases). Conclusion: The miniinvasive thoracic approaches become more popular.

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Introduction: A retrosternal or substernal goiter is a thyroid gland tissue extending into the chest cavity. They can be asymptomatic or symptomatic. A retrosternal goiter may involve one or both lobes of the thyroid gland and may cause deviation or compression of the trachea, possibly the esophagus or vascular structures. The treatment of a symptomatic substernal goiter is a surgical removal, thyroidectomy. This can be done from the cervical approach, but often this approach is not sufficient for the size of the thyroid gland and it is necessary to use a thoracic approach for definitive removal of the entire goiter. The aim of this presentation is to summarize experience and presentation of thyroidectomy options from various surgical approaches at our workplace. Methodology: In this presentation, the annual results of our workplace will be presented, as well as the individual options for operative approaches that we use for thyroidectomy at 3rd surgical clinics of the 1st Faculty of Medicine of the UK and the Motol General Hospital from January 1, 2019 to June 1, 2024; at the same time, individual indications and complications of such approaches will be also presented. Results: The number of retrosternal goiters operated with other than a cervical approach is not large. However, you can see in my presentation that it is sometimes a great advantage to use a thoracic approach in this issue. There are certain groups of patients by whom the thoracic approach cannot be used, and I mention that here. Conclusion: The use of a thoracic approach in substernal goiter operation is often a great advantage and necessity. This presantation will offer you a detailed view of our practical experience with this approach.

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Introduction Identification of a hyperfunctioning parathyroid gland (PG) is an important but challenging aspect of the treatment of hyperparathyroidism. In recent years, autofluorescence and ICG (indocyanin green) angiography appear to be promising methods to identify PT during surgery. The purpose of this study was to evaluate the efficiency of intraoperative autofluorescence and ICG angiography and compare their reliability with nuclear medicine methods (99mTc-MIBI scintigraphy, PET/CT). Materials and methods Before parathyroidectomy (PTE), sonography, scintigraphy, and, in cases of a negative or inconclusive result, PET or CT were performed. Total calcium and parathyroid hormone levels were measured. During the surgery, autofluorescence was evaluated, and then, after the intravenous application of 5 mg of indocyanine green, there was also fluorescence. A positive result of auto-fluorescence was indicated by a bright green coloration of the PG. In cases of radiation-guided PTE, the activity of 99 mTc-MIBI was simultaneously measured. Results The study included 29 patients with primary hyperparathyroidism, with a mean age of 61 years. Seventeen patients underwent scintigraphy and then radiation-guided surgery; the remaining 12 patients underwent PET/CT imaging. Auto-fluorescence was evaluated in all 29 patients; a positive result, a bright green coloration of the PG, was recorded in 10 patients and in 28 cases by ICG angiography. The positive surgical outcome, finding a hyperfunctioning PG and decrease in laboratory parameters, was recorded in a total of 27 patients (93.1%), in radiation-guided parathyreoidectomy in 16 cases (94%), and in surgery without a gamma probe with the use of autofluorescence/ICG angiography in 11 cases (91.67%). No significant difference was noted between the results of surgery with and without navigation. The application of ICG and fluorescence evaluation positively contributed to the correct identification of PG. Conclusion Intraoprative identification of a hyperfunctioning PG depends mostly on surgeons skills and primarily on preoperative imaging. ICG angiography is a promising method to identify PG that achieves similar outcomes compared to radiation-guided parathyroidectomy. It is therefore important, especially in cases where the gamma probe cannot be used (PG without 99mTc-MIBI accumulation and a negative/inconclusive result of scintigraphy or PET/CT). Supported by institutional grant of University Hospital Ostrava RVO-FNOs/2023-07

