Polish Journal of Otolaryngology最新文献

Gastrooesophageal reflux disease is the regurgitation of stomach contents into the esophagus, which causes troublesome symptoms or complications for the patient. Before starting the treatment, it is always necessary to objectively confirm gastroesophageal reflux disease, especially in correlation with ENT symptoms, as extra esophageal complications. In diagnostics, the "gold standard" is a 24-hour impedance-pH supplemented with endoscopy. Treatment without objective confirmation of the disease is not recommended, the more so that non-acid gas proximal reflux, detectable only in the MIIpH test, causes the greatest number of laryngological complications. It is important to confirm the coexistence of clinical symptoms of GERD with ESS. Considering the time of treating the disease and its consequences, it is worthwhile to be cautious and careful with the diagnosis of the disease, and the treatment should be carried out for a long time in relation to the recommendation, preferably in cooperation with an ENT specialist and gastroenterologist. The greatest therapeutic effectiveness is achieved by combining PPI with itopride while maintaining the appropriate doses of drugs and observing a sufficiently long duration of treatment, while maintaining the correct dose reduction and drug discontinuation regimen. In case of failure of pharmacological treatment, antireflux surgery should be take into consideration.

<b>Introduction:</b> Tumors of large salivary glands constitute about 2-3% of all head and neck tumors. Their incidence is statistically greater in males than in females, with the first symptoms usually appearing between the 4th and 7th decade of life. <br/><b>Aim:</b> The aim of the study was to assess the usefulness of the new classification proposed by European Salivary Gland Society (ESGS) in comparison with the divisions of procedures previously valid in the literature, making a retrospective analysis of patients operated on due to benign tumors of large salivary glands in the Department of Otolaryngology, Head and Neck Oncology of the Medical University of Lodz in 2012-2020. <br/><b>Material and methods:</b> The retrospective examination was based on the material consisting of: surgical protocols, histopathological results, imaging results and clinical observations. The material includes 283 patients (141 women and 142 men): 249 patients with parotid gland tumor and 34 patients with submandibular gland tumor. The most common histopathological diagnosis was pleomorphic adenoma, which was found in 105 patients (42.17%) and adenolymphoma diagnosed in 94 patients (37.75%). <br/><b>Results:</b> The most common type of surgery was superficial parotidectomy including total superficial parotidectomy in 86 patients (34.54%) and partial superficial parotidectomy in 49 cases (19.68%). Then, according to the frequency of surgery, extracapsular tumor dissection (ECD) was performed (91 patients - 36.55%). According to the ESGS classification, in most cases parotidectomy I, II (37.34% of all parotidectomies) and parotidectomy II (28.49%) were performed. In case of ECD, all tumors were located at level II. <br/><b>Conclusions:</b> In summary, the new classification is aimed at unifying, but also simplifying the current nomenclature, reducing the existing nomenclature errors. Determination of the exact location and extent of the tumor within the parotid gland facilitates postoperative monitoring of patients by ENT doctors and those of other specialties.

In the daily practice of an otolaryngologist, we encounter cases where the symptoms are not the result of disease but result from pharmacotherapy. In the case of symptoms such as hearing loss, tinnitus, or dizziness, polytherapy may be used as the basis for their occurrence, which, due to the lack of rationality in combining drugs, leads to symptoms that the patient and the doctor very often interpret as a new disease syndrome. The aim of the study is to show and to raise awareness of the fact that the symptoms of hearing organ impairment are frequently drug-related and only a modification of the currently used pharmacotherapy is a rational procedure in such cases. This paper describes 30 cases who developed side effects of polypharmacy in the form of hearing disorders, dizziness, and tinnitus. The causes of drug-related complications were discussed, as well as effective methods of their prevention.

<b>Introduction:</b> In the daily practice of an otolaryngologist, we encounter cases where the symptoms are not the result of disease but result from pharmacotherapy. In the case of symptoms such as hearing loss, tinnitus, or dizziness, polytherapy may be used as the basis for their occurrence, which, due to the lack of rationality in combining drugs, leads to symptoms that the patient and the doctor very often interpret as a new disease syndrome. <br><b>Aim:</b> The aim of the study is to show and to raise awareness of the fact that the symptoms of hearing organ impairment are frequently drug-related and only a modification of the currently used pharmacotherapy is a rational procedure in such cases. <br><b>Material:</b> This paper describes 30 cases who developed side effects of polypharmacy in the form of hearing disorders, dizziness, and tinnitus. The causes of drug-related complications were discussed, as well as effective methods of their prevention.

Introduction: The most common mechanism of post-traumatic facial nerve palsy are road accidents and falls. Treatment schemes as well as proper timing of surgery are still controversial. <br/><br/>Aim: The aim of the study was the evaluation of the effects of surgical treatment in patients with post-traumatic facial nerve palsy. Treatment results were correlated with epidemiological factors, mechanism of injury, level of nerve damage, time of surgery and its extent. <br/><br/>Material and methods: 9 patients with facial nerve palsy after head trauma were analyzed. In all patients complete paresis of the VII nerve occurred immediately after the injury. In 5 patients the nerve was damaged in the course of the longitudinal fracture of the temporal bone, in 3 as a result of its transverse fracture while in one woman there was no evident fracture line. In all cases, surgical treatment was performed between 4 days and 13 weeks after the trauma. In all cases transmastoid approach was used. Edema lesions of the nerve dominated in 6 patients, in two cases a bone fragment was noted along its course, in one person nerve was disrupted but primary reconstruction was not possible - the man was excluded from further analysis. The results of treatment were assessed by House-Brackmann (HB) scale 12 months after the procedure. <br/><br/>Results: Very good (HBI) or good (HBII) recovery of facial nerve function was achieved in 2 and 4 out of 8 patients respectively. Surgical timing, the extent of surgery, patient's age, mechanism of injury and level of nerve damage had no effect on the final outcome. <br/><br/>Conclusions: The management of post-traumatic facial nerve palsy should be individual. The commonly accepted recommendation on surgical treatment is to undertake it in patients with immediate-onset and complete paralysis. Patients who, due to their severe general condition, cannot undergo early facial nerve decompression may benefit from delayed treatment for up to 3 months after the injury.

