Polish Journal of Otolaryngology最新文献

<b>Introduction:</b> Severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) are frequently comorbid diseases caused by type 2 inflammation. The complete etiology of these forms still remains unexplained, which makes causal and fully effective therapeutic management impossible. New therapeutic options using the knowledge of Th2 inflammatory endotype are based on anti-IL5 (mepolizumab, reslizumab), anti-IL5R (benralizumab), anti-IgE (omalizumab), and anti-IL4/IL13 (dupilumab) monoclonal antibodies. Recently, biological therapy has provided a new personalized therapeutic option for patients with CRSw NP.<b>Aim:</b> The aim of the study was to evaluate the efficacy of mepolizumab, benralizumab, omalizumab, and dupilumab in the reduction of rhinological symptoms in severe asthmatic patients with chronic rhinosinusitis with nasal polyps.<b>Materials and methods:</b> In 32 (9 male, 18%) patients with CRSwNP and severe bronchial asthma treated with biologics - mepolizumab (19, 59%), omalizumab (5, 15%), benralizumab (6, 19%), and dupilumab (2, 6%) for 6 months, a subjective evaluation of rhinologic symptoms was conducted (TNSS, SNOT, smell evaluation).<b>Results:</b> In all analyzed groups, 6-month treatment with mepolizumab, omalizumab, and benralizumab resulted in significant improvement in rhinitis symptoms assessed by TNSS and SNOT scales as well as in the sense of smell. Due to the small group of patients treated with dupilumab, statistical analysis in this group was not performed.<b>Conclusions:</b> Our real-life observation confirmed that biological therapy based on phenotyping enables achieving optimal therapeutic effects for patients with CRSwNP and severe bronchial asthma. Biological therapy should be conducted through a collaborative and multidisciplinary approach.

<b>Introduction:</b> External ears are distinct and do not alter with age. Ear traits may be as reliable as fingerprints in identifying people. An external ear morphological analysis and observation of Basrah population ear features were undertaken to assess how beneficial the ear is for identification.<b>Aim:</b> This study gathered comprehensive data on the external ear phenotypic variations in the Basrah population.<b>Methods:</b> A cross-sectional study of 608 patients aged 7-70 years (308 men, 300 women). Abnormal ears were omitted. Photographs and population statistics were randomly collected.<b>Results:</b> The predominant ear shape among our population is oval, including 38.7% of males and 42.7% of females. Females predominantly exhibit tongue-type earlobes (44.7%), while males are more likely to possess arched lobes (39.6%). In both genders, the attached earlobe is the second most prevalent ear type, behind the free earlobe (41.2% in males and 60.0% in females). The long variety of the tragus is uncommon, while the knob-shaped variant is more prevalent, seen in 46.8% of males and 51.3% of females. The normal rolled helix is common in both genders. Many individuals in our population lack Darwin's tubercle.<b>Conclusions:</b> External ear forms vary according to heredity. Despite minor gender and country variations, it is useful in forensics, plastic surgery, and anomaly identification.

<b>Introduction:</b> The natural progression in the development of surgical approaches for bone conduction implant systems, such as the Cochlear™ Osia2, involves exploring alternative solutions aimed at ensuring patient safety, improving surgical outcomes, and simplifying procedural techniques.<b>Aim:</b> The aim of this study is to present an alternative surgical access technique for the implantation of the Osia2 system - SCOTNI, along with the benefits and risks associated with the procedure.<b>Materials and methods:</b> The analysis included 14 patients treated using the SCOTNI incision technique between July 2023 and February 2024. The study details the steps of the procedure employing this technique, intraoperative and postoperative outcomes, and characteristics of the patient group.<b>Results:</b> The implantation using the SCOTNI incision technique is associated with a short incision line and convenient exposure of the implantation site. This method allows for intraoperative bone polishing and repositioning of the OSI200 implant. However, in cases of excessive compression by postoperative dressings, there might be a need for system explantation.<b>Conclusions:</b> The SCOTNI technique enables the management of various complications that may arise during surgery while maintaining the full functionality of the system and aesthetic outcomes. Therefore, this technique represents a valuable option, providing better adaptation to individual patient needs without compromising device effectiveness.

1,8-cineole, renowned for its versatile therapeutic properties, has long been utilized in the treatment of respiratory system disorders. Its potential for oral administration offers a new dimension as an effective systemic therapy with anti-inflammatory and antibacterial effects. Maintaining stable levels of the compound in the body enhances treatment efficacy and reduces the risk of recurrence. Additionally, 1,8-cineole exhibits anti-biofilm activity, addressing biofilms often associated with chronic respiratory infections, thereby making it an effective tool in managing hard-to-treat infections. This article reviews the latest research and potential applications of 1,8-cineole in the treatment of respiratory infections, emphasizing its multifaceted mechanism of action.