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In our department we followed patients undergoing total thyroidectomy in years 2022 and 2023 and performed a prospective study. Our main goal was to diagnose patients with postoperative paresis of the superior laryngeal nerve in order to provide them early phoniatric care to maintain their quality of life. As a tool to determine the paresis we used a non-invasive, easy to perform voice field. Each patient’s voice performance was stored preoperatively together with video endoscopy of the larynx, so that the same examination could be performed one week after surgery for data comparison. The threshold value for determining paresis of the superior laryngeal nerve was a loss of at least 100 Hz in the higher tones of the patients' voice, repeatedly. A total of 52 patients were included in the study, from which 8 patients were later removed due to the following conditions: recurrent laryngeal nerve paresis, unrelated death, vocal fold polyps, noncompliance. 44 patients had an evaluable postoperative voice field and 2-3 postoperative controls. In 2022, we diagnosed 1 patient with NLS paresis from 23 operations (risk = 4.35%), in 2023 it was 2 patients from 21 operations (risk = 9.5%). The common risk of paresis is then 6.8%. No such study has been conducted at another site, so it makes it incomparable. In the literature, we can find that the risk of postoperative paresis ranges from 1 to 14%. In conclusion, we find the voice field as a tool for the diagnosis of NLS paresis to be sufficient, easy to perform and non-invasive. It is worth noting that the patients were not occupational voice users. The gold standard in the objective diagnosis of NLS paresis is laryngeal electromyography. However, introducing it into regular practice would be technically and personnel very demanding, and even reading the results is very dependent on the interpreter. In order to establish the vocal field as a routine tool, a study comparing the vocal field and laryngeal EMG would be necessary.

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Introduction: New neuromonitoring techniques for the integrity of the recurrent laryngeal nerve (RLN) in thyroid surgery allow a continuous monitoring and have been shown to lower the incidence of permanent RLN paralysis further in a recent European study. In 2018 new international guidelines have been implemented which forbid to continue a benign thyroid surgery in case of a permanent loss of signal on the first operated side. We wanted to see whether both measures have a noticeable influence in our own patient cohort. Method: All cases of bVFP who were seen in our neurolaryngologic clinic in Gera since 2008 were collected retro- and prospectively in a multicentric clinical registry (ethics approval obtained). In total 112 cases were seen. Results: The incidence of bVFP due to thyroid surgery in our cohort dropped from 65,1% (2008 to 2017, 28 of 43 cases) to 5,9% (2018 to 2023, 3 of 17 cases). For primary thyroid surgery is was only one case, which equals a reduction of 91%. However, these data do not necessarily reflect the true incidence of bVFP, as referral behavior to us has also changed. Conclusions: The effects of the implementation of new monitoring techniques and strict thyroid surgery guidelines are clearly visible in our local patient cohort and underline the value of both measures.

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The submental island flap is a relatively new reconstruction technique for covering defects after removal of head and neck tumors. The flap, which is pedicled on the submental artery, has only a limited range, but can be used for a number of different defects due to the favorable location of the donor region. The advantage of the flap is its low donor morbidity and its good color match with the facial skin. Since 2018, a total of 10 patients have been treated with a submental island flap. In a single case, partial necrosis of the epidermis of the flap was seen after venous congestion. Through early intervention, the infiltration of heparin into the flap and the treatment with split-thickness skin, a favorable cosmetic result was achieved in this case, as in the other nine cases. No metastases were transplanted in the flap pedicle. The submental island flap is safe to harvest, has a safe blood supply and is relatively versatile for reconstruction in the head and neck area. The authors believe it is particularly suitable for covering large defects in the parotid region. The presentation will demonstrate the harvesting technique, decision criteria for selecting the reconstruction, possible problems and selected cases. The low harvest morbidity, the quick and easy preparation and the relatively short operation time make this reconstruction a good alternative, especially for older patients with comorbidities.

