Polish Journal of Otolaryngology最新文献

<b>Introduction:</b> It is estimated that 20% of pediatric patients eligible for implantation have various forms of Inner Ear Malformations (IEM). Transimpedance Matrix Measurement (TIM) is a relatively novel electrophysiological measurement protocol of the impedance patterns of electrode contacts within the cochlea. <br><br><b>Aim:</b> Presentation of TIM measurements, in the form of a heatmap, in patients with IEM. <br><br><b>Materials and methods:</b> Among 112 implantations performed between 2018 and 2024 in the pediatric group, 23 patients were diagnosed with IEM (20.5%). TIM and Stenver's plain X-ray were performed for all patients. <br><br><b>Results:</b> In 19 patients, standard approach with mastoidectomy and posterior tympanotomy was performed, in 2 cases retrofacial approach, in 2 petrosectomy with blind sac procedure, and in 2 "banana technique". In most patients, electrode Contour Advance (CA) was used. One case of tip fold-over showed a characteristic cross pattern. For all other IEM there were normal diagonals but voltage distribution showed abnormal distribution within the cochlea. <br><br><b>Discussion:</b> Most patients received a CA electrode because of its greater rigidity and the possibility of inhibiting CSF leakage by applying a piece of connective tissue for sealing to the electrode. Heatmaps for different IEM types differ from each other, but it is still possible to recognize TFO. The voltage spread in the cochlea in IEM shows different patterns for particular types of anomalies. <br><br><b>Conclusions:</b> TIM measurement as a heatmap seems to be a quick and reliable method for detecting electrode array tip fold-over intraoperatively for patients with inner ear malformations. Our study complements the knowledge about the use of research based on TIM heatmap.

<b>Introduction:</b> The minimally invasive procedure of Laser-assisted Dacryocystorhinostomy (LDCR) has gained importance in the treatment of nasolacrimal duct obstruction, offering a potential alternative to traditional external and endonasal methods. This is an important topic in otolaryngology practice, as it offers an alternative to traditional endoscopic surgery. Due to the close anatomical proximity of the nose and the eye, addressing it requires collaboration within a multidisciplinary team. <br><br><b>Aim:</b> This study aims to evaluate the surgical effectiveness and factors influencing clinical outcomes. Anatomical issues such as nasal septum deviation and the size of the created ostium were assessed. <br><br><b>Materials and methods:</b> A total of 42 patients were included in the study, undergoing surgery on 46 nasolacrimal ducts. Follow-up evaluations were conducted at least 6 months post-surgery. <br><br><b>Results:</b> Anatomic and functional success was achieved in 93.48% of the patients. In patients without septal deviation, there were 35 successful outcomes and 2 failures, compared to 18 successes and 1 failure in the group with septal deviation. The findings revealed no significant correlation between septal deviation and surgical success, indicating that other factors may be more influential. Patients with an average-sized ostium reported better clinical outcomes and fewer tearing symptoms, while those with a deviated septum experienced more intermittent tearing. The overall mean ostium width was 2.37 mm. <br><br><b>Conclusions:</b> LDCR proved effective with a significantly shorter surgical time, benefiting patients seeking a quick recovery. While factors like anatomical abnormalities and septal deviation were not statistically significant for surgical success, patients with anatomical disorders often reported slightly poorer functional outcomes. Analyzing etiological factors and ostium development will help refine surgical techniques and improve patient satisfaction.

