Polish Journal of Otolaryngology最新文献

<b>Introduction:</b> Odontogenic infections are polymicrobial in origin and can be life-threatening. Antibacterial failure is an important issue in the treatment of odontogenic infections. Aim: This study aimed to determine the factors associated with antibacterial failure in patients with head and neck infections of odontogenic origin.</br></br> <b>Material and method:</b> This retrospective epidemiological study was performed using data collected from 229 patients with head and neck infections of odontogenic origin who were operated on in Shahid Rajaee hospital from March 2014 to December 2019.</br></br> <b>Results:</b> 123 (53.7%) patients were female and there were 106 (46.3%) males. The mean age SD was 33.01 13.37 years (range 7 to 80). The most common offending teeth were lower molars (81.7%) and lower premolars (5.7%). The most common site of infection was the submandibular area (36.4%) followed by the buccal (20.4%) and pterygomandibular (17.1%) regions. The most common pathogen was Streptococcus haemolyticus. The length of hospitalization was higher (4.66 days) in patients with failure of treatment compared to those without it (6.00 days) (P = 0.002). A combination of penicillin G and metronidazole was prescribed for all patients with failure of treatment compared to 57.6% in patients without failure of treatment (P = 0.002). There was no statistically significant difference between the two groups regarding age, duration of illness before hospitalization, WBC, gender, history of chemotherapy, hypertension, smoking, pregnancy, alcohol consumption, diabetes mellitus, the rate of fever, trismus, dysphagia, malaise, antibiotic before hospitalization, or surgical approach.</br></br> <b>Conclusion:</b> Possible determinants in this study were not associated with antibacterial failure. Further studies should be conducted to investigate this relationship.

Susac syndrome is a rare connective tissue disorder. The pathology affects the small vessels of the brain, retina, and inner ear, and therefore the main symptoms of the disease include encephalopathy, visual disturbances, and sensorineural hearing loss. The aim of this article is to review the current medical knowledge on Susac syndrome and to present our clinical experience regarding this disease entity. In the paper, we are also presenting a case of a 25-year-old patient who was diagnosed with Susac syndrome on the basis of clinical presentation and additional test results. Susac syndrome should be differentiated from multiple sclerosis and other causes of multifocal brain damage as early diagnosis and treatment play a key role in later prognosis.

Susac syndrome is a rare autoimmune vasculopathy involving the small precapillary arterioles of the brain, retina, and inner ear. It is characterized by a triad of symptoms: encephalopathy, visual disturbances due to obstruction of retinal artery branches, and sensorineural hearing loss. The study aimed to review the current medical knowledge on Susac syndrome and present our clinical experience regarding this disease entity. The paper also presents a case of a 25-year-old patient who was diagnosed with Susac's syndrome based on the clinical picture and the results of additional tests. This syndrome should be considered in the differential diagnosis of multiple sclerosis and other multifocal lesions of the central nervous system because early diagnosis of the disease and immunosuppressive treatment significantly alleviates its course and improves the prognosis.

Introduction: COVID-19 pandemic has had a significant impact on healthcare systems around the world. The rapid spread of the virus caused several restrictions, including limited access to outpatient clinics. The purpose of the study was to compare the characteristics and reasons of the visits of otolaryngological patients conducted during the first three waves of the COVID-19 pandemic with those of the prepandemic period.

Materials and methods: Volume, demographic data, type of visits, additional tests, referral types, and reasons for consultation were analyzed.

Results: There were 1578 visits performed before the pandemic and, respectively, 434, 1198 and 1299 during the first, second and third waves. The patients in the first and second waves were older than the patients before the pandemic (mean age 59, 56, and 52 years, respectively, for both comparisons p<0.0001). Regarding the type of visit, the vast majority were in-person visits in all groups. The highest percentage of teleconsultations was in the first wave and was equal to 3.46%. Before the pandemic, patients were admitted mainly due to upper respiratory system diseases (52.15%), while during the first wave the main reasons were tumors (39.86%, malignant and benign tumors comprised 29.26% and 10.6%, respectively).

Conclusions: The COVID-19 pandemic, especially the first wave, changed the profile of ambulatory patients. In the first wave, a higher prevalence of tumor patients and a lower prevalence of patients with diseases of the upper respiratory system were observed. The COVID-19 pandemic caused an increase in number of teleconsultations, but its role was limited.

