Cortical presentation of language functions in patients after total laryngectomy: a fMRI study.

PURPOSE: The aim of this study is to use functional magnetic resonance (fMRI) to analyse the cortical presentation of selected language functions in patients after a total laryngectomy. METHODS: Eighteen patients after total laryngectomy treated with electrolarynx speech and 18 volunteers were included. The mean number of patients' post-operative speech rehabilitation sessions was five (range of 3-8 sessions). Four paradigms were used, including noun generation, pseudoword reading, reading phrases with pseudowords, and nonliteral sign reproduction. RESULTS: In noun, the most significant difference between the groups was the stronger activation of both lingual gyri in the volunteers. Pseudoword reading resulted in stronger activations in patients than in volunteers in the lingual gyri, the right cerebellum, the right Broca's area, and the right parietal operculum. Reading phrases with pseudowords involved different parts of the Brodmann area 40. During nonliteral sign reproduction, there was a stronger activation of the left Broca's area in volunteers and a stronger activation of the left premotor cortex in patients. CONCLUSION: This study provides evidence of altered cortical activation in response to language tasks in patients after a laryngectomy compared with healthy volunteers, which may be considered brain plasticity in response to a laryngectomy.

Rationale for Increasing Oncological Vigilance in Relation to Clinical Findings in Accessory Parotid Gland-Observations Based on 2192 Cases of the Polish Salivary Network Database.

The accessory parotid gland (APG, Vth level) differs in histological structure from main parotid tissue. This gives rise to the hypothesis, mirrored in clinical observations, that the representation of tumours is different than in the rest of the gland. The aim of the study was to analyse the epidemiological and histological differences of parotid tumours located in regions I-V, with particular emphasis on the distinctiveness of region V. To define the epidemiological factors that will indicate the risk of histological malignancy from clinically benign appearance, multicentre prospective studies conducted between 2017-2021 by five Head and Neck Surgery University Departments, cooperating within the Polish Salivary Network Database 1929 patients (1048 women and 881 men), were included. The age, gender, patient occupation, place of inhabitation, tumour size, clinical features of malignancy, histology, and facial nerve (FN) paresis were analysed for superficial (I_II) and deep (III_IV) lobes and with special regard to the tumours affecting region V. Twenty eight tumours were located exclusively in region V (1.45% total) and seventy-two tumours were found in region V exhibiting extensions to neighbouring regions (3.7% total), characterised as significantly younger and less frequent in retirees. In I-IV regions, approximately 90% of tumours were benign, with pleomorphic adenoma (PA) and Whartin tumour (WT) predominance. In region V, PA exceeded 75% but WT were casuistic (2/28). Incidences of malignancies in region V was 40% but clinical signs of malignancy were evident only in tumours > 4 cm or in the presence of FN paresis. In 19% of patients with a benign appearance, imaging revealed malignancy; however, 38% of patients showed false negative results both in terms of clinical and radiological features of malignancy. Logistic regression models in 28 patients with tumours located exclusively in region V vs. 1901 other patients and in 100 patients with V extension vs. 1829 other patients showed no clinical symptoms of malignancy binding with final malignant tumour histology as a single variable or in combination with other variables. The logistic regression models obtained in this study show strong linkage between tumour location and predictors (age, male gender, and tumour diameter) and also aimed to function as a good classifier. Our conclusion is that, despite the very clear image of the mid-cheek tumour which is easily accessible in palpation and ultrasound examination, it is necessary to improve oncological vigilance and preoperative patient preparation.

Transient Facial Nerve Palsy as a Complication of Local Anesthesia After Tonsillectomy.

Chronic tonsillitis is a common otolaryngological disease worldwide. The treatment of choice is tonsillectomy, which is one of the most frequently performed procedures in Ear, Nose and Throat Departments. As with any surgical procedure, there are possible complications. Among them, rarely encountered and reported mainly in the pediatric population, is a short-term, transient facial nerve palsy resulting from local anesthetic administration. Here, we present a rare case of a 20-year-old woman with recurrent angina, who developed short-term, fully transient peripheral facial nerve palsy immediately after tonsillectomy under local anesthesia.

Effect of Systemic Prednisone Treatment on Changes of Inflammation Markers in Chronic Rhinosinusitis.

