[Transient evoked otoacustic emission in children with juvenile idiopatic arthritis]. / Otoemisja akustyczna wywolana trzaskiem u dzieci z mlodzienczym idiopatycznym zapaleniem stawów.

Juvenile idiopathic arthritis (JCA) is an inflammatory systemic disease of connective tissue which etiology is still unknown. Progressive arthritis is the basic symptom, with pain, oedema, stiffness and movement impediment are typical for. Chronic process of arthritis might be accompanied by rheumatoid nodes, pericarditis, myocarditis, changes in the lungs and kidney, which appear with various frequency and indicates on systemic form of disease. The incudo-malleolar and incudo-stapedial joints are synovial in type. It should be expected that these joints might be affected by rheumatoid changes similar to those observed in joints in other parts of the body. Copeman was the first who described transient conductive hearing loss in patients with exacerbated rheumatoid process--and he called it oto-arthritis. He stressed that it was the consequence of the rheumatoid lesions in joints of ear ossicules. In adult patients with JCA in 60% of cases the perceptive hearing-loss is observed possibly because of the chronic course of the disease and its farmacological treatment. The aim of the study was the assessment of the functional state of the peripheral part of hearing organ on the basis of TEOAE. This study was preceded by examination of hearing with pure tone audiometry, speech audiometry, high frequency audiometry and impedance audiometry. The analysis of results was done in correllation to form of JCA and its activity. The research was carried out on the group of 45 children suffering from JCA; 14 boys and 31 girls between 5-18 years of age. In all children from experimental group the examination was performed in the active phase of disease process. Mean duration of the disease was 33.5 month. In all children TEOAE was obtained no matter on the form of JCA. Children with systematicus form of JCA--more aggressive type than others--have the recordings of TEOAE with small amplitude and narrow range of frequency. Those results show that rheumatoid lesions in conductive mechanism of the middle ear are insufficient for the development of the conductive hearing loss. As a results of chronic pathological process destructions of hearing organ may lead to the cochlear lesions and this way to perceptive hearing loss.

The effect of hormonal factors on the hearing organ in women, after surgical castration. Preliminary report.

BACKGROUND: Estrogens have not only direct and beneficial effect on relaxation of the arteries increasing the blood flow in the blood vessels, but also their level of secretion has considerable effect on synthesis of acetylcholine a neurotransmitter indispensable for appropriate functioning of the hearing organ. The aim of this study is analysis of the effect of hormones on the hearing organ in women who underwent surgical castration. MATERIAL: The study included 40 females, aged between 32 55 years who had undergone an operative treatment mainly because of uterine myoma. A group of 50 women aged between 32 50 years with appropriate hormone level comprised the control group. METHOD: Each woman investigated underwent the following examinations: gynaecological, otolaryngological and laboratory tests, such as: evaluation of levels of estradiol (E) and folliculin stimulating hormone (FSH). The assessment of hearing was carried out using tone and speech audiometry, tympanometry, test registration of auditory brain stem responses (ABR) and otoacoustic emissions (EOAE). The examinations mentioned above are performed in women as initial examinations before surgical treatment and as follow-up examinations 1, 3 and 12 months after the surgery. RESULTS: The results presented in this paper include initial examinations and follow-ups 3 months after the surgical treatment taking into consideration the correlation with the results of laboratory tests and the results obtained in the control group.

Acoustic assessment of voice signal deformation after partial surgery of the larynx.

OBJECTIVE: The main objective of the present study was to assess the degree of voice signal impairment among patients who had undergone partial surgery of the larynx due to cancer of this organ. Such on evaluation may be helpful in the selection of the optimal surgical technique for the treatment of tumors displaying a varying degree of local advancement. METHODS: A prospective examination was carried out among 128 patients. Additionally a comparative study of the control group consisting of 36 healthy males was carried out. Acoustic tests were carried out in an echo-free chamber. The temporal changes in the value of acoustic pressure of the uttered text were registered. The 'distance' between the normal speech signal and the pathological voice has been established. RESULTS: The values of the fundamental frequency increase together with an increase of the range of resection of anatomical structures. The biggest differences in the value of results describing the distance from the standard were observed after hemilaryngectomy. The shortest distance from the acoustic standard was observed after chordectomy. No significant differences in the degree of voice signal impairment among patients who had undergone extended chordectomy and hemilaryngectomy were observed. CONCLUSION: The above findings can be of help in arriving at an optimum solution in cases of partial surgery of the larynx. The problem is particularly important in situations where there is the choice between different types of surgery.