<b>Introduction:</b> Central venous thrombosis (CVT) represents a well-documented complication of acute otitis media (AOM) and acute mastoiditis (AM). Despite widespread antibiotic utilization, which has significantly reduced the incidence of severe AOM/AM complications, recent years have witnessed an increasing frequency of thrombotic complications in pediatric patients, not invariably presenting with classical neurological manifestations.<b>Aim:</b> This study aimed to investigate the potential correlation between COVID-19 infection and increased CVT incidence, while sharing therapeutic experiences, given the absence of standardized treatment protocols for otogenic CVT in pediatric populations.<b>Materials and methods:</b>A retrospective observational analysis was conducted on patients admitted to the Department of Pediatric Otolaryngology at the Medical University of Warsaw for otogenic CVT between 2018 and 2023, with treatment completion by January 2024. The investigation encompassed the extent of thrombotic changes, concurrent complications, anticoagulation therapy modalities and duration, and therapeutic monitoring protocols.<b>Results:</b> The study cohort comprised 13 patients, with complete follow-up data available for 11 subjects. Low-molecular-weight heparin (LMWH) monotherapy achieved a 60% success rate (defined as complete recanalization), while combination anticoagulation therapy demonstrated a 16.67% success rate. Notably, all cases exhibited regression of active thrombosis, constituting a satisfactory therapeutic outcome.<b>Conclusions:</b> Anticoagulation therapy demonstrated both efficacy and safety, with no significant hemorrhagic complications observed. These findings underscore the necessity for multicenter analysis to establish evidence-based clinical guidelines.

<b>Introduction:</b> The exposure to unsafe sound levels is considered a risk factor for developing noise-induced hearing loss (NIHL). Personal listening devices (PLDs) represent a common source of recreational noise among young adults. First changes of NIHL could be detected at extended high frequencies (EHFs).<b>Aim:</b> This pilot study aimed to analyze hearing thresholds at conventional frequencies (CFs) and EHFs in young adults due to the PLD use.<b>Methods:</b> Hearing thresholds of 114 otologically normal adults aged 18 to 30 years unexposed to occupational noise were assessed using conventional and extended high-frequency audiometry. Data on PLD use, leisure time noise exposure, health and lifestyle, were acquired using a questionnaire.<b>Results:</b> Differences in hearing thresholds were found at CFs but not at EHFs according to the listening frequency (daily vs less frequent listening); duration of one PLD use of more than 30 minutes; and total listening time ≥7 hours/week. Only the highest frequency was affected by loud volume listening.<b>Conclusions:</b> Changes in hearing thresholds were found at CFs, whereby long duration, high volume and daily use were associated with lower hearing thresholds in otologically healthy adults.

<b>Introduction:</b> Deep neck infections (DNI) are potentially life-threatening conditions. The infections are commonly polymicrobial, and develop as a result of oral cavity infections, tonsilitis, laryngitis, trauma, or malignancy. Timely diagnostics and management are essential to prevent severe complications such as airway obstruction, sepsis or mediastinitis. Our study highlights the clinical characteristics of DNI etiology, complications, and treatment outcomes.<b>Aim:</b> This study aimed to provide a structured overview of a cohort of 111 patients with deep neck infection, comprising patient characteristics, etiology, clinical imaging, and complications along with the prognosis according to the used therapeutic strategy.<b>Methods:</b> This is a retrospective analysis of 111 patients who were hospitalized with DNI. We evaluated the demographics, clinical presentation, microbiological findings, and treatment outcomes. Statistical analyses including Pearson's chi-square, Mann-Whitney U test, independent-samples Kruskal-Wallis test and binary logistic regression were used to asses our data.<b>Results:</b> There was a predominance of male patients (62.2%) in our cohort. We found an increased DNI incidence over life in the middle-to-older age groups. The median patient age was 53 for male patients and 55 for female patients. The median hospital stay in our study was 10 days. Odontogenic infections were the leading etiology (37.8%), followed by complications of tonsillitis (23.4%) and phlegmonous laryngitis (12.6%). As many as 38.7% of patients had the following complications: airway obstruction in 25.2%, mediastinitis 10.8%, and sepsis 5.4%. The most commonly used antibiotics were ceftriaxone + metronidazole (28.8%) and amoxiclav (13.5%). The most common bacterium found in swab cultures was Streptococcus constellatus, and complications were more common in patients with a positive culture for <i>Acinetobacter baumannii</i>. Antibacterial resistance was found in 28.8% of the specimens. There was a significant association between antibiotic resistance and complication rates (P<0.05).