<b>Introduction:</b> Despite well-established qualification criteria and pre-operation tests, there is still uncertainty about post-implantation performance in CI patients. One of the most interesting factors that affect the outcome is the survivability and function of cochlear nerve endings. ECAP (Evoked Compound Action Potential) is one of the tools that might be useful in the prediction of rehabilitation outcomes. Speech audiometry is one of the most commonly used and established performance tests. The study hypothesis is that there might be a correlation between ECAP values and speech audiometry results obtained over time.<b>Aim:</b> The aim was to check if changes within postop ECAP values correspond tochanges in speech intelligibility.<b>Materials and methods:</b> The study was designed as a retrospective observational one. Data was evaluated on a selected group of patients, with no blinding or control group. The study group consisted of 25 adult cochlear implant recipients, all with Cochlear devices, implanted at the Department of Otolaryngology of the Medical University of Bialystok, Poland, between 2016 and 2020. Data included ECAP measurements and speech audiometry results obtained during the first year of rehabilitation. The statistical analysis of the significance of data change over time and its correlation was performed.<b>Results:</b> Change of data over time was significant (P<0.05) for almost all data groups but it did not translates to the correlation of speech and ECAP.<b>Conclusions:</b> There is no statistically confirmed evidence suggesting that obtaining speech intelligibility is connected with change in ECAP values, which requires further research.

<b>Introduction:</b> In the pathophysiology of chronic upper respiratory tract inflammation, an important role is attributed to the disturbances of the patient's microbiome in terms of diversity and functioning, to the decreased abundance of commensal bacteria and the increase of pathogenic bacteria. In recent years, there has been growing scientific interest in the role of probiotics - administered both locally and orally - in the management of various diseases, particularly inflammatory conditions such as chronic rhinosinusitis. <br><br><b>Aim:</b> To assess the use of nasal rinsing with probiotics in patients with rhinitis and rhinosinusitis (primary and secondary). <br><br><b>Material and methods:</b> A total of 51 patients (31 women and 20 men) were included in the study, including 24 patients with granulomatosis with polyangiitis during immunosuppressive therapy (12 women and 12 men) and 27 patients (19 women and 8 men) with rhinitis (chronic rhinosinusitis with polyps, chronic rhinosinusitis without nasal polyps, atrophic rhinitis with nasal septum perforation, and allergic rhinitis). Exclusion criteria were: cystic fibrosis, primary ciliary dyskinesia, pregnancy, severe lung, heart, kidney disease, use of oral probiotics, use of intranasal probiotics in the last 6 months, sinus surgery in the last 6 months, lack of consent to participate in the study, antibiotic therapy in the last 2 months. Patients were scheduled to undergo nasal rinsing with a probiotic solution, with the following parameters assessed before and after the procedure: SNOT-22 scores and the severity of nasal lesions according to the Lund-Kennedy scale. In the group of patients with rhinitis, the ENS-6 questionnaire was also conducted and symptoms assessed on the VAS scale (visual analogue scale): nasal discharge, nasal obstruction, facial pain, impaired sense of smell, nasal irritation, nasal itching, and severity of crusting. <br><br><b>Results:</b> The study showed that nasal rinsing with a probiotic solution is well tolerated and does not cause any adverse effects. In both groups, a reduction in symptoms was observed based on the SNOT-22 questionnaire (p = 0.002 in GPA, ns - in rhinitis/ rhinosinusitis). According to the Lund-Kennedy scale, the reduction in the intensity of changes in both groups was statistically significant. In addition, patients with primary rhinitis or rhinosinusitis also experienced a reduction in nasal mucosa irritation and crusting intranasal (p<0.05). <br><br><b>Conclusions:</b> Probiotic nasal rinsing appears to have a beneficial effect on the condition of the nasal mucosa in patients with both primary and secondary (GPA-related) rhinosinusitis and is generally well tolerated.