[Clinical and electrophysiological studies of the organ of hearing of newborn infants. III. Evaluation of the organ of hearing of newborn infants from high risk pregnancy using brain stem evoked response audiometry (ABR)]. / Badania kliniczne i elektrofizjologiczne narzadu sluchu u noworodków. Czesc III. Ocena narzadu sluchu u noworodków z ciazy wysokiego ryzyka przy zastosowaniu sluchowych odpowiedzi pnia mózgowego (ABR).

In a group of 130 tested newborns, pathological brain stem responses derived from acoustic stimulus was achieved in 28 cases (21.5%). 85.2% of newborns in this group of birthed babies comprised a high-risk pregnancy group. Based on criteria evaluating monitoring and parameters achieved ABR responses: conduction hearing disorders were found in 7 newborns, sensori-neural in 12 cases, and neurological dysfunction was observed in 9 cases. Control testing was carried through for three months following the initial evaluation allowing for the elimination of 12 children in a group of 19 for further testing and observation. This represents 42.85% of children initially evaluated as possessing a hearing disorder and 9.2% from the total of those tested. Results obtained during successive control testing were carried-out in a 3-6 month period following the initial examination and allowed for decisions to be made. Conforming to: 4 children (3.07%) were supplied with hearing aids and hearing rehabilitation begun, 1 child (0.76%) was referred to rehabilitation the deaf, whereas the 2 remaining children (1.53%) are currently under neurological observation. Nonetheless, testing older children eliminates cases that present with lack of success at the initial evaluation or transitory hearing impairment that is self-limited, although ABR testing, while the child is on the unit, allows for the introduction of hearing-organ controls of newborns based on population testing.

[Clinical and electrophysiological investigations of hearing in neonates. I. Behavioral audiometry and auditory brainstem response in evaluation of the auditory apparatus in pre- and full-term neonates]. / Badania kliniczne i elektrofizjologiczne narzadu sluchu u noworodków. Czesc I. Audiometria zachowania i ABR w ocenie narzadu sluchu u noworodków urodzonych o czasie i przedwczesnie.

Auditory Brain stem Responses (ABRs) and behavioural thresholds were studied in 130 neonates born between 25 to 42 weeks of gestational age. ABR thresholds were determined by the weakest stimulus that elicited a recognizable and replicable wave V. Behavioural audiometric thresholds for 1 and 2 kHz pure tones were determined by taking the lowest of threshold for eliciting auro-palpebral reflex. In 130 tested neonates ABR responses were normal in 102 (78.5%) while 28 babies (21.5%) elicited a pathological response. In the normal ABR group mean thresholds values ranged between 24.7-35 dBHL, and it was observed that the thresholds diminished with neonatal maturation. Behavioural audiometry disclosed that 77.5% normal full-term neonates responded to pure tone 1000 Hz, with mean threshold of 92.83 dBHL, while only 59.09% of pre-term neonates responded to pure tone stimuli at 101 dBHL.

[Clinical and electrophysiological studies of the organ of hearing in newborn infants. II. Study of maturity of the auditory pathway by brain stem responses (ABR) in newborn infants]. / Badania kliniczne i elektrofizjologiczne narzadu sluchu u noworodków. Czesc II. Dojrzewanie drogi sluchowej w odpowiedziach pnia mózgowego (ABR) u noworodków.

