Polish Journal of Otolaryngology最新文献

<b>Introduction:</b> The facial nerve (FN) follows a complex route in the temporal bone. Successful temporal bone surgery requires knowledge of its course which can be achieved using imaging methods such as computed tomography. This investigation aims to analyze the FN course in its mastoid portion and second genu and the frequency of its atypical course.</br></br> <b>Material and methods:</b> This is a retrospective study that enrolled 104 CT scans of temporal bones of patients followed up in the outpatient clinic of the Otorhinolaryngology Department of Dentistry Faculty of the Medical University of Warsaw between 2020 and 2022. FN courses were classified as straight, bulging, or letter "S"-like. Other parameters estimated: </br> • position of the second genu according to the prominence of the lateral semicircular canal (classified as lateral, medial, or middle) and its distance from a line adjacent to the lateral semicircular canal was measured;</br> • the distance between the short process of the incus and the outermost point of the second genu;</br> • the course of the mastoid portion of FN and the location of SG in comparison to the tympanic portion of n. VII. The course was later classified as lateral, medial, or middle.</br></br> <b>Results:</b> Among the 104 assessed temporal bones, the course of the mastoid portion of FN was classified as bulging in 47 cases (45.2%). Straight and letter "S"-like courses were present in 41 (39.4%) and 16 (15.4%) cases, respectively. Deviation of the second genu according to the prominence of the lateral semicircular canal was medial in 86 cases (82.7%), and middle in 4 cases (3.8%). In the rest, second genu was paramedian to the prominence of the later circular canal. The mean distance between the short process of the incus and the outermost point of SG was 4.9 mm (0.73 mm). The mastoid portion was located laterally, medially, and in the middle of the tympanic portion plane in, respectively, 4.8%, 83.7%, and 11.5%. The second genu was located laterally, medially, and in the middle of the tympanic portion plane in 1.9%, 73.1%, and 25%, respectively. In conclusion, seven temporal bones (6.7%) of five patients presented with a lateral displacement of FN in relation to the established anatomical landmarks.</br></br> <b>Conclusions:</b> Although the atypical course of FN, including the lateral displacement of the mastoid portion, is rare, screening for it is crucial before surgical exploration.

<br><b>Introduction:</b> The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. However, we observe rare cases when numerous pathologies overlap, resulting in an unclear and complicated clinical presentation of the glottis.</br> <br><b>Aim:</b> The aim of this paper is to present cases of overlapping etiopathological factors which poses a challenge when making a diagnosis and referring a patient for adequate treatment.</br> <br><b>Material and method:</b> The study presents different photographs of the glottis, including some unique and unusual images in which overlapping pathologies were captured. The photographs are accompanied by case descriptions, comments, and pathological analyses.</br> <br><b>Results:</b> Four selected photographs showed a bunch of exophytic growth lesions with foci of whitish plaques, covered by yellowish crusts, with thinned, reddened vocal folds presenting foci of leukoplakia. The study discussed possible causes of vocal folds edema, diffuse erythema, presence of crusts or exudate, whitish debris/plaques or development of leukoplakia, non-neoplastic ulceration, as well as injected and reddened mucous membrane. Chronic infectious laryngitis, idiopathic ulcerative laryngitis, and drug-induced laryngitis were also mentioned. The study also raised the issues concerning diabetics and patients treated with inhaled corticosteroids, including candidiasis and primary aspergillosis of the larynx.</br> <br><b>Conclusions:</b> To conclude, everyday clinical practice involves encountering cases of unclear onset and course, with complicated presentation of the glottis. Therefore, comprehensive history-taking and thorough investigation of systemic causes are of immense importance. Recommended management includes conducting the most meticulous differential diagnosis, implementing treatment for the most likely cause, and, whenever possible, refraining from biopsy in order to avoid permanent damage to vocal cords.</br>.

Chronic rhinosinusitis with nasal polyps (CRSwNP) has a significant impact on the well-being and social functions of the patient. The generalized inflammatory process with the formation of nasal polyps and excess eosinophils in the mucosa of the paranasal sinuses is called type 2 inflammation, which is mediated by Th2 lymphocytes – cells of the immune system responsible for chronic inflammatory processes. Today, we also know the key pro-inflammatory mediators against which new drugs have been developed, the so-called biological drugs, are produced in cell lines. In this document, we present currently available biologicals approved for the treatment of patients with T2-related chronic rhinosinusitis.