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Aim The aim of the study was the epidemiological analysis of malignant neoplasms of the hypopharynx and larynx in a 10-year cohort of the ENT clinic in Pilsen and identification of trends. Material and methods 456 patients with laryngeal or hypopharyngeal malignancy were included. The parameters monitored in this retrospective study were histology, sex, age, localization, TNM classification, treatment and presence of duplicity. Results The study population consisted of 10.7% women (n=49) and 89.3% men (n=407). The mean age was 64.5 years. Squamous cell carcinoma was the most common malignancy and occurred in 97.6% (n=445), other malignancies were diagnosed in 2.4% (n=11). TNM classification of squamous cell carcinoma included T1 range in 32.8% (n=146), T2 in 20.9% (n=93), T3 in 28.8% (n=128), T4 in 17.5% of patients (n=78). Locoregional metastatic process was diagnosed in 43.8% (n=195), 55.5% had N0 stadium (n=247), 3 patients had unknown Nx extent (0.7%). Distant metastasis were present in 10.6% of patients (n=47), 87.8% had no distant metastases (n=391) and 1.6% were undetermined (n=7). Surgical therapy was used in 52.6% of cases (n=234), in 18.2% in combination with radiotherapy (n=81) and in 7.6% with chemoradiotherapy (n=34 ). In 40.4% of patients, oncological therapy was the primary therapy (n=180). 7% of patients (n=31) had palliative treatment, refused treatment or died before treatment. Multiplicity of malignancies was found in 41 patients (9.0%). Conclusions The dominant malignancy in the study area is still squamous cell carcinoma. There is a trend towards the use of hybrid imaging methods in diagnostics and a clear shift towards primary oncological treatment in therapeutic trends. A concerning fact is that 18% of patients had multiplicity or distant metastases at the time of diagnosis.

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Introduction Squamous cell carcinoma of the larynx is a malignant tumour arising from the squamous epithelium of the larynx and is the 23rd most common malignancy. In the Czech Republic, laryngeal carcinoma was diagnosed in 518 patients in 2016, 533 patients in 2017, and 452 patients in 2018. Methods In this retrospective analysis, we studied patients with early-stage glottic laryngeal carcinoma (Tis-T2N0M0), thus patients in clinical stage 0, 1 and 2. A total of 44 patients treated between 2016 and 2018 in the Oncology Centre of St. Anne’s University Hospital and Masaryk Memorial Cancer Institute in Brno with this extent of involvement were included. The study compared the outcomes of first-line oncological treatment, including surgical and non-surgical modalities, recurrence timing, disease-free interval, and five-year survival rates. Results Out of these 44 patients, 22 were treated surgically in Saint Anne’s University Hospital. No recurrences were observed among these patients, and 7 patients died from causes other than the cancer. Treatment for 22 patients was provided in the Masaryk Memorial Cancer Institute in Brno. Of these 22 patients, 20 underwent curative radiotherapy with a total dose of 70 Gy, while 2 patients received concurrent therapy, with one patient completing 2 cycles and the other 3 cycles of cisplatin. Among 8 patients who received primary non-surgical treatment, recurrence was confirmed and leading to total laryngectomy for each. Of these patients, 7 died, with one death attributed to the underlying condition – verrucous type carcinoma. Conclusion Surgical treatment of early-stage laryngeal carcinoma demonstrates high efficacy with no recurrences in our patient cohort, with mortality due to causes other than the cancer itself. In contrast, patients receiving non-surgical treatment have a higher risk of recurrence, leading to more subsequent surgeries, including total laryngectomy. Specific challenges in treatment are associated particularly with the verrucous type of carcinoma.

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The incidence of malignant melanoma has been gradually increasing in recent years. There are worldwide recommendations for treatment procedures for malignant melanoma, an integral part of which is the collection and examination of the sentinel lymphnode. At the ENT clinic in Pardubice Hospital, sentinel lymphnodes in the head and neck area have been evaluated since 2016. The authors present a group of 85 patients with cutaneous malignant melanoma of the head and neck treated from 2016 to 2023. SLNB examination was performed in 33 patients (38%), more than one SLN was identified in half of the cases, positive SLNB was detected in 4 cases (12%). Recurrence/generalization of malignant melanoma occurred in 8 of 33 patients who underwent sentinel node examination (24%), in 1 of 4 patients (25%) who refused sentinel node examination, and in 11 of 48 patients without an indicated SLNB (23%). The survival time due to the relatively short period of examination has not been monitored in the group, the results are also partially affected by the smaller number of patients. SLNB is one of the most important prognostic factors in cutaneous malignant melanoma, including head and neck involvement. The head and neck area can be considered specific in the issue of the sentinel node, with different characteristics than in other parts of the body, and therefore there is some controversy in the literature.