(1) Objective: We aimed to evaluate the effect of treatment with prednisone on nasal and systemic periostin and eotaxin expression, IgE in plasma and eosinophils in tissue. (2) Methods: We compared the values of nasal and systemic periostin, eotaxin, IgE and eosinophils in tissue in patients treated with only nasal steroids before FESS, group 1, with those treated with an oral steroid-prednisone, group 2. (3) Results: A statistically significant decrease in the level of periostin, eotaxin and IgE in plasma was achieved in patients treated with prednisone one week before and after surgery (in sequence: p < 0.0476, p < 0.0006, p < 0.0031). In patients treated with steroids, we also observed a lower level of periostin in the epithelium (p < 0.044), eotaxin in the stroma (p limit value < 0.075) and eosinophils (p < 0.031) in the tissues collected during the operation. (4) Conclusions: Systemic steroid treatment with prednisone distinctly decreases periostin, eotaxin and IgE expression in plasma. We also observed a lower level of periostin in the epithelium, eotaxin in the stroma and eosinophils in the tissues. We need more attempts to find inflammatory markers associated with chronic rhinosinusitis. Identifying drugs that decrease inflammatory parameters would allow for more targeted therapy.

[Early and late complications after implantation of the Provox 2 voice prosthesis in patients after total laryngectomy]. / Powiklania wczesne i pózne po implantacji protezy glosowej Provox 2 u chorych po laryngektomii calkowitej.

INTRODUCTION: Effective communication is an important element of social life. For a long time depravation of the capacity of such communication has been perceived as one of the most aggravating disabilities. It happens when the necessity to remove the larynx in patients with cancer appears. Contemporary methods of speech rehabilitation in patients after total laryngectomy create the possibility to communicate by three methods. One of them is generated speech with the use of voice prosthesis. MATERIAL AND METHODS: The examination included group of 76 patients (7 women, 69 men) after total laryngectomy with implanted voice prosthesis Provox 2. All the patients were operated on at the Department of Otolaryngology CM UMK. The early and late complication after implantation of voice prosthesis was analyzed. RESULTS: In our material we observed more frequentyly late complications. In 97.4% a leakage through or around the prosthesis was observed. In 35 cases we observed leakage through the wide tracheooesophagal fistula with good outcome due to spontaneusly contract of it after removal of the prosthesis. In four cases we used stitches above the fistula and in three patients we did tracheostomal plastic. The granulation tissue from the region of the fistula was removed in 11 patients. Spontaneous falling out of the prosthesis appeared in 6 cases. The late complications as tracheal immflamation, stricture of the oesophagus or occlusion of the fistula were less common. CONCLUSIONS: The late complications after implantation of Provox 2 prosthesis are more common in this type of patients' rehabilitation. The leakage through or around the prosthesis required its exchange and generated additional medical costs, which should be reserved in medical insurance policies.

Bioabsorbable dressing impregnated with betamethasone and ciprofloxacin after endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study.

BACKGROUND: In addition to its hemostatic and stabilization role, biodegradable nasal packing can be used as a carrier for drugs after functional endoscopic sinus surgery (FESS). The aim of this study was to compare the influence of biodegradable synthetic polyurethane foam (NasoPore) soaked with ciprofloxacin, or betamethasone, or both to the same foam soaked with saline after FESS. METHODS: 120 adults with chronic rhinosinusitis, with and without polyps, directed for bilateral full-house FESS were enrolled for the study. The patients were randomized and blinded into 3 groups, depending on the type of postoperative procedure applied. Thus, NasoPore soaked with antibiotic was provided to the first group; in the second group, the steroid was used; and the combination of both, in the third group. In each case, the aforementioned procedure was administered on one side of the nose, while NasoPore was soaked in saline on the other, at the end of the surgery, respectively. The patients were requested to complete a questionnaire during their postoperative visits at 2, 10, 30, 90, and 180 days, scoring the level of complaints on the VAS scale, separately for each side. The evaluation of the healing process was performed at each visit using rigid endoscopy and subsequently rated on numerical scales. RESULTS: Decreased mucosal edema and secretion; reduced Lund-Kennedy score; and favorable influences on facial pressure, nasal blockage, and smell were most evidently seen in the group receiving the antibioticsteroid combination. CONCLUSIONS: The application of biodegradable nasal packing with betamethasone and ciprofloxacin in sino-nasal surgery has positive effects not only on the healing process but also impacts patient's comfort. To optimize it, however, further research is needed.