Introduction: The clinical syndrome that includes asthma, nasal polyps and hypersensitivity to nonsteroidal anti-inflammatory drugs is referred to as airway disease exacerbated by nonsteroidal anti-inflammatory drugs. Patients usually have the most severe form of nasal polyps. Asthma and chronic rhinosinusitis with nasal polyps share a common inflammatory profile, involving type 2 helper T lymphocytes. T-cell activity can be inhibited via the programmed death receptor, PD-1, leading to modulation of the immune response. Therefore, the purpose of this study is to evaluate the expression of genes encoding PD-1 and its ligand PD-L1 in nasal polyp tissue in patients with asthma exacerbated by non-steroidal anti-inflammatory drugs and to correlate the results with clinical data.

Material and methods: The material used for the study consisted of 54 tissue sections of nasal polyps. In the specimens, the expression of PD-1 and PD-L1 genes was determined at the mRNA level by qPCR. Statistical analysis was used to evaluate the results of the study.

Results: The expression of PD-1 and PD-L1 genes in the tissue of polyps was statistically significantly higher than in the nasal mucosa of patients in the control group. In addition, there was a correlation between the expression of both genes at the mRNA level and the severity of nasal polyps in the paranasal sinuses analyzed from computed tomography images of the paranasal sinuses and assessed using the Kennedy scale.

Conclusions: Determining the expression of PD-1 and PD-L1 genes may provide a marker for the severity of polypoid lesions. In addition, learning more about the PD-1/PD-L signaling pathway and how it can be modulated may provide a potential therapeutic strategy for patients with inflammatory diseases.

Introduction: Injury of the external branch of the superior laryngeal nerve can cause a hoarse or weak voice due to the functional loss (dysergia) of the cricothyroid muscle. Defining the anatomical variations of the external branch of the superior laryngeal nerve and estimating the frequency of it, it makes crucial for surgical interventions.

Aim: To reveal the topography of the external branch in the Anatolian population, to prevent injury of it during the surgical intervention in the anterior neck region.

Materials and methods: Twenty-six bilateral hemilarynges (4 females, 22 males) were dissected. The morphometric and morphological features of the external branch were examined. The obtained results were compared statistically left and right.

Results: Landmarks such as the thyroid gland and laryngeal prominence were determined for the detection of the external branch. The variations of the course of the external branch and the points of piercing the cricothyroid muscle or inferior constrictor pharyngeal muscle were evaluated.

Discussion: Although safe approaches have been described for nerve protection during neck surgeries, it can expose injuries during preliminary surgery approaches as the nerve is thinner and more superficial than other branches of the vagus nerve. However, it can be detected more easily and safely during the surgical approach by knowing the defined anatomical landmarks and morphological variations of the external branch.

Conclusion: The anatomical variations described can be a safe and important guide in surgical approaches to be applied in the anterior neck region.

Introduction: It is estimated that about 60% of patients with head and neck cancer (HNC) show poor nutritional status, and approximately 80% lose weight during treatment. The impact of surgical procedures on the risk of further weight loss, severe malnutrition and cachexia is a significant clinical problem that determines the higher incidence of postoperative complications, reduced effectiveness of the treatment used, longer hospitalization time, poor quality of life and higher mortality among patients. Bioelectrical impedance analysis (BIA) is currently recognized as a useful method of assessing the body composition and therefore the nutritional status of cancer patients. The aim of this study is to investigate whether measured and calculated parameters of BIA change shortly after surgery and could reflect the health of cells and body composition changes.

Materials and methods: We enrolled 54 patients (males) with advanced HNC in this observational study. We collected detailed anthropometric and BIA derived data. The Subjective Global Assessment (SGA) was used to assess the nutrition.

Results: In the assessment performed one week after the surgery, compared to the condition on the day of surgery, the patients had significantly lower values of nutritional status (weight; body mass index - BMI; SGA), body composition (free fat mass - FFM; intracellular fluid - ICF; total body water - TBW). Other changes include a significant increase in fat mass (FM) or extracellular fluid (ECF). Moreover, a significant reduction of phase angle (PA, one of the most important BIA derived prognostic factors) was also noted.

Conclusions: Apart from the baseline assessment of the body composition and diagnosing nutritional disorders, it seems, that BIA should be considered also in the monitoring of HNC patients undergoing surgery.

