Polish Journal of Otolaryngology最新文献

<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.

Hypereosinophilic diseases represent a heterogeneous group that poses a significant medical challenge. An increased number of eosinophils in the blood can be a dominant symptom of hematologic diseases, such as myeloid hematopoietic cancers or lymphomas. However, it is more commonly associated with other health conditions, such as allergies, infections, and systemic inflammatory diseases. Distinguishing between eosinophilic vasculitis with polyangiopathy (EGPA) and idiopathic hypereosinophilic syndrome (I-HES) can be difficult in clinical practice. In this report, we provide practical guidelines for clinicians that may aid in the diagnosis and treatment of these diseases. Additionally, we discuss the role of biologic IL-5 inhibitors in their therapy, as mepolizumab is approved for the treatment of EGPA and I-HES. We believe that the proposed guidelines will be helpful for clinicians, especially those who are not familiar with hypereosinophilic diseases.

<b>Introduction:</b> In its assumptions, rhinoplasty is intended to improve the aesthetics and restore normal function of the nose. In the Polish literature, a new tool has recently emerged for simultaneous assessment of the impact of rhinoseptoplasty on the external appearance and functionality of the nose.<b>Aim:</b> The aim of this study consisted in the surveying of patients having undergone rhinoplasty procedures using a validated and translated Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) questionnaire and the Rhinoplasty Outcome Evaluation (ROE) questionnaire to assess the functional and aesthetic outcomes of rhinoplasty.<b>Materials and methods:</b> A total of 106 subjects (N = 78 [73.6%] women and N = 28 men [26.4%]) aged 18 to 56 years (M = 33.99; SD = 9.77) participated in the study. The data were subjected to statistical analysis.<b>Results:</b> The analysis revealed significant differences between the measurements for all analyzed variables (p < 0.001). Statistically significantly lower SCHNOS scores and significantly higher ROE scores were reported in the postoperative assessments, with a strong effect for the difference of means (> 0.5).<b>Conclusions:</b> Properly performed rhinoplasty results in both aesthetic and, most importantly, functional improvement regardless of the patient's age and gender.

<b>Introduction:</b> Chronic rhinosinusitis (CRS) is a long-lasting inflammatory condition affecting the sinonasal mucosa, which is likely triggered by a dysfunctional immune response. Vitamin D is recognized as an immunomodulator influencing both innate and adaptive immunity. Recently, this mechanism of action has sparked interest regarding the possible role of vitamin D in CRS pathogenesis and/or course of the disease.<b>Aim:</b> The aim of this study was to investigate the association between preoperative serum vitamin D levels and an early outcome of endoscopic sinus surgery (ESS) as well as its influence on the severity of CRS.<b>Materials and methods:</b> This prospective observational study included 25 patients with CRS with nasal polyps undergoing ESS and 18 healthy controls. The disease was confirmed clinically and radiologically. Demographic and clinical data for each subject were collected. Preoperatively, disease severity was evaluated by the patient using the Visual Analog Scale (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22), and by a researcher using the Lund-MacKay (LMS) and Lund-Kennedy (LKS) scoring systems. On the day of surgery, serum 25-hydroxyvitamin D was measured with the use of electrochemiluminescence binding assay. Six weeks postoperatively, reassessment was performed, including the VAS, SNOT-22, and LKS.<b>Results:</b> Serum 25-hydroxyvitamin D level was not significantly lower in CRS patients compared to healthy controls. Subjective and objective measures of CRS severity showed no correlation with vitamin D status. However, participants with higher vitamin D levels presented better outcomes 6 weeks postoperatively.<b>Conclusions:</b> Contradicting numerous previous studies, these findings failed to confirm the correlation between the occurrence or severity of CRS and vitamin D status. Nevertheless, vitamin D status seems to affect ESS early outcomes.

<b>Introduction:</b> The vestibular organ (VO) is essential for maintaining balance and stabilizing visual images during head movements. To evaluate its function, the strength of the vestibulo-ocular reflex (VOR) is assessed using kinetic tests like the Sinusoidal Harmonic Acceleration Test (SHAT), video Head Impulse Test (vHIT), and slow-phase peak velocity (SPV) measurement in the caloric test (CT). Despite their limited sensitivity and specificity, they are used to determine eligibility for positions requiring strong balance control.<b>Aim:</b> To determine the range of VOR gain in young healthy individuals in SHAT, vHIT and CT. To search for correlations between vestibular test results and age and gender of the subjects.<b>Materials and methods:</b> Sixty two healthy individuals, with 32 males and 30 females, aged 7 to 33 who met the inclusion criteria were included in the study. Each participant underwent SHAT, vHIT and CT. Standard statistical methods and Spearman's rank correlation were used.<b>Results:</b> The age of the subjects correlated negatively with the VOR gain in SHAT. There was no correlation between results for SHAT, vHIT or CT.<b>Discussion:</b> Various factors, such as vestibular stimulation and anatomical variations, affect vestibular test results. While these tests complement each other in diagnosing vertigo, they are not recommended for healthy individuals qualifying for high-vestibular-performance occupations.<b>Conclusions:</b> With age, the sensitivity of the VO to kinetic stimuli decreases. The inability to calibrate stimuli can result in varied responses among individuals. A comprehensive evaluation of the VO requires testing across different frequency ranges.