Short Term Pre-Operative Oral Corticosteroids-Tissue Remodeling in Chronic Rhinosinusitis with Nasal Polyps.

Chronic rhinosinusitis is a process involving a number of adverse changes in the mucosa of the paranasal sinuses and nasal polyps. The main histological features of tissue remodeling are changes in epithelial structure, oedema, degradation of ECM (extracellular matrix), angiogenesis, and subepithelial fibrosis. In this study, patients were divided into two groups: group 1-patients with CRSwNP (chronic rhinosinusitis with nasal polyps) taking a nasal steroid and an oral steroid in the preoperative period, and group 2-patients with CRSwNP taking only the nasal steroid in the preoperative period. All samples were subject to histopatologic evaluation. The aim of this study was to investigate the effect of oral corticosteroids and topical steroids on the tissue of paranasal sinuses. We have shown statistically significant decreases in tissue eosinophilia per 5HPF and decreased fibrosis in group 1. No significant differences were presented in the percentage of total tissue oedema, epithelium, neutrophils, basement membrane thickening and vessels. Using systemic administration of 40 mg of prednisone for seven days decreased the counts of eosinophils and decreased fibrosis in the nasal polyps tissue in CRSwNP.

Tissue remodelling in chronic rhinosinusitis - review of literature.

CRS is a process involving a number of adverse changes in the mucosa of the paranasal sinuses and nasal polyps, e.g. increased fibroblast proliferation, angiogenesis, increased formation of fibrous tissue (subepithelial fibrosis) and tissue destruction. There are biomarkers whose levels can be increased in chronic inflammation of the paranasal sinuses: peripheral blood eosinophilia, IgE immunoglobulin, cytokines - IL-4, IL-5, IL-13, IL-25, IL-33, periostin, P-glycoprotein, CXCL-12, CXCL-13, INF-Υ, TNFα, TGFß1, albumins, eotaxin. These biomarkers are not pathognomonic for CRS. The concentration of biomarkers is also increased in bronchial asthma and atopic dermatitis. The TGFß, in particular, the ß1 subunit, was identified as the main factor involved in the remodeling of tissue stroma. In conjunction with the continuous improvement of tissue testing methods, it is advisable to search for new factors that will more accurately allow the assessment of tissue remodeling in the chronic processes of paranasal sinuses.

Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study.

INTRODUCTION: Endoscopic sinus surgery can lead to crusting or synechiae formation, which can affect the healing process. OBJECTIVE: The aim of our study was to compare the influence of steroid versus antibiotic versus saline solution impregnated absorbable nasal spacers on postoperative wound healing and patient satisfaction. METHODS: Eighty patients, 33 women and 47 men, were enrolled in this study. At the end of the surgery, two pieces of 4cm biodegradable material were applied in each ethmoid cavity. One of them was impregnated with saline solution, while the second one with steroid, or with antibiotic. RESULTS: We observed statistically significant differences in the Lund-Kennedy score between the control and both treatment groups: for the Antibiotic-group on days 10 and 30 (p=0.009; p=0.009) and for the Steroid-group on day 90 (p=0.008). The extended endoscopic appearance of nasal mucosa indicated statistically significant differences in crust formation on day 10 comparing the steroid and control dressing (p=0.025), in secretion type on days 10 and 30 comparing the antibiotic and control dressing (p=0.003; p=0.016) and additionally for steroid and control on day 90 (p=0.046). On Day 90 we observed statistically significant differences in the absence of mucosal edema in the S-group compared to controls (p=0.007). CONCLUSIONS: The results of this study reveal the significant positive influence of steroid- and antibiotic-impregnated biodegradable nasal packing on the postoperative healing process and patient satisfaction compared to the saline soaked dressing.

Diffuse idiopathic skeletal hyperostosis inducted stridor and dysphagia.