<b>Introduction:</b> The COVID-19 pandemic constituted a significant challenge for healthcare systems. Epidemiological restrictions led to deferral of healthcare and influenced the variety of symptoms reported by patients suffering from Sudden Sensorineural Hearing Loss.</br></br> <b>Aim:</b> The aim of the study was to compare the duration of treatment implementation and symptoms reported by patients suffering from SSNHL before and during the COVID-19 pandemic.</br></br> <b>Material and methods:</b> Patients admitted to the Military Institute of Medicine - National Research Institute for SSNHL treatment were included in a survey conducted between 01.10.2021-31.12.2021. Questions on symptoms reported, chronic conditions, timeframe between first symptoms and implementation of pharmacotherapy, and hyperbaric oxygen therapy were included in the survey. The results were compared with data obtained by the Team between 01.2017-12.2019.</br></br> <b>Results:</b> 34 patients (19 females, 15 males) of the average age of 46.3 who participated in the survey indicated a significantly delayed implementation of pharmacotherapy and hyperbaric oxygen therapy in comparison to population from before the pandemic (12.08 vs. 5.41 [days]; 17.5 vs. 8.29 [days]). The survey also showed differences in the number of symptoms reported.</br></br> <b>Discussion:</b> The differences in time of implementation of SSNHL treatment could have been related to pandemic restrictions which contributed to longer queueing for health benefits and fear of contact with health service. Differences in symptomatology point towards SARS-CoV-2 as a pathogenetic factor of SSNHL.</br></br> <b>Conclusions:</b> The COVID-19 pandemic significantly influenced the treatment of Sudden Sensorineural Hearing Loss. The study demonstrated a diverse symptomatology of SSNHL before and during the pandemic.

Objective: In tympanoplasty, surgical reconstruction of the tympanic membrane and ossicular chain is well-established; however, its hearing results still require improvement. Custom 3D printing of individualized ossicular prostheses seems to be an attractive solution for optimal prosthesis adjustment and better hearing results.

Aim: The aim was to design a custom ossicular prosthesis using a 3D printing method based on Cone-beam Computed Tomography (CBCT) scans and assess the acoustic conduction properties of such prosthesis.

Material and methods: A cadaver fresh frozen temporal bone was used. Based on CBCT images, a new incus prosthesis was designed and 3D printed. Next, canal wall-up tympanoplasty was performed. The intact ossicular chain and reconstructed 3D-printed prosthesis chain movements/vibrations were measured with Laser Doppler Vibrometer (LDV) system and analyzed in detail.

Results: The CBCT scans provided enough information about the anatomical structures. For frequencies 500 and 1000 Hz and 80 dB SPL sound intensity, collected velocities were higher for the intact ossicular chain than the 3D-printed ossicular prosthesis. The intensity thresholds for movement at 500 and 1000 Hz were lower in the intact ossicular chain than in the 3D-printed ossicular prosthesis. At 2000 Hz, there was the same intensity threshold value in the two measured circumstances.

Conclusion: It is possible to design a custom individually fitted ossicular prosthesis using a 3D printing method based on CBCT scans. The acoustic conduction properties of such 3D-printed prosthesis showed differences in movability pattern between the intact and reconstructed ossicular chain. More data are needed to analyze the acoustic properties of such designed prostheses in detail. The results of our experiment showed the 3D-printed prosthesis presents the potential to be an interesting option for conductive hearing loss treatment caused by chronic otitis media and the ossicular chain defects.