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Background/Introduction Follow up of patients with oropharyngeal squamous cell carcinoma (OSCC) mainly relies on physical examination and imaging methods. Novel approaches are developed to detect early stages of tumor recurrence, as number of patients with HPV positive OSCC is increasing. Results from other studies indicate that monitoring blood levels of cell-free DNA (cfDNA) could be a promising method in follow up of these patients. Methods This prospective study is ongoing from 2023 in Thomayer University Hospital. Blood samples are collected from patients with histologically confirmed HPV positive OSCC. Blood samples from patients who undergo surgery are taken one day before operation, then one day, one week and four weeks after operation and after that every three months until two years of monitoring. Patients who undergo radiotherapy are drawn every two weeks until the end of radiotherapy and after that every three months until two years of monitoring. Both groups will be then sampled every six months until five years from start of the therapy. Detection of cfDNA is made using ddPCR in Biocev laboratories. Results The first patient who underwent combined therapy (surgery and postoperative radiotherapy) had an input value of cfDNA 16735 ng/mL, the other two patients who underwent only radical radiotherapy had input values of 600 ng/mL and 1470 ng/mL respectively. The first day after surgery and three weeks after the end of radiotherapy were cfDNA levels undetectable. Conclusion(s) Our results indicate that blood levels of cfDNA are strongly related to the mass of the tumor, so we assume that tumor recurrence would be followed by sudden increase in cfDNA levels. However, we have to wait for the results from the remaining part of our study. Supported by MH CZ – DRO (Thomayer University Hospital -TUH, 00064190)

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Introduction: This retrospective study analyzes the clinical data of patients diagnosed with deep neck space infections (DNSI) at the ENT-HNS Clinic of FNUSA Brno over a five-year period from 2018 to 2023. The objective was to evaluate the epidemiology, clinical presentation, diagnostic methods, treatment approaches, and outcomes associated with DNSI. Methods: Data from patient records, including demographic information, etiology, imaging findings, microbiological results, treatment modalities, and complications, were systematically reviewed and analyzed. The results were contrasted with the most recent studies. Results: Key findings indicate a notable prevalence of DNSI in middle-aged adults, with odontogenic and tonsilogenic sources being the most frequent causes. Advanced imaging techniques, particularly CT scans, played a crucial role in diagnosis. A combination of surgical drainage and antibiotic therapy was the predominant treatment strategy. Mediastinitis was identified as the most feared complication, with a lethality rate of approximately 33%. The overall lethality across all patient groups was 6%. Risk factors such as drug substance abuse and immunosuppression were identified as significant contributors to the development of severe complications Conclusion: The study underscores the importance of prompt diagnosis and multidisciplinary management in improving patient outcomes for DNSI. Further research is suggested to optimize treatment protocols and reduce the incidence of severe complications associated with these infections.

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Introduction: Facial nerve paresis leads to dysfunction of the mimetic muscles, which is a limiting problem in daily life not only functionally but also affecting patients' self-esteem and social functioning. Many patients, after previous reinnervation and corrective surgical procedures, do not wish to undergo further procedures involving general anesthesia. As an alternative to static surgical corrections, we are now considering thread lifting. Methodology: We evaluated the results of corrective procedures using thread lifting carried out between January 2023 and July 2024 on a cohort of 23 patients. Photodocumentation and objective assessment were performed using 3D computer analysis allowing evaluation of facial symmetry. Results: An individual application plan was established for each patient. All procedures were performed under local anesthesia, which patients tolerated without difficulties, with an average duration of 45 minutes, and no hospitalization was required. No complications were recorded as a result of the procedures performed. In all cases, successful correction of facial asymmetry was achieved. Conclusion: Optimal surgical treatment of facial muscle palsy requires a systematic approach, individual planning, and usually involves several stages. No single procedure can comprehensively address all aspects, and corrective procedures are essential for achieving maximum subjective satisfaction and quality of life for patients. The proposed and tested method utilizing thread lifting proved to be safe with minimal burden for patients. The type of material used allows the procedure to be combined both with reinnervation procedures and as a definitive approach. To evaluate the benefits, we consider it necessary to assess long-term results on a larger cohort. Support: This work was supported by the research projects of Charles University GAUK 43252 Evaluation of Facial Functions of the Facial Nerve Using 3D-PC Visualization through the Kinect Method and the Cooperatio Program, research area SURG.