Introduction: The primary treatment method for T2 immune response-related airway inflammations, such as eosinophilic inflammation, is topical glucocorticosteroid therapy. However, its effectiveness is limited by the challenge of drug penetration into the perinasal cavity. The introduction of a new generation of pulsating nebulizers has partially addressed this issue. Pulsating nebulizers (vibrating aerosol) enhance the penetration of nebulized medication into the paranasal sinuses, thereby opening a new therapeutic option for the treatment of chronic sinusitis. Consequently, a new regulatory indication has been approved for the use of budesonide in chronic rhinosinusitis with nasal polyps.Aim: The aim of the study was to compare the aerodynamic particle size distribution (APSD) of the dispersed suspensions of the test drug (TD) and the reference drug (RD) administered using the PARI SINUS2 nebulizer system, consisting of the PARI LC SPRINT SINUS nebulizer and the PARI SINUS2 compressor.Material and methods: Comparison of the APSD of the dispersed suspensions of the TD and the RD administered using the PARI SINUS2 nebulizer system. Twelve nebulizations of each formulation were tested using six PARI SINUS2 nebulizer systems, with two repetitions per system. The methods were review of studies and own research. The APSD study was conducted using a next-generation impactor (NGI) and a laser diffraction spectrometer after nebulization of 2 mL suspensions of TD and RD via the PARI SINUS2 nebulizer system. Statistical analyses included descriptive statistics as well as 90% and 95% confidence intervals for the difference in means and the ratio of means of the examined parameters.Results: The TD was well-suited to the nebulization procedure. Both formulations (TD and RD) exhibited significant variability in the aerosol droplet distribution at different levels of the NGI cascade impactor. In the case of TD, larger droplets were more easily generated, which promoted deposition of the drug at the upper levels of the impactor. The equivalence of the two forms of budesonide, RD and TD, in the treatment of chronic rhinosinusitis with nasal polyps using a pulsating nebulizer was demonstrated. These indications were acknowledged by the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products (URPLWMiPB) and added to the Product Information of TD.Conclusions: Both budesonide formulations were effective. Budesonide administered via vibrational nebulization is effective in the treatment of chronic rhinosinusitis with nasal polyps.

Introduction: Despite expanding indications for endoscopic optic nerve decompression (EOND), uniform guidelines are lacking, resulting in variability innerve exposure and hindering comparisons of treatment effectiveness.Aim: This study aims to propose a standardized approach for planning and performing EOND based on radiological and anatomical studies.Materials and methods: EOND was performed on fifteen freshly frozen cadaver heads using non-standard oblique reconstruction planes from computed tomography (CT) studies to trace the optic canal's circumference. The final decompression point was positioned a few millimeters posterior to the cranial end of the canal, where the nerve is surrounded by bone on 180 degrees of its circumference. After the transnasal procedure, transcranial access was used to verify the adequacy of the decompression.Results: The mean distances from the decompression endpoint to the orbital apex, cranial optic canal (OC) end, and lateral optico-carotid recess were 8.2 mm ±1.0, 3.0 mm ±1.1, and 0.4 mm ±0.8, respectively. In all 30 procedures, adequate coverage of the decompression was confirmed via the transcranial approach.Conclusions: Using non-standard oblique CT reconstruction planes allows for precise, individualized planning for EOND, reducing the risk of overly short or excessive decompression. Therefore, this method may be used to standardize the extent of optic nerve decompression performed using the endoscopic technique.

<b>Introduction:</b> Estrogen and progesterone levels fluctuate throughout the menstrual cycle, influencing various physiological functions in women. <br><br><b>Aim:</b> This study aimed to investigate the relationship between hormonal changes and alterations in the upper respiratory tract during different phases of the menstrual cycle. <br><br><b>Materials and methods:</b> Forty healthy, non-pregnant women participated in the study. Two subgroups were analyzed: Subgroup 1 included 25 women examined in a single phase (follicular phase [FP]: n = 11 or luteal phase [LP]: n = 14), while Subgroup 2 comprised 15 women assessed during both phases. Nasal patency was evaluated with rhinomanometry and Eustachian Tube (ET) function with tympanometry; all patients underwent screening for nasal obstruction and ear blockage. Menstrual cycle phases were confirmed via ultrasound and hormonal assays. <br><br><b>Results:</b> Nasal obstruction and ear blockage, as reported in the screening, rhinomanometry, and tympanometry, were significantly more pronounced in the LP than in the FP. The LP was associated with reduced nasal airflow and middle ear pressure. Hormonal correlations revealed that higher progesterone and estrogen levels in the LP were linked to increased nasal obstruction and ET swelling, validated by both subjective reports and objective measurements. <br><br><b>Conclusions:</b> Elevated progesterone and estrogen levels during the LP significantly impact nasal patency and ET function in women. The findings indicate a marked increase in nasal resistance during the LP, highlighting the hormonal influence on upper respiratory tract dynamics.

<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.