In a group of 130 tested children, 102 of whom a property had evaluated on brain stem responses, we tested the influence of newborn maturation on values of response parameters, their configuration and threshold values. It was shown that newborn maturation lowers in a statistically significant way the threshold values of acoustic stimulus. Also, the configuration of the monitoring changes with age of child tested. Newborn maturation increases the frequency of occurrence of waves II, IV, V and VI though decreases of incidence IV/V complex. In the group of the youngest pre-term babies IV/V complex were present in 50% of cases, whereas in the group of newborns carried to term its present could be verified only in 5-11% of cases. Newborn maturity also influences in an essential way the average latent time consecutive waves as well as central conduction time determined by interpeak latency I-V. Coefficient correlation values for these parameters shows a negative statistical significance correlation. That is, a decreasing of average values of these parameters with maturation of the newborn. It was also shown that structures of the hearing pathway responsible for generation of early and late components of brain stem responses nature at different periods. Peripheral structures of the hearing pathway are significantly more mature at birth than are central structures.

[History of electrophysiological investigations of organs of hearing]. / Historia badan elektrofizjologicznych narzadu sluchu.

Development of electrophysiological examinations of organ of hearing was examined, starting from Luigi Galvani's discovery of electrical activity of biological tissue, through experimental research aiming at localization of cortical hearing centres. The studies by Wever and Bray, as well as, Ruben's team of Baltimore underline the significance of potentials expressing electrical activity of cochlea and acoustic nerve fibres. Pioneer studies of Hallowel Davis (called "father of ERA studies"--Electric Response Audiometry) and his first wife, Paulina. Several other studies done by his research team were mentioned. Besing on these papers and papers of some other authors, a short description of slow cortical potentials and cochlea potentials was done as they were discovered and introduced to clinical tests. The discussion covered also investigations of Sohmer and Feinmesser, as well, as, those of Jewett and Willistone on systematization of structures generating waves in auditory brain stem responses. The paper is concluded with the description of the recent classification of auditory potentials induced by an acoustic stimulus. The discussion on the development and progress of electrophysiological studies of the organ of hearing is concluded with some remarks on otoacoustic cochlea emission discovered by David Kemp of London in 1978.

ABR audiometry in evaluation of hearing organ in neonates from high-risk pregnancy.

In a group of 130 tested newborns, pathological brain stem responses derived from acoustic stimulus was achieved in 28 (21.5%) cases. 85.2% of newborns from this group of birthed babies comparised a high-risk pregnancy group. Based on the criteria of evaluating ABR parameters of the achieved responses, three categories of hearing dysfunctions were distinguished: conductive hearing loss in 7 cases, sensori-neural in 12 cases and neurological dysfunctions in 9 cases. Control testing which was carried out after three months following the initial evaluation, allowing for the elimination of 12 children in a group of 19 for the further testing and observation. This represents 42.8% of children initially evaluated as possessing a hearing disorder and 9.2% from the total of those tested. Results obtained during successive control testing were carried-out in a 3-6 month period following the initial examination an allowed for decisions to be made. Conforming to: 4 children (3.07%) were supplied with hearing aids and rehabilitation begun, 1 child (0.76%) was referred to rehabilitation the deaf, whereas the 2 remaining children (1.53%) are currently under neurological observations.

Maturation of the acoustic path-way in brain stem responses (ABR) in neonates.

In a group of 130 tested children, 102 of whom had a property evaluated brain stem responses, we tested the influence of newborn maturation on values of response parameters, their configuration and threshold values. It was shown that newborn maturation lowers in a statistically significant way the threshold values of acoustic stimulus. Also, the configuration of the monitoring changes with age of child tested. Newborn maturation increases the frequency of occurrence of waves II, IV and VI though decreases of incidence IV/V complex. In the group of the youngest pre-term babies IV/V complex were present in 50% of the cases whereas in the group of newborns carried to term its present could be verified only in 5-11% of cases. Newborn maturity also in an essential way shortening the latent time consecutive waves as well as central conduction time determining by interpeak latency I-V. Coefficient correlation values for those parameters shows a negative statistical significance correlation. That is, a decreasing of average values of those parameters with maturation of the newborn. It was also shown that structures of the hearing pathway responsible for generation of early and late components of the brain stem responses mature at different time. Peripheral structure of the hearing pathway are significantly more mature at birth than are central structures.

Fourier analysis in the objectivisation of auditory brain stem responses in newborns.