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition characterized by calcification and ossification of soft tissues, mainly ligaments and enthesis. Dysphagia is the commonest complaint, stridor secondary to osteophyte compression has rarely been documented. The osteophytes may cause symptoms by mechanical compression or by inducting inflammatory reaction. When an upper segment of the C-spine is involved, particular C3 - C4 level, the larynx may be affected. This could be result of hoarseness, stridor, laryngeal stenosis and obstruction. Sometimes vocal fold paralysis may result from injury to the recurrent laryngeal nerve. Treatment of the breathing problems required first on stabilization the airway with tracheostomy. Next step is osteophysectomy which generally relief patients from symptoms.

[Primary squamous cell carcinoma of the frontal sinus--a case report]. / Pierwotny rak zatoki czolowej--opis przypadku.

INTRODUCTION: Primary frontal sinus cancer is rare tumor of the paranasal sinuses. Tumors in the frontal sinuses are more often extensions from the ethmoid sinus--secondary involvement. The authors present a case of man with primary squamous cell carcinoma of the right frontal sinus. MATERIAL AND METHODS: A 49 years old man was admitted to the Dep. of Otolaryngology with right frontal sinus tumor. The man had painless forehead and upper lid swelling followed by orbital symptoms--diplopia. CT showed large destruction of anterior frontal sinus wall and invading thought inferior wall to the orbit. The patient was qualified to frontal sinus operation with right orbit content removal. Histopathologic postoperative examination showed squamous cell carcinoma G2 of right frontal sinus. RESULTS: A combined treatment, surgery and postoperative radiotherapy succeeded in good result. The 5-year survival rate in this case is 100%. CONCLUSIONS: Frontal sinus cancers are rare and diagnosed in late clinical stage. The treatment is both, surgery and obligatory postoperative irradiation. The effect of treatment is still insufficient in most cases.

[The surgery voice rehabilitation after total laryngectomy with the Provox system]. / Chirurgiczna rehabilitacja glosu chorych po laryngektomii calkowitej z zastosowaniem systemu provox.

THE AIM OF STUDY: Comparison the voice quality of patients after total laryngectomy using the Provox 2 voice prosthesis and patients with esophageal speech and to discuss difficulties and complications related with its implantation. MATERIAL AND METHODS: The study group consists of 39 patients after total laryngectomy and Provox puncture. 36 patients underwent primary puncture, 3 patients - secondary puncture. 32 patients underwent radiotherapy. The time starting of speech learning was approx the 9th day after total laryngectomy and 1st-3th day after secondary implantation. The authors subjectively and objectively analyzed voice of 34 patients with fistular speech and it compared with esophageal speech of 10. The spectrograms analysis of the voice was based on Remacle's scale. The study showed juxtaposition of early and late complications of patients with voice prostheses. RESULTS: 90% of patients (35 patients) learned the fistular speech. The speech was louder and more intelligible than esophageal voice in subjective estimation. The fistular voice had higher of mean volume (61,1 dB vs. 59 dB), mean longer maximum phonation time (9,5 s vs. 2,2 s), mean higher base frequency FO (108 Hz vs. 87Hz) and smaller variability of FO based on mean Jitter ratio (3,8% vs. 6,6%), mean Shimmer ratio (23,18% vs. 23,52%) and mean HPQ ratio (127,34 vs. 141,73) than esophageal voice in objective estimation. Mean range of frequency of the speech was smaller but it was in higher frequencies. The most frequent type of spectrogram was 3th type in experimental group and 2nd type in control group. The mean lifetime of prostheses was 295 days. The most common cause of replacement of the prosthesis was leakage associated with mycosis infection (26 cases). Early complications were observed. The most frequent of them was infection around the fistula during supplementary radiotherapy (7 cases after primary puncture). The most frequent of later complications was widening of fistula and leakage around prosthesis (4 cases). CONCLUSIONS: Rehabilitation of patients after total laryngectomy is better using Provox system than learning esophageal speech (according to voice quality aspect). Using of voice prostheses in patients after total laryngectomy can combine with appearance of complications.

[Silent sinus syndrome in child]. / Zespól cichej zatoki u dziecka.

