Poszczepienne gruźlicze zapalenie ucha środkowego i jego powikłania – opis przypadku

Introduction

Tuberculosis is a major problem of constant importance all over the world. Notably, in the developed countries it is due to immunosuppressive therapy and AIDS. Primary otological tuberculosis constitutes a very small share of cases of this disease. Moreover, the appearance of tuberculomas remains unique to even greater extent.

Case report

Clinical history of a patient who has already been infected tuberculosis for 60 years in result of the BCG vaccination. Ponto-cerebellum angle tumour appeared in his brain as complication ensuing the disease. The first therapeutic method used was based on antituberculous drugs, subsequent surgical intervention (cerebello-pontine angle tumor removal via translabirynthin approche) was necessary however. We suspected another cause of this lesion – cholesteatoma or facial nerve neurinoma. Correct diagnosis give only histopatological examination. Because of facial nerve palsy, facial nerve reconstruction was necessary (connection of n. VII and n. XII).

Conclusion

This case reminds us that correct diagnosis of tuberculosis remains a serious problem despite the long experience and the development of diagnostics and treatment methods. Nowadays we observe the unusual clinical manifestations of the disease (e.g. such as ear pain, tinnitus, rapid hearing loss) more frequently.     

Brodawczaki odwrócone nosa i zatok przynosowych w materiale własnym

Introduction

The aim of this work was to analyze the occurrence of inverted papilloma within the nose and paranasal sinuses, the extent of lesions and the clinical course in the patients who underwent endoscopic surgery.

Materials and methods

Between the years of 2006–2012, at the Department of Otolaryngology and Laryngological Oncology, 2295 patients were subjected to surgery due to paranasal sinus diseases. The material was based on their past medical histories. The analysis includes the age and gender of the patients, the type of surgery, and results of histopathological examinations. A surgical procedure covered the paranasal sinuses with lesions diagnosed in CT. The qualified patients had inverted papilloma in histopathological results.

Results

Among 2295 patients who were operated because of chronic inflammatory changes, inverted papilloma was histopathologically diagnosed in 49 cases. In 16 patients with inverted papilloma, inflammatory changes were present on one side only, while in 33 cases inverted papilloma was confirmed histopathologically on one side. The analysis of age and gender of the study group showed that the highest occurrence of inverted papilloma was in patients over 50 years of age. In the majority of the studied cases, inverted papilloma spread in the middle nasal concha and the maxillary or ethmoid sinus.

Conclusions

In surgery, the endoscopic technique allows for an effective removal of inverted papilloma from the nose and paranasal sinuses. According to the authors, endoscopy is the most valuable method for post-operative monitoring of recurrent inverted papilloma.     

Zębopochodne stany zapalne tkanek miękkich twarzy i szyi w materiale Oddziału Otolaryngologii Szpitala Wojewódzkiego im. św. Łukasza w Tarnowie – obserwacja 5-letnia

Introduction

In the ethology of inflammations within the head and neck area, odontogenic ethology still plays an important role. Early recognition, diagnosis and management of odontogenic infections are requisites for avoiding or minimizing the development of potential complications.

The aim of the study

The aim of this study was to retrospectively analyze the clinical presentation, surgical management and cost implications of patients treated for odontogenic inflammations of head and neck area at the Department of Otolaryngology in the Regional Hospital in Tarnów in last 5 years.

Materials and methods

The study was based on medical documentations of 65 patients, 34 males and 31 females between the age of 16–83 years.

Results

Despite common accessibility of wholesome education and dental prevention, a lot of patients disregard their disorders. That's why treatment of odontogenic inflammations is often difficult and prolonged. The authors reveal a cost burden in a public health care as a result of odontogenic inflammations.     

Wartość oznaczeń wybranych parametrów diagnostycznych: ferrytyny,ultraczułego CRP i rozpuszczalnych fragmentów cytokeratyny 18. (TPS) w ocenie skuteczności terapii chorych z polipami nosa

Background

Chronic rhinosinusitis with nasal polyps is social, clinical and cost-effective problem, by reason of bothersome symptoms, chronic nature of the disease, tendency to recur and lack of satisfying treatment.

Aim

The aim of this study is assessment of suitability of hsCRP, ferritin and blood levels in nasal polyps patients in evaluation of treatment efficacy.

Methods

The study enrolled 38 patients between 20 and 68 years of age. Patients were divided into 2 groups. Levels of ultrasensitive CRP ferritin and TPS have been measured in all patients. The ultrasensitive CRP levels have been measured by chemiluminescence method. Ferritin levels have been measured by MEIA method. The TPS levels have been measured by chemiluminescence method.