Fourier analysis (FFT) of auditory brain stem responses induced by stimuli of 90, 70 and 40 dB HL was carried out in group of 45 full-term and pre-term neonates. It was stated that with postnatal newborn's development complex IV/V was observed more frequently for the more immature newborn. It influences also the power strength spectrum obtained. In responses with IV/V complex the frequency range is considerable and significantly reduced by about 100-200 Hz. It was observed that general state of newborn at the birth influences the frequency range as well as from the shape of score reproducibility and reliability of spectrum is significantly better. It was noticed also that the shape and form of spectrum in about threshold and threshold responses is significantly similar irrespective of the intensity of threshold stimulus. The shape and form of responses spectra for stimuli of 30-40 dB HL (in a group of children with normal hearing) and of 80-90 dB HL (in a group of children with severe hearing impairment) are identical. The above findings allow us to show the importance of Fourier analysis for objectivisation of subjective evaluation of auditory brain stem responses.

[Auditory brainstem responses in full-term infants and pre-term neonates]. / Audiometria odpowiedzi pnia mózgowego (ABR) u noworodków urodzonych o czasie i przedwczesnie.

Auditory Brainstem Responses (ABR) and behavioural threshold were studied in 52 infants born between 28-41 weeks of gestational age (GA), which have been between 33-42 weeks of postconceptional age (PCA) (Gestational age + postnatal age). Peak latencies of wave V and interpeak latency I-V were measured as a function of maturational changes and stimulus intensities. Behavioural audiometric threshold to pure tone were determined through behavioural observation of auditory-palpebral reflex. In the group of full-term infants threshold responses for clicks lay between 32.5 to 35.1 dB. In the group of pre-term neonates the threshold lay between 37.6 do 40 dB. Behavioural audiometry disclosed that full-term infants responded to pure tone stimuli with mean threshold of 86 dB, while the pre-term infants would respond to pure stimuli at 91 dB. The latency of wave V responses decreases progressively from a mean of 7.84 ms at 33-35 weeks of PCA, to 6.57 ms at 40-41 weeks of PCA. The ABR shows a remarkable variability in wave V latency with relatively stable interpeak latency I-V with decreases stimulus intensities.

[The examination card for a child with suspected hearing loss or deafness]. / Karta badania dziecka podejrzanego o niedosluch lub gluchote.

An audiological examination card for a child has been worked out, allowing a detailed collection of anamnestic data concerning: family history, gestation, labour, neonatal period, infancy and early childhood. The items and possible answers contained in the card are so prepared that it can be used for computer analysis of the data obtained.

[Class I HLA antigens in patients with sensorineural hearing loss: preliminary report]. / Antygeny HLA klasy I u chorych z czuciowo-nerwowym uposledzeniem sluchu. Doniesienie wstepne.

The frequency of class I HLA antigens of 36 sensorineal hearing loss patients with bilateral, progressive and sudden deafness were analyzed. It was found that HLA-B41 and HLA-Cw7 were more frequent than in 1152 control population (Chi2= 1656 and 14.45 respectively). The differences were highly significant (p < 0.001) The homozygosity of HLA-Cw/Cw7 in examined patients was also statistically different in comparison with 616 healthy individuals (p < 0.025). Determination of soluble form class I HLA antigens (s-HLA-I) in semiquantitative method according to Tait et al. (1981) and McLean et al. (1983) was performed. In 24 of sera SNHL patients and in 126 healthy persons the level of sHLA-Cw7 was examined. The preliminary results show that distribution of soluble Cw7 antigen in patients sera and healthy controls were significantly decreased in cases of SNHL (Ch2 = 28.23; p < 0.0001). The authors suggest an existing relationship between SNHL and sHLA-Cw7, Further study may resolve this relation and possibilities of monitoring sHLA-Cw7 during therapy and course of this disease.

[Selected parameters of immune reactivity in patients with sensorineural hearing loss. III. Metabolic activity of neutrophils]. / Wybrane parametry reaktywnosci immunologicznej chorych z czuciowo-nerwowym uposledzeniem sluchu. III. Aktywnosc metaboliczna granulocytów obojetnochlonnych.