INTRODUCTION: Silent sinus syndrome (SSS) is rare clinical entity described in ophthalmology and otolaryngology literature. It is characterized by spontaneous and progressive enophthalmos and hypoglobus caused by maxillary collapse in the setting of chronic maxillary sinus hypoventilation. The authors report an unusual case of SSS in child. MATERIAL AND METHODS: A 15 year old boy presented with 6 months history of developing of right cheek deformity with no clinically signs and symptoms of chronic rhinosinusitis. According to nasal endoscopy and CT and NMR scans the silent sinus syndrome was recognized. What is the most important, the deformity of anterior maxillary wall was the main problem and complaint. The patient underwent surgical endoscopic uncinectomy with medial antrostomy. RESULTS: The performed treatment successfully corrected both the cheek and the upper eyelid sulcus deformity. The control CT scans performed 3 months after surgery showed normal sinus ventilation with wide medial antrostomy. CONCLUSIONS: Silent sinus syndrome in a child is characterized by more active resorption and remodeling of anterior maxillary wall with clinically visible deformity. The goal of the treatment is restoration of normal maxillary sinus aeration and this guaranty further normal sinus development.

Clinical outcome and patient satisfaction using biodegradable (NasoPore) and non-biodegradable packing, a double-blind, prospective, randomized study.

INTRODUCTION: Nasal packing after endoscopic sinus surgery is used as a standard procedure. The optimum solution to minimize or eliminate all disadvantages of this procedure may be accomplished using biodegradable packs. OBJECTIVE: The aim of this study was to compare patient satisfaction and clinical outcome associated with absorbable and non-absorbable packing after FESS. METHODS: In total, 50 patients were included in a prospective, double-blind, randomized trial. One side was packed with polyurethane foam, while the opposite side was packed with gauze packing. On the 2nd, 10th, and 30th postoperative day, the patients were questioned with the aid of a visual analog scale. The standardized questionnaires for bleeding, nasal breathing, feeling of pressure, and headache were used. The presence of synechiae, infection, or granulation was noted and recorded with the video-endoscopy. RESULTS: A significant difference according to lower pressure was found in the NasoPore group compared to the controls on day ten after surgery. The NasoPore packing had lower scores with respect to postoperative nose blockage on the 2nd and 10th days. Mucosal healing was better for the NasoPore group, both at day ten and 30 compared with the control group. CONCLUSION: The overall patient comfort is higher when using NasoPore compared to non-resorbable traditional impregnated gauze packing. Intensive saline douches applied three to four times per day are mandatory after the operation to prevent synechiae formation and fluid resorption by the packing.

Ophthalmic complications of endoscopic sinus surgery.

INTRODUCTION: The proximity of the paranasal sinuses to the orbit and its contents allows the occurence of injuries in both primary or revision surgery. The majority of orbital complications are minor. The major complications are seen in 0.01-2.25% and some of them can be serious, leading to permanent dysfunction. OBJECTIVE: The aim of this study was to determine the risk and type of ophthalmic complications among patients operated due to a chronic rhinosinusitis. METHODS: This is a retrospective study of 1658 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with or without polyps or mucocele. Surgeries were performed under general anesthesia in all cases and consisted of polyps' removal, followed by middle metal antrostomy, partial or complete ethmoidectomy, frontal recess surgery and sphenoid surgery if necessary. The ophthalmic complications were classified according to type, frequency and clinical findings. RESULTS: In our material 32.68% of the patients required revision surgery and only 10.1% had been previously operated in our Department. Overall complications occurred in 11 patients (0.66%). Minor complications were observed in 5 patients (0.3%) with the most frequent being periorbital ecchymosis with or without emphysema. Major complications were observed in one patient (0.06%) and were related to a lacrimal duct injury. Severe complications occurred in 5 cases (0.3%), with 2 cases and referred to a retroorbital hematoma, optic nerve injury (2 cases) and one case of extraocular muscle injury. CONCLUSIONS: Orbital complications of endoscopic nasal surgery are rare. The incidence of serious complications, causing permanent disabilities is less than 0.3%. The most important parameters responsible for complications are extension of the disease, previous endoscopic surgery and coexisting anticoagulant treatment.

Rare benign pleomorphic adenoma of the nose: short study and literature review.