BackgroundThe Eustachian tube is a complex and inaccessible structure, which is responsible for the ventilation of the middle ear. The aim of the study was the assessment of an impact of chronic sinusitis on the auditory tube function. MethodsThe prospective analysis of 84 surgically treated chronic sinusitis patients was carried out. This study is based on preoperative results of impedance audiometry in correlation with the data from the medical history of chronic sinusitis, symptoms reported by the patients, results of Computered Tomography (CT) and the stage of inflammatory changes according to Lund and Mackay score. ResultsThe significant majority of patients of our study (65) had advanced auditory tube symptoms, while 4 patients suffered from symptoms significantly impacting daily life. In patients with chronic sinusitis the analysis demonstrated that tympanometry type B (12.67) and C (12.4) occured with significantly higher number of points of Lund-Mackay score than type A (9.2). In allergy sufferers type B of tympanometry was more often observed with characteristically bilaterally located inflammatory changes in maxillary and anterior ethmoid sinuses.ConclusionThe profile of chronic sinusitis patient in whom Eustachian Tube Dysfunction is more often observed, is as follows: Lund and Mackay score above 12pathological changes are bilaterally observed in maxillary and frontal ethmoid sinuses decrease of nasal patency nad postnasal dripAllergyoverusing alcohol and cigarettes, at least alcoholWorse result of Lund and Mackay score and the age of patients are 2 factors favoring the dysfunction of the Eustachian Tube.

Introduction: Mnire's disease is characterized by vertigo episodes with nausea and vomiting accompanied by aural symptoms. Diagnosis is based on clinical manifestation and sensorineural hearing loss confirmed in pure tone audiometry.

Aim: The purpose was to evaluate clinical features and audiological and vestibular tests in patients with definite Mnire's disease.

Material and methods: Seventy patients were enrolled in this study. The severity of the main clinical symptoms and audiological and vestibular tests were evaluated. The correlation between the clinical features and test results was evaluated.

Results: 14.29% of patients presented complete clinical characteristics as the first manifestation of Mnire's disease. 50% of patients suffered from isolated aural symptoms during the early stage of the disease. The subpopulation reporting hearing improvement after vertigo attack (28.57%) was characterized by shorter disease duration than the rest of the group. A statistically significant correlation between disease duration and pure tone average was found. 17.14% of patients reported Tumarkin drop attacks in their past medical history. Neither disease duration nor functional level scale was different in these patients compared to other patients.

Conclusions: Mnire's disease is often characterized by isolated aural symptoms or incomplete clinical manifestation during the early stage of the disease. The correlation between disease duration and pure tone average confirms that endolymphatic hydrops evolution causes hearing loss. A patient's quality of life is a fundamental aspect of clinical assessment. No significant correlation between disease duration and functional level scale was found. Thus Mnire's disease should be considered an individually variable and dynamic phenomenon.

The authors would like to present the possibilities of reconstructive surgery using free microvascular flaps with bone elements in the treatment of cavities in the head and neck area. The cavities in the presented article resulted both from resection of tumors in the head and neck area as well as congenital defects and radiation damage. The authors would like to discuss the difficulties that may arise during the postoperative period, including the maintenance of the graft's viability, the healing of the donor site and systemic problems. The article presents 33 reconstruction surgeries performed on 31 patients using different flaps, briefly describing their advantages and technical difficulties that may arise during the microvascular anastomoses. The authors emphasise the importance of a well-conducted qualification for the surgery as well as the need to discuss the course of the surgery and recovery and other possible treatment options with patients and their families. The complications that happened in the presented group and how they were treated are described. The authors discuss in details the 3 cases with different types of reconstructive procedures and draw attention to the importance of postoperative care consisting of the constant monitoring of the viability of the graft carried out by qualified personnel of the Otolaryngology Department and appropriately conducted anticoagulant therapy.

Otitis media with effusion (OME), is a common childhood disease and is characterized by long-term fluid retention in the middle ear spaces without signs of acute infection. Surgical treatment of OME in the form of a tympanostomy is one of the most commonly performed medical procedures by pediatric ENT surgeons worldwide. In February 2022, the Journal of Otolaryngology - Head and Neck Surgery published updated guidelines from the American Academy of Otolaryngology - Head and Neck Surgery for tympanostomy tuba in children between 6 months and 12 years of age. They are aimed at both otolaryngologists and pediatricians, as well as other medical personnel who are directly involved in the care of patients with tympanostomy tuba or are candidates for the procedure. The previous version of the guidelines was developed in 2013. With the cooperation of the Board of Expert chaired by the National Consultant in Pediatric Otorhinolaryngology, Prof. Wieslaw Konopka, PhD, during the VII International Conference "Otology, 2022" which took place on September 15-17, 2022 in Torun, the previously published recommendations and consensuses from other countries, both European and non-European, were analyzed and the task of developing new national diagnostic and therapeutic recommendations for OME was undertaken.