The evaluation of peripheral blood neutrophils functional state in 27 patients with progressive bilateral and 7 patients with sudden unilateral sensorineural hearing loss (SNHL) before and in the first period of ubiquitine therapy was performed. The metabolic activity of cells in NBT reduction tests: spontaneous (NBT-sp) and stimulated with LPS E. coli (NBT-st) were examined. The results in mean percentage and absolute number of NBT-positive cells, relative coefficient of neutrophil metabolic activity (CNMA) and also calculated NBT index were presented. Significant percentage of patients with increased NBT-sp test values before treatment and in the second examination were noticed. Relative CNMA was 3-6 times higher than normal values. The neutrophils of patients had a remarkably decreased ability to response to LPS stimulation. In patients with progressive bilateral SNHL during treatment with TFX considerable increase of patients (from 37.9 to 76.5%) with normal values in NBT-st reduction tests was found. The increased values of NBT-sp reduction tests and relative CNMA may suggest the presence of inflammation process or infection. The decreased values of NBT index which were observed confirm the existence of disturbances in neutrophils metabolic activity and lack of functional reserve of these cells. Usefulness of NBT reduction tests in patients with SNHL is discussed.

Spectral analysis of auditory brain stem responses in perceptive hearing loss.

The Fourier analysis of auditory brain stem responses in 45 patients aged 19 to 56 treated because of perceptive hearing loss in Cracow ORL Clinic was carried out. The group consisted of: 15 patients with sudden deafness, 15 patients with Menier's disease and 15 cases with retrocochlear hearing impairment. In cases with recruiting cochlear hearing loss considerable and significantly extension of frequency range in brain stem responses was observed. Moreover, responses induced by stimulus intensity causing recruitment are identical for both ears as far as their shape and power spectrum is concerned, despite wide variety of responses caused by stimulus of different intensity. It is assumable that Fourier analysis of auditory brain stem responses gives possibility of objective evaluation of subjectively determined recruitment syndrome.

[Immuno-genetic significance in sensorineural hearing loss (SNHL) in the light of our own investigations]. / Immunogenetyczne uwarunkowania w gluchocie odbiorczej (SNHL) w swietle wyników badan wlasnych.

The immunogenetic analysis in 152 patients with sensorineural hearing loss (SNHL) was studied. HLA class I antigens and haplotypes were calculated on the basis of typical linkage between HLA-A, -B, and C loci. Soluble form of HLA antigens (sHLA-I) in blood serum in a semiquantitative microabsorption test according to McLean et al. were also determined. It was found that the frequency of HLA-A2, -A25(10), -B39(16), -Cw5, and -Cw7 were different in patients with SNHL in compared to the control group (n = 1554). This deference's were highly significant, especially for HLA-Cw7 antigens (chi 2 = 88.88; p < 0.0000...1). The frequency of haplotype HLA-A25-B18-Cw7 in patients was also different (f = 362 x 10(4) vs 51 x 10(4)), and highly significant compared to the healthy individuals (n = 1944) (chi 2 = 27.37; p < 0.0000...1). Among 23 typed HLA class I antigens, significantly higher mean level was observed for 14 sHLA antigens then in control group (n = 248). The levels of sHLA-I antigens in patients sera may suggests participation of sHLA molecules in etiopathogenesis of SNHL. This hypothesis may indicate the existence of autoimmunogenetic background of SNHL within high concentrations of certain sHLA-I antigens.

[Evoked response audiometry in newborn infants examined earlier by fetal audiometry]. / Audiometria ABR u noworodków badanych wczesniej przy uzyciu audiometrii plodowej.

The aim of this study was to investigate the influence of acoustic stimulus on behavioural heart responses of fetuses near term (38 to 42 weeks of gestational age) and comparison assessment of FHR to Auditory Brain Stem Responses (ABR) in the same babies after their birth. The study group consisted of 30 babies with pathological pregnancies and control group of 30 neonates of physiological pregnancies. Our results indicated, that the pattern of FHR accelerations after application of acoustic stimulus was significantly altered and depended on of the kind of pregnancy. Duration and amplitude of FHR obtained in the patients with complicated pregnancy were significantly smaller in comparison to the pattern observed in normal patients (142 msec to 249 msec, and 36 to 22 as well). Comparing the results obtained in FA (Fetal Audiometry) and ABR (Auditory Brain Stem Responses) we can say, that prolonged latency between a stimulus and accelerations is also combined with the prolonged latency of consecutive waves in ABR. Shortened duration of accelerations and its decreased amplitude could respond to the diminished amplitude in ABR recordings.