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Introduction: Ultrasound-guided radiofrequency ablation (RFA) of the thyroid is a minimally invasive treatment method that can be an alternative to surgery for patients with thyroid nodules. The most common indications for performing RFA are benign non-functional nodules (both cystic and non-cystic), goiter (confirmed as benign), and even micropapillary carcinoma. According to meta-analyses and systematic reviews, RFA has demonstrated good efficacy and safety. RFA works based on the thermal effects of high-frequency electric current on tissue. Methods: We included all RFA we perfomed at our department fdrom Autumn 2023. Results: : Since the fall of 2023, we have performed a total of 5 procedures on 4 female patients, with one being a re-RFA. The treatment was always indicated for cystic swelling of benign nature. The procedure was performed under ultrasound guidance. Post-procedure, a laryngoscopy was conducted to exclude any laryngeal pathology (especially vocal cord paresis), and on the first day after the procedure, a follow-up neck ultrasound was performed. Postoperatively, one patient developed a subcutaneous hematoma, but no serious complications were observed. Follow-up care is provided in endocrinology. Conclusion: Radiofrequency ablation represents one of the treatment options for thyroid swelling. According to meta-analyses, RFA is effective and safe in treating benign nodules. In our case, we did not observe any serious complications and noted a favorable effect on the swelling.

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Introduction Vascular anomalies are a heterogenous group of congenital blood vessel disorders. They can be subcategorized into vascular tumors and malformations. Tumors grow by cellular hyperplasia rapidly during the first six months of life, involute with time, beta blocker therapy can be effective. Malformations represent a localized defect in vascular morphogenesis. They are present at birth, slow growing, infiltrative, and destructive. Almost all vascular malformations eventually require intervention. Case study Our patient was a girl with a multifocal vascular anomaly of the soft tissues in the face (orbit, root of the nose, cheek). Maximized propranolol therapy was not much effective. In the subsequent years, the condition progressed; therefore, it was decided to perform an angiography where a capillary vascularized expansion of the right cheek supplied from one branch of the maxillary artery surgery was detected. The malformation in the face was extirpated after previous sclerotization of the supply vessel at the age of nine. Afterwards a lateral orbitotomy with radical resection of the orbital portion of the malformation was performed. Three months after the procedure, a progression of the vascular malformation in the orbital area occurred. Digital subtraction angiography is now planned with a subsequent surgical resolution of the remaining part of the malformation. Results Postoperatively, a relatively favorable cosmetic effect was achieved, and visual function improved. Now the finding in the orbit has re-progressed. Conclusions Treatment of this type of vascular malformation consists of embolization, surgical extirpation, or a combination of these modalities. Treatment and timing are often individualized to the patient and the extent of disease. In the presented case, our main concern was the bulbar dysfunction and the unfavorable cosmetic appearance of the right cheek. The treatment led to a substantial alleviation of the difficulties.