Introduction: Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. <br/>Aim: The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. <br/>Material and methods: The material covers 71 patients treated in the years 1985-2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or the double approach - external with the use of endoscopes, or only the endoscopic approach was used. In the entire population, external surgeries were performed in 37 patients, double access in 8 and endoscopic access in 26 patients. <br/>Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation.<br/> Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.

The main objective of the study was to determine the validity of intraoperative antiseptic treatment during endoscopic sinus surgery and the impact of such a treatment on the postoperative outcomes. Fifty-five patients with chronic sinusitis, qualified for surgical treatment were enrolled into the trial. It was designed as a prospective, randomized, blinded study. The surgical procedures were performed on both sides, in the same scope. In the next stage, after opening, one side was flushed with saline solution, and the other side with octenidine solution. The analysis showed a statistically significant reduction in postoperative crusting measured using the Lund-Kennedy scale between the test and the control group. Intraoperative lavage of the paranasal sinuses in both control and study group showed an effect on decreasing the total number of positive postoperative cultures relative to preoperative ones. Study showed a beneficial effect of the intervention consisting in rinsing with Octenisept on the reduction of crusting in the postoperative assessment.

Objectives Chronic purulent cholesteatoma of the middle ear, as well as to a lesser extent chronic granulomatous otitis media, lead to destruction of bone structures within the middle ear space. Above process is controlled by the OPG/RANKL/RANK system. Material and methods An analysis of 140 patients operated on due to chronic otitis media was performed. For the detailed analysis in the scanning electron microscope, 40 patients were selected who had been diagnosed with chronic cholesteatoma of the middle ear and chronic granulomatous otitis media. Finally the study in SEM included 20 patients. Results The regular structure of cholesteatoma depicted in the Scanning Electron Microscope concerned 5 patients with diagnosed. In the remaining 7 patients, the system was irregular and even chaotic. Lack of regularity can also be observed in the case of granulation tissue, which in the SEM image presented itself as an irregular tissue mass without detectable regularities. Conclusions 1. Regular pattern of the cholesteatoma matrix cells observed in some patients with chronic cholesteatoma of the middle ear reduces the molecular permeability of inflammatory cytokines, concurrently limiting the destructive activity on bone structures. 2. The presence of inflammatory granulation tissue in the middle ear is accompanied by an influx of leukocytes: neutrophils and lymphocytes, which are the source of pro-inflammatory cytokines, the growth of which activates the processes leading to the damage of bone tissue and the development of inflammation. 3. No specimen of acquired cholesteatoma revealed presence of commensalism like organism on the surface of exfoliated human epithelium of Demodex species.

Introduction Gastroesophageal reflux disease (GERD) may cause extra-esophageal complications, including laryngopharyngeal reflux disease (LPR). It is caused by morphological changes in the laryngeal mucosa due to the regurgitation of gastric contents. Laryngopharyngeal reflux has a wide symptomatology. There is no pathognomonic image of the larynx for LPR. In the diagnosis of LPR, the subjective RSI scale is commonly used, which assesses symptoms in conjunction with the laryngoscopic assessment of the larynx on the RFS scale. The aim of the study was to diagnose the clinical form of dysphonia in patients with laryngopharyngeal reflux (LPR) using the HS camera and HSDI technique. Material and methods The study included a group of 72 patients of both genders, age 20 to 65, who obtained more than 13 points in the RSI scale and more than 7 points in the RFS scale. Results Application of HSDI technique with camera in the high speed (HS) and high resolution (HR) mode allowed precise objective diagnosis of organic and functional disorders of a hyperfunctional dysphonia.

Objective: To develop a comprehensive operative report schema based on the accuracy of primary operative reports (OpR) assessed on a department's experience with parotid gland tumor re-operations.

Design: Retrospective cross-sectional study.

Setting: A tertiary referral center, the Department of Otolaryngology and Laryngological Surgery, Poznan University of Medical Sciences, Poland from 2008 to 2017.

Subjects: Out of 1154 surgeries, 71 patients underwent reoperation. Their OpR were categorized into accurate and non-accurate, and re-operation field and re-operation course were categorized as anticipated or unanticipated, according to defined criteria.

Intervention: None Main outcome measures: The impact of accuracy of the first OpR on re-operation course.

Results: In this series, OpR were 39% (14/36) accurate, 61% (22/36) non-accurate. Re-operation fields were 16% (11/71) anticipated, 37% (26/71) unanticipated. Re-operation courses were 37% (26/71) anticipated, 63% (45/71) unanticipated. An anticipated re-operation course followed 20% (5/26) of accurate and 20% (5/26) of non-accurate primary OpR. An unanticipated re-operation course followed 20% (9/45) of accurate and 40% (18/45) of non-accurate OpR. There is no significant relationship between the re-operation course and accuracy of the first OpR (Chi2(1)=0.69; p=0.40466). The most common variable that affected non-accuracy of the OpR was facial nerve function after surgery (6/12).

Conclusions: The operative report should be based on clear criteria, robust classification and comprehensive protocol. This will improve follow-up and facilitate the planning of re-operation.