Pleomorphic adenoma is one of the most common benign tumors of the major salivary glands. It can also occur in the minor salivary glands, which exist in the nasal cavity. Intranasal pleomorphic adenoma usually originates from glands of the nasal septum mucosa. We present the results of endoscopic endonasal surgery of this pathology. The aim of the study was to present the endoscopic technique for nasal septum pleomorphic adenoma surgery. The retrospective examination of 3 patients was performed. There were 2 women and 1 man. Age ranged from 15 to 46 years. All the patients presented with nasal obstruction and occasional epistaxis for at least for 6 months. We performed endoscopic surgery to remove the tumors. In all cases we dissected the septal perichondrium to achieved free margins of the tumor. The microscopic examination revealed an epithelial and myoepithelial component with tubular structures composed of two cell layers, ducts, and a solid area found in a loose myxochondroid area. Additionally, immunohistochemical staining was performed using antibodies against cytokeratin, Ki-67, and vimentin. Patients' postoperative course was uneventful, and no complications were encountered. No recurrence was present during patients' postoperative visits. Nasal benign pleomorphic adenoma is a rare tumor which should be taken into consideration in the nasal cavity during surgery. The correct histological diagnosis can be confirmed by additional histological studies. Endoscopic endonasal surgery is reserved for small tumors.

Assessment of voice quality after carbon dioxide laser and microdebrider surgery for Reinke edema.

OBJECTIVES: Surgery of Reinke edema requires reduction of the degenerated superficial lamina propria and preservation of the vibratory epithelium. MATERIAL AND METHODS: Sixteen patients were included for microdebrider and 10 patients for carbon dioxide (CO2) laser surgery. Vocal analysis was performed before and at 1 and 3 months after surgery. Subjective rating of voice quality was completed by the grade, roughness, breathiness, asthenia, and strain scale. The objective assessment was conducted by Multi-Dimensional Voice Program software. RESULTS: We found consistent improvement in all parameters both in CO2 laser and microdebrider group. The normalization of all parameters were statistically better after microdebrider surgery. The most statistically significant improvements were accounted in reduction in grade of hoarseness, roughness, and asthenia and acoustic analysis. CONCLUSIONS: Microdebrider is a useful and safe tool for Reinke edema treatment. The oscillatory cutting knife and low suction protect lamina propria resulting in better vibratory function.

Evaluation of fully biodegradable nasal packings in functional endoscopic sinus surgery ­ a multi-centre study.

THE AIM: This work was to compare an innovative solution, i.e. a fully biodegradable nasal packing Nasopore®, with a traditional one, in the aftercare of patients subjected to functional endoscopic sinus surgery. MATERIAL AND METHOD: Prospective, blinded study with sequential enrollment conducted at three study centres. One of the investigators evaluated during surgery the level of bleeding in each of the nasal cavities and at the end of surgery he applied the test packing, the biodegradable dressing Nasopore®, to one randomly chosen nasal cavity, and a control packing to the other one. The other investigator removed during aftercare the control packing and conducted the follow-up. During the control visits (24-48 hours, 10 and 30 days post-op.) the subjects evaluated their headache, pain in the nose, pressure in the forehead as well as their nasal obstruction. RESULTS: A total of 39 women and 44 men at the age of 47 years on average (min. 19, max. 82) were qualified for the study. The largest differences between different types of nasal dressings were observed with regard to reduction of nasal obstruction in the fist 10 days after surgery (P<0.005). In relation to the pain in the area of the head and nose as well the pressure in the forehead on every visit, better outcomes were observed for the test dressing. Statistical difference (P<0.05) was observed on the fist follow-up visit for the headache and pressure in the forehead as well as on the fist and second visit for the pain in the nose. CONCLUSION: The fully biodegradable nasal dressing Nasopore® may constitute significant improvement and facilitation of aftercare in functional endoscopic sinus surgery while increasing the patients' satisfaction and lowering the postoperative discomfort.

Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study / Tampão nasal absorvível embebido em esteroides versus antibióticos para cicatrização de feridas após cirurgia endoscópica nasossinusal: estudo randomizado, duplo cego, placebo controlado