Results

Comparison of mean ferritin levels in both study groups in each stage of observation shows the significant difference of mean values in only 6 weeks after surgery. Mean ferritin level is significantly lower in group I than in group II (p < 0.05). Mean hsCRP levels vary from one corresponding to ferritin levels. Statistically significant difference between study groups in 2nd and 6th week after surgery has been ascertained (p < 0.05). Similarly, like in ferritin levels, the TPS levels are significantly different in 6th week after surgery.

Conclusions

Analysis of ferritin, hsCRP and TPS serum levels indicates that these may be useful in assessment of treatment efficacy in patients with nasal polyps. Rise of the chosen inflammatory state parameter level in the postoperative monitoring and anti-inflammatory treatment introduction in nasal polyps patients may inhibit the recurrence of the disease.     

Proces gojenia perforacji błon bębenkowych u szczurów

Introduction

Tympanic membrane (TM) perforations are commonly seen in clinical practice as a result of trauma or in the course of otitis media. The TM is a unique structure suspended in air which makes its healing processes different than in the skin wounds.The aim of the study was otoscopical and histological evaluation of the rat's TM healing process.

Material and methods

56 male Wistar rats were used for the study. Fifty of them had TMs perforated bilaterally using CO₂ laser, additional 6 served as a controls. The animals were sacrificed on either day 1, 2, 3, 6 and 10 post injury. Process of healing was assessed otoscopicaly, subsequently TM were dissected and processed for histological evaluation.

Results

At day 6 after perforation half and on day 10 all of TM were healed. On the first day, in histological evaluation, focal thickening of the epithelial layer was observed at some distance from the edge of perforation, on the side of annulus. On the following day proliferation of epithelium covering outer surface of TM on the side of the malleus handle and annulus was clearly visible. An eosinophilic mass containing macrophages and granulocytes was seen in front of the migrating epithelium. On day 3–6 migrating epithelium reached the edge of perforation. Proliferation of the connective tissue layer followed the epithelium.

Conclusions

The present results indicate that the squamous epithelium covering the outer surface of TM constitutes the first layer which restores continuity of TM. The proliferation of the connective tissue occurs in the direct vicinity of the proliferating and migrating epithelium.     

Wyniki leczenia operacyjnego raka krtani w różnych typach laryngektomii częściowej na podstawie materiału własnego

The aim

of the study was to evaluate the oncological results of laryngeal cancer treatment performed in the Laryngology University Ward in Zabrze in the years 1990–2000, depending on the type of partial surgery applied.

Materials and methods

Retrospective clinical material includes 209 patients in whom surgery was a primary treatment method. No distant metastases (M1) or another malignant cancer were found. In all 209 patients the squamous cell carcinoma of various degree of malignancy (G₁–G₃) was found. The most common operation in the analyzed group was a chordectomy – 83 surgeries (40%), next, vertical partial laryngectomies – 38 (18%), horizontal glottis surgeries – 28 (13%). In 79 patients (38%) partial laryngectomy was complemented with a nodal operation.The median of the observation period was 9 years. Local recurrence, nodal recurrence and distant metastasis are rated as treatment failure. Treatment effectiveness was evaluated with relation to overall survival, disease-free survival, cause specific survival and local control. All the above-mentioned parameters were analyzed with the updated percentages method. The level of statistical significance was assumed to be p ≤ 0.05.

Results

The best oncological results were observed after vertical operations. In the vertical operations group the most favourable oncological results were noted after chordectomy. 83% overall survivals, 82% disease-free survivals, 93% cause specific survivals and 96% local controls in the 5-year observation. On the other hand, the least favourable treatment results were observed after ¾ subtotal partial operation, after horizontal supraglottic operation and after reconstruction operation with CHP. Statistically significant differences in treatment results between the groups of patients after various types of partial operations were found in relation to local controls and disease-free survivals.     

Polska wersja testu Sniffin’ Sticks – adaptacja i normalizacja

Introduction

Sniffin’ Sticks Test (SST) is a complex smell test, enabling the diagnosis of various aspects of olfactory sensitivity. It is one of the most popular tools for olfactory testing all over the world; however, so far it has not been commonly used in Poland.

Aim

The presented study had the following aims: assessment of the applicability of the SST in Poland, adaptation of the identification subtest, normalization of the whole battery and comparison of the Polish results to the norms in the original tool.

Materials and methods

We tested olfactory sensitivity of 281 healthy volunteers aged 18–87 years. We used the full version of the SST (threshold, discrimination and identification subtests).

Results

The results of the presented study are the modified version of the identification test response questionnaire and clearly defined normative values for the Polish people of different ages. Normative values and results in Poland were not significantly different from the previously reported findings for the original, German tool. Additionally, consistent with previous reports, olfactory sensitivity of the eldest group of the Polish people was lower than performance in younger age groups.

Conclusions

The presented findings suggest that the adapted version of the Sniffin’ Sticks Test might be used for both medical and research purposes in Poland.     