Allergic rhinitis (AR) is a common chronic respiratory disease, that affects millions of individuals, has significant impact on their quality of life, productivity, and other existing conditions, including asthma and conjunctivitis. Despite a substantial burden on individuals, society and health economies, AR remains under-diagnosed, under-estimated and under-treated. Main symptoms defining this IgE-dependent inflammation of nasal mucosa are: sneezing, itchy nose, rhinorrhoea and nasal congestion. Real-world data obtained by mobile technology offer new insights into AR phenotypes and therapy. Clinical management aims to relieve or control symptoms, resolve allergic inflammation, and potentially induce allergen tolerance, using allergen immunotherapy. Most cases of AR respond rather satisfied to pharmacotherapy. A very useful tool, especially recommended for everyday clinical practice, is VAS (visual analogue scale) which can help with: to assessing the intensity of AR symptoms as well as choosing the most optimal therapeutic option. Pharmacological treatment of the condition should be safe; effective and easy to administer as we treat patients with chronic condition, sometimes for a long time. Most frequently used treatment of AR include oral, intranasal or ocular antihistamines, intranasal corticosteroids or combined intranasal antihistamines and corticosteroids. Based on real-life clinical experience it can be concluded that a fixed combination of intranasal corticosteroid and intranasal antihistamines (mainly MP-AzeFlu) may be considered to be most beneficial, particularly in monotherapy and AR resistant to previous treatment. Some AR patients are not satisfied with provided treatment results when the disease becomes only partially controlled. We still have unmet patients needs and we are still looking for better therapeutic options in this area. New initiatives such as EUFOREA are developed in parallel with existing ones, such as ARIA to integrate patients and healthcare professionals in the therapeutic process and create new recommendations that are closest to the idea of precision medicine, delivering the right treatment to the right patient at the right time.

Objective: The purpose of this report to determine sudden death following operation, radiotherapy (RT) or chemoradiotherapy (CRT) for head and neck cancer.

Study design: Retrospective, observational, single-center.

Methods: Data from 729 consecutive patients diagnosed with head and neck cancer (confirmed using multiple modalities) who underwent operation, RT or CRT at Kagoshima University Hospital between April 2011, and March 2020 were analyzed. A total of 199 patients underwent operation, 223 patients underwent RT and 307 underwent CRT. 175 patients who received operation, 118 patients who received RT and 190 who received CRT had a complete response.

Results: There were 13 cases of sudden death reported in 10 years. 12 were male and one was female.Sudden death occurred in 3/175 patients (1.7%) who received operation, in 4/118 patients (3.4%) who had received RT and in 6/190 (3.1%) who had received CRT.

Conclusions: We present the first report on cases of sudden death after operation, RT and CRT for head and neck cancer. Otolaryngologists should still follow these patients carefully after such treatment given that sudden death does occur in some patients.

Introduction: The aim of the study was to analyze the causes of the occurrence and treatment results of sudden hearing loss / deafness in own material.

Material and methods: The tests were performed in 64 women aged 10-89 years and 70 men aged 18-85 years, who were treated in the Department of Otolaryngology due to sudden hearing loss / deafness in 2011-2020. A retrospective analysis was carried out on the basis of the data contained in the medical documentation, taking into account: gender, age of patients, type of symptoms, establishing the circumstances and possible causes of the appearance of symptoms, audiological and imaging tests, the cause of the sudden hearing loss / deafness and applied treatment.

Results: In the conducted research it was found that sudden hearing loss / deafness was the most common in women and men in the age range of 51-60 years and 61-70 years. Sudden hearing loss/ deafness was accompanied by the following symptoms in both women and men: tinnitus in 48,4% and 74,3%, tinnitus and vertigo in 28,1% and 14,3%, and vertigo in 6,3% and in 1,4%. In own research, the most common cause of sudden hearing loss/deafness in women and men was respectively: idiopathic cause in 43,8% and 40,0%, infectious in 18,8%, vascular in 12,4% and 12,9%, and neurovascular conflict (included separately) in 12,4% and 12,9%, while in men the acoustic trauma should also be mentioned in 18,5%. The best results in the treatment of sudden hearing loss / deafness on a three-point scale, which depends on the treatment method used, both in women and men, i.e. complete relief of symptoms obtained after the use of vascular drugs with steroid therapy and hyperbaric oxygen therapy - in 25,0% and 22,9%, partial relief of symptoms occurred after vascular treatment with steroid therapy - in 28,1% and 37,2%.

Conclusions: Sudden hearing loss / deafness in both women and men was accompanied by tinnitus, tinnitus and vertigo and vertigo at the same time. In own research the most common cause of sudden hearing loss / deafness in both women and men was: idiopathic, infectious, vascular and neurovascular conflict. The best emergency treatment outcomes of sudden hearing loss / deafness according to a three-level scale, depending on the applied method of treatment, both in women and men, i.e. complete relief of symptoms was obtained after the use of vascular drugs with steroid therapy and hyperbaric oxygen therapyKey words: causes, occurrence, treatment results, sudden hearing loss / deafnes.