[Analysis of causes of the parotid pleomorphic adenoma recurrence]. / Analiza przyczyn nawrotów gruczolaków wielopostaciowych przyusznicy.

Out of the total number of 173 patients who had undergone surgery for pleomorphic adenoma of the parotid gland, 19 had to be treated owing to the recurrence of the tumor, following earlier surgery 12 patients were reoperated on by means of the enucleation technique; 5 underwent superficial parotidectomy; in 2 cases the recurrence took on the form of tumor of the parapharyngeal space, which was removed through the cervical-parotid approach. The causes of the recurrences were analyzed taking into consideration the operation technique applied in the first surgery. A serious consequence of pleomorphic adenoma recurrence is the possibility of its becoming malignant, which took place in 2 cases (10.5%), as well as a permanent paralysis of facial nerve during the reoperation, which occurred in 4 cases (21%).

[Selected parameters of immunologic reactivity in patients with sensorineural hearing loss. I. Receptor activity of T lymphocytes]. / Wybrane zagadnienia reaktywnosci immunologicznej chorych z czuciowo-nerwowym uposledzeniem sluchu. I. Receptorowa aktywnosc limfocytów T.

Receptors activity of peripheral T cells for sheep erythrocytes was analyzed in 67 healthy individuals and in the 29 patients with progressive, bilateral hearing loss and in 7 patients with sudden deafness on unknown etiology. The ability of T lymphocytes to form non-immune complete and incomplete rosettes in TEt and TEa tests was evaluated before and at the beginning of ubiquitine therapy. The mean values of rosette forming cells (RFC) in percentage and absolute numbers and the statistical analysis were presented. It was found that the receptor activity of T lymphocytes in TEt test was not significant different from the results of healthy control group. On the other hand highly significant differences were observed (p < 0.001) in subset of "active" T-cells determined in TEa rosette test. The relative coefficient of receptor activity of lymphocytes (CRAL) calculated for complete TEa rosettes was high different (p < 0.0008). Normalization of the results of TE rosette tests after first period of ubiquitin biotherapy was observed.

[Selected parameters of immune reactivity in sensorineural hearing loss patients. II. CD3+, CD4+ and CD8+ subsets of T lymphocytes]. / Wybrane parametry reaktywnosci immunologicznej chorych z czuciowo-nerwowym uposledzeniem sluchu. II. Subpopulacje CD3+, CD4+ i CD8+ limfocytów T.

Subpopulations CD3+, CD4+ and CD8+ of T lymphocytes in 67 healthy individuals and in 36 sensorineural hearing loss (SNHL) patients with unknown etiology were determined. The patients were studied in two groups, i.e. 29 patients with bilateral and progressive hearing loss and 7 patients with sudden deafness. The ratio of CD4+ and CD8+ was also calculated. The results were presented as the mean value for percentage and absolute numbers of the cells together with statistical analysis. The acquired results of two group patients with SNHL were completed before and at the beginning of ubiquitine therapy. The highly significant differences (p < 0.001) for CD8+ subset in comparison with the results of control group was found. The restitution effect of ubiquitine treatment for CD3+ and CD4+ T lymphocytes subpopulation in SNHL patients was observed. Additionally in patients with sudden hearing loss the CD8+ subset was also normalized. The ratio of CD4+:CD8+ in patients with bilateral and progressive hearing loss was lower (1.27 +/- 0.21) that in control group (1.66 +/- 0.25) and significantly different (t = 7.31; p < 0.001). It was shown that the distribution of examined CD system markers which depended on CD4+:CD8+ ratio was normal only in 27.6% of patients with SNHL. It was a group of 9 patients in whom hearing loss appeared after bacterial or virus infections. No changes in the CD4+:CD8+ subpopulation ratio at the beginning of ubiquitine therapy was observed. The distribution of normal results for T cell subpopulations in patients before and during treatment was presented in table III. Our results indicate that the observations may have an important diagnostic value. The authors suggest that the CD system antigens determination in monitoring the clinical status of SNHL patients and also in patients treated with drugs influencing the immune system is needed.