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Introduction: nasopharyngeal tumors have complex and unique etiopathogenesis, typical histological findings and biological behavior. Benign tumors are extremely rare, less than 1% of tumors in the head and neck region. Malignant tumours of the nasopharynx account for 3% of ENT malignancies, most commonly carcinoma, followed by lymphomas and very rarely other malignancies. Material and Methods: 48 patients entered the retrospective analytical study, 39 of whom met the inclusion criteria, of whom 28 were men (71.8%) and 11 were women (28.2%). Statistical analysis of the data was subsequently performed in this cohort. Results: 30 patients (76.9%) with nasopharyngeal carcinoma (NPC) were included. Other tumors were Hodgkin's lymphoma in 1 man (3.6%), non-Hodgkin's lymphoma in 6 patients (15.4%). 1 rhabdomyosarcoma and 1 myoepithelial carcinoma were diagnosed among other malignancies. Neck swelling was the most common symptom in a total of 26 patients (66.7%), of whom 21 were male (75% of males) and 5 were female (45.5%). Nasal obstruction was another common symptom in 11 patients (28.2%). Headache was reported by 8 patients (20.5%), nasal secretion was present in 7 patients (17.9%), otitis media secretorica and weight loss were identical in 6 patients (15.4%). Patients with NPC had an overall survival of 5 or more years in 6 cases (30%); 3 females (75%), 3 males (18.8%). The situation was different for lymphomas, with 4 patients surviving 5 or more years overall; 2 females (66.7%), 2 males (100%). The patient with rhabdomyosarcoma survived over 5 years, as did the patient with myoepithelial carcinoma. Conclusion: Our results are consistent with published evidence, especially in terms of geographic prevalence influenced by race, genetic factors, and patient lifestyle. In our cohort of patients, nasopharyngeal carcinoma occurred in 76.9% of cases (5 times more in males than females) with a mean age over 50 years. Lymphomas and other tumors accounted for less than a quarter of the cohort.

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Introduction: The trigeminal nerve is also responsible for nasal innervation via chemoreceptors. The intranasal trigeminal system mediates the perception of nasal airflow and sensations such as burning, warming, stinging, cooling through special receptors known as transient receptor potential (TRP) channels. Some trigeminal stimuli (e.g. menthol) lead to a subjective improvement in nasal patency. Dysfunction of the trigeminal nerve has been noted in patients with loss of smell and in some nasal pathologies (e.g. empty nose syndrome, chronic rhinosinusitis with/without polyps, allergic rhinitis, septal deviation etc.). Objective: To create a simple and reliable test to examine the intranasal function of the trigeminal nerve in the nasal cavity. Methods: Healthy participants with normal nasal patency were included. For subjective perception of nasal patency we used VAS score for each side separately. Then examination was performed with 10 markers, 8 of them with trigeminal stimuli such as menthol, acetic acid, cloves etc. We included also one olfactory stimulus (vanilla) and neutral (water). Patients first applied markers to both nostrils and to each side separately. Participants then described the sensations (cooling, warming, burning, stinging) and pleasure of the given smell. Results: 24 participants were included (5 men, 19 women, age between 20-68 years). The mean value of VAS for right side was 8,58 out of 10 and for left side 8,96 out of 10. Eucalyptus and menthol was evaluated as cooling in 87,5 % of participants, acetic acid (dilution 50 %) as stinging (79,2 %); formic acid as stinging (87,5 %), citronella as cooling (54,2 %), acetic acid (dilution 75 %) as stinging (91,7%), cloves as warm (50 %), and camphor as cooling (70,8 %). The most pleasant was vanilla and the least pleasant was formic acid. The examination lasted approximately 20 minutes. No complications were noted during the examination. Conclusion: Examination of the intranasal function of the trigeminal nerve is not commonly used in ENT practice despite the fact, that there are several tests to examine the intranasal function of the trigeminal nerve. We expect its use in evaluation of nasal patency in patients with nasal pathologies.

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Introduction: Vagal nerve stimulation (VNS) is performed during the head and neck surgeries to prevent reccurent laryngeal nerve injury. It has also emerged as a potential therapeutic approach for various cardiovascular disorders. Understanding its impact on cardiac-specific markers such as troponin I, copeptin, and NT-pro BNP is crucial for assessing its efficacy and safety in clinical settings. Methods: We performed a prospective study in patients, which were indicated for hemithyroidectomy or total thyroidectomy with no severe cardiovascular comorbidities. The group included 75 patients undergoing surgery using continuous or intermittent neuromonitoring. Venous blood samples were obtained preoperatively, within 3 hours after surgery (postoperatively) and 24 ± 12 hours after surgery (first day after surgery). Serum levels from collected blood were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Results: We present the dynamics of cardiospecific markers Troponin I, Copeptin and N-terminal prohormone of brain natriuretic peptide (NT-pro BNP) after vagal nerve stimulation during intraoperative neuromonitoring in a group of patients undergoing thyroid surgery. The results are related to the extent of the procedure (hemithyroidectomy, total thyroidectomy) and type of neuromonitoring (continuous or intermittent) at the Otorhinolaryngological Clinic of the 3rd Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady. Conclusion: Intraoperative neuromonitoring of the recurrent laryngeal nerve and recently the vagus nerve is one of the modern methods used regularly in thyroid surgery. Impact on autonomic nervous system is mentioned as a main protentional risk during the vagal nerve stimulation. The aim of our study was to demonstrate the safety of intraoperative neuromonitoring and indicate potential dynamics of specific cardiac markers during vagal nerve stimulation. The work was supported by research projects of Charles University: GA UK No. 260623, and COOPERATIO 43 SURG.