Leczenie raka wargi w materiale Kliniki Otolaryngologii i Onkologii Laryngologicznej Collegium Medicum w Bydgoszczy Uniwersytetu Mikołaja Kopernika w Toruniu

The subject of this study is methods and results of treatment of 21 cases of lip cancer between 2007 and 2012, which included 15 men and 6 women, aged 48–63. In 18 cases it was squamous cell carcinoma, in other 3 basocellulare carcinoma.     

Epidemiologia raka krtani i gardła dolnego w latach 1988–2012 w materiale Kliniki Otolaryngologii Uniwersytetu Medycznego w Białymstoku

Malignant tumour is the second cause of death in Poland, behind cardiovascular disease. 26% of men and 23% of women die of it. Head and neck tumours are the fifth most frequent group of malignant tumours. These are mostly squamous cell carcinomas. The carcinogenic factors of tobacco smoke play an indisputable role in the pathogenesis of these tumours.Aim of workAnalysis comprising: number of patients, sex and age, site and stage of the primary tumour (T), clinical assessment of neck lymph nodes (N). The results underwent statistical analysis.Materials and methodsThe study involved 1313 patients who underwent surgery in the period 1988–2012 in the Otolaryngology Clinic in Bialystok (1199 men and 114 women, aged 32–86 years).ResultsIn the study group the proportion of men was 91.3% and women 8.7%. Histopathological verification confirmed squamous cell carcinomas in 99%. The primary tumour was most often located in the supraglottic area of the larynx (48.0%) and its clinical stage was T3 (33.5%). T1 tumours were statistically significantly more frequently found in the glottis and T4 tumours – in the hypopharynx and in the transglottic area. Swollen lymph nodes in the neck were found in 52.4% of the patients, most often N2 (37.4%). The highest percentage of patients with lymph node reaction was found in the youngest group (76.6%) and the lowest – in the eldest group (30.0%). Swollen lymph nodes were statistically relevantly more frequent in patients with supraglottic or hypopharynx tumour.     

Ocena niedosłuchu u osób powyżej 60. roku życia korzystających z aparatów słuchowych

Objective

To assess the hearing impairment in people over 60 years old using hearing aids. This was a single-center study, but it is planned to extend it further to the whole country.

Materials and methods

The study was focused on patients with hearing aids. During the assessment 57 people were included in the observation in order to control the status of their hearing loss and benefit from traditional hearing aids as well as the possibility to apply the auditory implants in case of a little benefit from hearing aids. The otoscopy and pure tone audiometry were performed as well as the questionnaires on demographic and epidemiological data of patients were collected as well as the quality of their life with hearing aids was subjectively assessed.

Results

The results show that 91% of patients have sensorineural hearing loss (SHL), the remaining 9% – severe mixed hearing loss. Severe SHL was found in 22 patients, the moderate hearing loss was observed in 37%, and the profound SHL was the case in 5 patients. Minimal SHL was observed in 7% of patients (n = 4). More than 73% of the study subjects were male (n = 38). The average age of the patients who completed the survey was 74 years old. Thirty-five patients used their hearing aid over 3 years and less than 70% of them used it every day all day. Hearing aid was not actively used by 10 patients. Over the last year 51.92% of the patients underwent a hearing examination.

Conclusions

The bone anchored hearing aid was suggested to 2% of subjects and the cochlear implant was offered to 10 patients. The data analysis shows the need to educate and inform the elderly about alternative methods of hearing loss treatment.     

Operacje ratujące w nieresekcyjnych guzach szyi. Wyniki leczenia po podwiązaniu tętnicy szyjnej wspólnej

The aim of this study was to analyze two cases with advance tumors of the neck with infiltration of the common or internal carotid artery. Patients were surgically treated in Department of Otolaryngology Poznan University of Medical Sciences. Authors present the current state of knowledge concerning the proceedings in unresectable tumors of the neck and possibility to use the salvage surgery. Based on literature data and our own experience a risk of the carotid artery infiltrations is difficult to assay in diagnostic procedure. It decrease the possibility of radical surgery resection and indicate the most advance stage. Choosing the proper treatment requires interdisciplinary cooperation: ENT specialist, radiologist, vascular surgeon and oncologist. The high rate of complications and local recurrence rate makes the results of treatment are unsatisfactory.     

Audiovisuelle Telekommunikation durch Multimediatechnologien in der HNO-HeilkundeISDN – Internet – ATM ISDN – Internet – ATM

Telemedizin beinhaltet eine medizinische T?tigkeit, die auf diagnostischem, therapeutischem und sozialen Gebiet, unter Einschaltung eines übertragungsmediums, eine visuelle und akustische Informationsübermittlung über weite Entfernungen an einen oder mehrere ?rzte erm?glicht.