Abstract Introduction: Endoscopic sinus surgery can lead to crusting or synechiae formation, which can affect the healing process. Objective: The aim of our study was to compare the influence of steroid versus antibiotic versus saline solution impregnated absorbable nasal spacers on postoperative wound healing and patient satisfaction. Methods: Eighty patients, 33 women and 47 men, were enrolled in this study. At the end of the surgery, two pieces of 4 cm biodegradable material were applied in each ethmoid cavity. One of them was impregnated with saline solution, while the second one with steroid, or with antibiotic. Results: We observed statistically significant differences in the Lund-Kennedy score between the control and both treatment groups: for the Antibiotic-group on days 10 and 30 (p = 0.009; p = 0.009) and for the Steroid-group on day 90 (p = 0.008). The extended endoscopic appearance of nasal mucosa indicated statistically significant differences in crust formation on day 10 comparing the steroid and control dressing (p = 0.025), in secretion type on days 10 and 30 comparing the antibiotic and control dressing (p = 0.003; p = 0.016) and additionally for steroid and control on day 90 (p = 0.046). On Day 90 we observed statistically significant differences in the absence of mucosal edema in the S-group compared to controls (p = 0.007). Conclusions: The results of this study reveal the significant positive influence of steroid- and antibiotic-impregnated biodegradable nasal packing on the postoperative healing process and patient satisfaction compared to the saline soaked dressing.

Resumo Introdução: A cirurgia endoscópica nasossinusal pode levar à formação de crostas e sinéquias, o que pode afetar o processo de cicatrização. Objetivo: O objetivo do nosso estudo foi comparar a influência do espaçador nasal absorvível embebido em esteroide versus antibiótico versus solução salina na cicatrização de ferida pós-operatória e na satisfação do paciente. Método: Oitenta pacientes, 33 mulheres e 47 homens, foram incluídos neste estudo. Ao final da cirurgia, dois tampões de material biodegradável de 4 cm foram aplicados em cada cavidade etmoidal. Um deles foi embebido em solução salina, enquanto no segundo foi utilizado esteroide, ou antibiótico. Resultados: Observamos diferenças estatisticamente significantes no escore de Lund-Kennedy entre os grupos controle e ambos os grupos tratamentos: para o grupo antibiótico nos dias 10 e 30 (p = 0,009; p = 0,009) e para o grupo esteroide no dia 90 (p = 0,008). O aspecto endoscópico da mucosa nasal indicou diferenças estatisticamente significantes na formação de crostas no dia 10, na comparação do esteroide com o curativo controle (p = 0,025), no tipo de secreção nos dias 10 e 30, na comparação do antibiótico com o curativo controle (p = 0,003; p = 0,016) e adicionalmente para esteroide e controle no dia 90 (p = 0,046). No dia 90, observamos diferenças estatisticamente significantes na ausência de edema da mucosa no grupo E (esteroide) em relação aos controles (p = 0,007). Conclusões: Os resultados deste estudo revelam uma influência positiva significante no uso de tampão nasal biodegradável embebido em esteroides e antibióticos no processo de cicatrização pós-operatória e satisfação do paciente em comparação com o curativo embebido em solução salina.

Cortical activity in tinnitus patients and its modification by phonostimulation.

OBJECTIVE: The goal of this study was to observe spontaneous cortical activity and cortical activity modulated by tinnitus-matched sound in tinnitus patients and healthy subjects with no otoneurologic symptoms. METHOD: Data were prospectively collected from 50 tinnitus patients and 25 healthy subjects. Cortical activity was recorded in all subjects with eyes closed and open and during photostimulation, hyperventilation and acoustic stimulation using 19-channel quantitative electroencephalography. The sound applied in the tinnitus patients was individually matched with the ability to mask or equal the tinnitus. The maximal and mean amplitude of the delta, theta, alpha and beta waves and the type and amount of the pathologic EEG patterns were noted during each recording. Differences in cortical localization and the influence of sound stimuli on spontaneous cortical activity were evaluated between the groups. RESULTS: The tinnitus group exhibited decreased delta activity and increased alpha and beta activity. Hyperventilation increased the intensity of the differences. The tinnitus patients had more sharp-slow waves and increased slow wave amplitude. Sound stimuli modified the EEG recordings; the delta and beta wave amplitudes were increased, whereas the alpha-1 wave amplitude was decreased. Acoustic stimulation only slightly affected the temporal region. CONCLUSION: Cortical activity in the tinnitus patients clearly differed from that in healthy subjects, i.e., tinnitus is not a "phantom" sign. The changes in cortical activity included decreased delta wave amplitudes, increased alpha-1, beta-1 and beta-h wave amplitudes and pathologic patterns. Cortical activity modifications occurred predominantly in the temporal region. Acoustic stimulation affected spontaneous cortical activity only in tinnitus patients, and although the applied sound was individually matched, the pathologic changes were only slightly improved.