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Introduction: Acute unilateral vestibulopathy (AUVP) is defined as an acute peripheral vestibular syndrome without evidence of central neurological or audiological symptoms. Currently, there is no uniform instrumental testing protocol for the diagnosis and follow-up of patients with AUVP. Vestibular tests provide information in the different frequency bands of the vestibuloocular reflex (VOR); therefore, the aim of our study is to evaluate the contribution of multifrequency VOR testing in the evaluation of patients with AUVP. Methods: 40 patients (15 females and 25 males) with a diagnosis of AUVP were prospectively examined. Multifrequency testing included spontaneous nystagmus with visual fixation cancellation (SPN), Head Shaking Test (HST), bithermal air caloric test and video Head Impulse Test (vHIT). The first examination was performed within one week of AUVP, follow-up examinations were performed 3 and 6 months apart. At the third examination, the Dizziness handicap inventory (DHI) questionnaire was completed. Results: The rate of the slow component of spontaneous and induced nystagmus during HST and the values of unilateral weakness (UW) during caloric testing decreased during follow-up with a statistically significant difference (p<0.05) between both the first and second and between the second and third examinations. On vHIT, there was a statistically significant increase in the gains of individual channels during follow-up. Dissociation of vHIT and caloric test results was found in 25% of patients at the second and 17,5% of patients at the third examination. There was a statistically significant difference in the changes in test results of patients with different DHI. Conclusion: Multifrequency VOR testing provides a comprehensive overview of the status of vestibular function, recovery dynamics and clinical impact of residual vestibular dysfunction after AUVP.

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Introduction: Thymoma might be known by its name as a benign tumor, but this is not entirely the case. According to the WHO classification, there are 5 subtypes of thymoma, namely A(best prognosis), AB, B1, B2, B3(most severe subtype). Case report: A case report of a 32-year-old female patient admitted to the Department of Otorhinolaryngology and Head and Neck Surgery in 2023 is presented. The patient was admitted electively on the recommendation of an endocrinologist for removal of a tumor in the jugulum. The first consideration according to imaging was a lipofibroma, hamartoma or ectopic thyroid. Surgical procedure in which removal of this tumor in the jugulum without complications, postoperative course favorable. Surprisingly, however, the histology result showed thymoma AB, a lesion with malignant potential, and thus the patient was assigned the diagnosis C 38.1. Classification of thymoma AB pT1a cN0M0. Subsequently, the patient was discussed within the oncology board, when the subsequent radiotherapy was arranged. Initiation of radiotherapy was less than 2 months after surgery, with a total dose of 54 Gy and a total of 27 fractions over 6 weeks. The patient was followed up regularly during and after radiotherapy at the Oncology Clinic. No signs of local recurrence or dissemination on follow-up imaging, patient in complete remission of disease at this time. Conclusion: Despite its name, thymoma is considered a disease with malignant potential. Therefore, its therapy is ideally approached by surgical staging followed by oncological therapy (radiotherapy, chemotherapy, hormone therapy, or immunotherapy). It is advisable to think of this diagnosis if one encounters a patient with a swelling in the jugulum that is not clearly related to the thyroid gland. Thymoma is more common in patients with autoimmune diseases (e.g. mysthenia gravis, Good syndrome).