Polish Journal of Otolaryngology最新文献

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.

Recently, there has been a significant increase in the number of patients hospitalized and undergoing surgery due to parotid gland tumors. We have observed an increase in the total number of salivary gland tumors, and hence an increased number of malignant tumors. Etiological factors of salivary gland tumors are still unknown. Oxidative stress (OS) has been suggested to be an important indicator of carcinogenesis in some tumors. Therefore, the aim of our study was to assess the state of OS in patients with selected benign and malignant parotid gland tumors. After final postoperative histological diagnosis of the tumor, patients were divided into the following groups i.e. pleomorphic adenoma 35 patients, Warthins tumor (WT) - 17 patients, mucoepidermoid carcinoma - 9 patients and 45 controls. The final study group included 106 patients. We found an increase in plasma lipofuscin levels in patients with all investigated parotid gland tumors. Furthermore, the activity of Cu/Zn-SOD in Warthins tumor patients was statistically lower compared to the controls, pleomorphic adenoma or mucoepidermoid carcinoma.In conclusion, we sustain the hypothesis on the presence of a low intensity whole-body OS in patients with parotid gland tumors. Furthermore, LPS may be a useful marker of OS in patients with benign and malignant tumors. Moreover, pathological mechanisms connected with WT seem to be different compared to malignant neoplasms and other benign tumors. It seems that Cu/Zn-SOD, as an antioxidative enzyme, may play an important role in those mechanisms taking part in WT.

ntroductionIn all otologic surgeries, the facial nerve can be considered the most important structure that must be protected. The surgical damage risk of the facial nerve will be increased in presence of facial canal dehiscence (FCD).AimIn this study, we aimed to evaluate the FCD and its associated situations in patients with chronic otitis media undergoing mastoidectomy.Materials and Methods850 patients who performed ear surgery were reviewed. Patients who did not perform mastoidectomy were excluded. In patients, the ratios, localization of FCD, and association of facial canal dehiscence with cholesteatoma were researched. Association between FCD and closed-cavity tympanomastoidectomy, open-cavity tympanomastoidectomy, and radical mastoidectomy procedures, and also an association between FCD and primary or revision surgery was evaluated. ResultsFacial canal dehiscence was found in 8.4% of patients. The relationship between dehiscence and cholesteatoma was found significant (p<0.001). In the comparison of radical mastoidectomy and closed-cavity tympanomastoidectomy, dehiscence was higher in the radical mastoidectomy group (p<0.03). In revision cases, dehiscence was seen more frequently (p<0.003). FCD incidence was higher in adult patients than in pediatric patients (p<0.001). Twenty of 468 patients who were operated on for cholesteatoma had congenital cholesteatoma. ConclusionFacial canal dehiscence can be seen especially in cases with cholesteatoma and when performing radical mastoidectomy and revision surgeries. Therefore, a detailed evaluation of the status of facial nerve and determination of situations in which occurrence of FCD is more likely both preoperatively and intraoperatively will minimalize potential complications.Keywords: Cholesteatoma, tympanic, radical mastoidectomy, oval window, tympanomastoidectomy.

SummaryPurpose. The aim of the study was to evaluate serum concentrations of total sialic acids (TSA) in patients with squamous cell carcinoma of the larynx preoperatively and 4 years postoperatively and to compare the results with the serum concentration of sialic acids in patients with non-neoplastic laryngeal lesions.

Methods: The study comprised 52 patients with squamous cell carcinoma of the larynx and 25 patients with non-neoplastic laryngeal lesions. Serum TSA concentrations were assessed in all patients preoperatively. Four years after surgery, serum TSA concentrations were assessed again in 21 patients from the study group in whom recurrence was not detected.

Results: Significantly higher serum concentrations of TSA were found in patients with laryngeal cancer compared to the control group (p< 0.0000001). Changes in TSA concentrations in the study group depended only on cancer grade (G). Significantly higher TSA concentrations were found in G3 patients. Such a relationship was not found for other parameters assessed. Alcohol consumption was the only important factor that affected TSA concentration in the control group. Significantly higher TSA concentrations were found in patients who admitted alcohol abuse. Significantly lower TSA concentrations were observed in patients with laryngeal cancer who were assessed 4 years postoperatively (p < 0.000106).

Conclusion: Serum concentration of TSA was increased significantly in laryngeal cancer and decreased significantly after several years of successful treatment. Further studies are warranted to assess the possibility of using sialic acids as a marker or target for immunotherapy.

Key words: sialic acids, squamous cell carcinoma of the larynx, markers in laryngeal cancer, N-acetyl-5-neuraminic acid.

Background: Acute rhinosinusitis (ARS) is a common and well-defined disorder, primarily of viral aetiology, with rhinovirus and coronavirus accounting for more than 50% of viral ARS. The fight with COVID-19 pandemic resulted in an increased availability viral testing, which in turn allowed testing for presence of SARS-Cov-2 in all patients presenting common cold (or ARS) symptoms. The aim of this study was to assess the clinical characteristics of acute rhinosinusitis in patients diagnosed with COVID-19.

Methodology/principal: This study is a post-hoc analysis. Patients symptoms were evaluated using a structured questionnaire twice: directly after a positive SARS-Cov-2 result and 7-12 days following the first evaluation. Subjects were asked about presence of nasal and systemic symptoms as well as headache.

Results: A total of 130 COVID-19 symptomatic patients were recruited into the study, 58 (45%) patients met EPOS2020 diagnostic criteria for ARS. Of all ARS patients, 72% presented with rhinorrhoea, 69% with pain perceived over paranasal sinuses, 62% with nasal congestion, 52% with cough, 45% with olfactory dysfunction, 38% with fever, 33% with facial pressure and in 22% pain was exacerbated by sinus palpation.

Conclusions: Half of COVID-19 subjects has ARS. The course of SARS-Cov-2 ARS does not seem to differ significantly from ARS of other aetiologies. Since ARS in the course of COVID-19 seems to meet the definition of ARS proposed by EPOS 2020, we hypothesize that substances validated for ARS treatment, such as intranasal corticosteroids could be effective in SARS-Cov-2 ARS.