<b>Introduction:</b> In the course of middle ear diseases, a disturbed influence of the system transmitting sound through the middle ear on the function of the inner ear is observed. The audiometric consequence of the disease process taking place in the middle ear is the shift in bone conduction (BC) thresholds, which is called pseudoperceptive hearing loss (the so-called Carhart effect). The natural process of aging of the hearing system (age-related hearing loss) means that the manifestation of the Carhart effect varies in different age groups.<b>Aim:</b> The aim of the study is to assess the influence of the sound transmitting system in the middle ear and the aging of the hearing system on the variability of the Carhart effect in middle ear diseases.<b>Methods:</b> The study included 532 patients with audiometrically confirmed Carhart effect, diagnosed and treated for middle ear diseases in 2010-2020. Three groups of patients were distinguished: otosclerosis, otitis media with effusion treated surgically with myringotomy and subsequent drainage of secretions from the middle ear, chronic otitis media. The behavior of the Carhart effect was assessed by pure tone audiometry performed before and after the therapeutic process.<b>Results:</b> The restoration of physiological amplification of the sound transmitted through the ossicular chain led to a statistically significant change in the Carhart effect and a strong positive correlation between the change in the Carhart effect and the change in average BC thresholds. Canal wall down tympanoplasty coexisting with significant damage to the ossicular chain weakened the influence of middle ear mechanics on the inner ear, being a factor that adversely affected the change in the Carhart effect and the change in average BC threshold values.<b>Conclusions:</b> 1. Restoring the physiological amplification of sound transmitted through the ossicular chain leads to a statistically significant change in the Carhart effect and a change in the average BC threshold values; 2. The role of the impact of aging of the hearing system on the behavior of pseudoperceptive hearing loss is best visible in the case of a properly preserved system transmitting sound through the middle ear; 3. As the damage to the ossicular chain progressed, the type of reconstruction of the ossicular chain played a major role in the audiometrically observed change in the Carhart effect; 4. Canal wall down tympanoplasty coexisting with significant damage to the ossicular chain weakened the influence of middle ear mechanics on the inner ear, being a factor that adversely affected the change in the Carhart effect and the change in average BC threshold values.

<b>Introduction:</b> Head and neck cancer (HNC) incidence and mortality have increased significantly among the elderly in Poland over the last two decades. This trend reflects the challenges of an aging population and underscores the need for specialized cancer care for seniors.<b>Aim:</b> The study aimed to analyze the morbidity and mortality of HNC among the elderly (ages 60-69, 70-79, and 80+) in Poland between 1999 and 2021, and predict trends until 2035, emphasizing the dynamics in the 80+ age group.<b>Material and methods:</b> Data from the Polish National Cancer Register were analyzed, focusing on specific HNC types classified by ICD10 codes. Regression and correlation analyses were conducted to evaluate the significance of trends in absolute and relative cases and mortality. The analysis used a Bonferroni correction for multiple comparisons to determine statistical significance.<b>Results:</b> A significant increase in HNC cases and mortality was observed across all age groups, with the steepest relative growth in the 80+ cohort. Absolute case increases were similar for the 70-79 and 80+ cohorts, while the relative increase was highest in the 60-69 and 80+ groups. Mortality trends mirrored incidence trends, with men showing a higher increase in the 80+ group, while women had significant increases in the 60-69 cohort.<b>Conclusions:</b> The findings highlight a rapid rise in HNC incidence and mortality among the elderly in Poland, emphasizing the need for tailored treatment strategies, particularly for the 80+ age group. There is a growing demand for specialized care to optimize treatment outcomes and ensure quality of life for elderly HNC patients.

Introduction: The main goals of septorhinoplasty are to correct cosmetic and functional defects, which may occur in a patient with no history of previous trauma. As the most prominent facial feature, the nose has an increased risk of injury. Nasal fracture may eventually result in significant defects; posing challenges to the surgeon.

Aim: The aim of the study is to compare the technique used in post-traumatic and non -traumatic cases of rhinoplasties.

Materials and methods: The study group consisted of 227 patients, mean age 37.511.4 years, median 36 years, age range from 18 to 79 years. Statistical analysis was performed using the Statistica 13.3 package StatSoft, Dell Statistica. Categorical variables are presented as frequencies and percentages. The Chi2 or Fisher's exact test - when the number in cells were less than 5, was respectively used to check whether there was a correlation between nasal injuries and surgical technique. The level of statistical significance was assumed to be equal to α=0.05.

Results: Statistically significant differences were found in the use of five techniques. Septal filtration to the spine (44.1% vs 10.7%), septal extension graft (5.9% vs 1.3%), spreader graft (41.1% vs 21.1%) and osteotomy (85.3% vs 61.0%) were all performed more in patients with nasal trauma. On the other hand, LC steal was performed significantly more often in patients without nasal trauma (36.5% vs 22.1%).

Conclusions: Nose injuries lead to cosmetic and functional complications pose a challenge to the rhinoplasty surgeon. Optimal management in the case of posttraumatic nose requires surgeon's experience and precise surgical planning.