Investigation of sinonasal anatomy via low-dose multidetector CT examination in chronic rhinosinusitis patients with higher risk for perioperative complications.

The aim of the study was to compare visualisation of the surgically relevant anatomical structures via low- and standard-dose multidetector CT protocol in patients with chronic rhinosinusitis (CRS) and higher risk for perioperative complications (i.e. presence of bronchial asthma, history of sinus surgery and advanced nasal polyposis). 135 adult CRS patients were divided randomly into standard-dose (120 kVp, 100 mAs) or low-dose CT groups (120 kVp, 45 mAs). The detectability of the vital anatomical structures (anterior ethmoid artery, optic nerve, cribriform plate and lamina papyracea) was scored using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon. Polyp sizes were quantified endoscopically according to the Lildholdt's scale (LS). Olfactory function was tested with the "Sniffin' Sticks" test. On the low-dose CT images, detectability ranged from 2.42 (better than poor) for cribriform plate among anosmic cases to 4.11 (better than good) for lamina papyracea in cases without nasal polyps. Identification of lamina papyracea on low-dose scans was significantly worse in each group and the same was the case with cribriform plates in patients with advanced polyposis and anosmia. Cribriform plates were the most poorly identified (between poor and average) among all the structures on low-dose images. Identification of anterior ethmoid artery (AEA) with reduced dose was insignificantly worse than with standard-dose examination. The AEA was scored as an average-defined structure and was the second weakest visualised. In conclusion, preoperatively, low-dose protocols may not sufficiently visualise the surgically relevant anatomical structures in patients with CRS and bronchial asthma, advanced nasal polyps (LS > 2) and history of sinus surgery. Low mAs value enables comparable detectability of sinonasal landmarks with standard-dose protocols in patients without analysed risk factors. In the context of planned surgery, the current preferences of the tube should be carefully evaluated for different patient constitutions to minimise the risk of complications.

Hearing Tests on Mobile Devices: Evaluation of the Reference Sound Level by Means of Biological Calibration.

BACKGROUND: Hearing tests carried out in home setting by means of mobile devices require previous calibration of the reference sound level. Mobile devices with bundled headphones create a possibility of applying the predefined level for a particular model as an alternative to calibrating each device separately. OBJECTIVE: The objective of this study was to determine the reference sound level for sets composed of a mobile device and bundled headphones. METHODS: Reference sound levels for Android-based mobile devices were determined using an open access mobile phone app by means of biological calibration, that is, in relation to the normal-hearing threshold. The examinations were conducted in 2 groups: an uncontrolled and a controlled one. In the uncontrolled group, the fully automated self-measurements were carried out in home conditions by 18- to 35-year-old subjects, without prior hearing problems, recruited online. Calibration was conducted as a preliminary step in preparation for further examination. In the controlled group, audiologist-assisted examinations were performed in a sound booth, on normal-hearing subjects verified through pure-tone audiometry, recruited offline from among the workers and patients of the clinic. In both the groups, the reference sound levels were determined on a subject's mobile device using the Bekesy audiometry. The reference sound levels were compared between the groups. Intramodel and intermodel analyses were carried out as well. RESULTS: In the uncontrolled group, 8988 calibrations were conducted on 8620 different devices representing 2040 models. In the controlled group, 158 calibrations (test and retest) were conducted on 79 devices representing 50 models. Result analysis was performed for 10 most frequently used models in both the groups. The difference in reference sound levels between uncontrolled and controlled groups was 1.50 dB (SD 4.42). The mean SD of the reference sound level determined for devices within the same model was 4.03 dB (95% CI 3.93-4.11). Statistically significant differences were found across models. CONCLUSIONS: Reference sound levels determined in the uncontrolled group are comparable to the values obtained in the controlled group. This validates the use of biological calibration in the uncontrolled group for determining the predefined reference sound level for new devices. Moreover, due to a relatively small deviation of the reference sound level for devices of the same model, it is feasible to conduct hearing screening on devices calibrated with the predefined reference sound level.

The usefulness of free dicom viewers in rhinologic practice.

Indroduction: The planning of the course of surgery in patients with paranasal sinus disorders requires the meticulous evaluation of computed tomography (CT) scans. However, ENT doctors still often receive unsatisfactory DICOM images, which require multiplanar reconstruction (MPR). THE AIM: The objective of the present study was to evaluate and test DICOM viewers with MPR function currently available on the Internet for free. MATERIAL AND METHODS: Detailed Internet searches and analysis of databases were carried out to find the maximum number of browsers. Available software was downloaded to assess, qualitatively and quantitatively, the parameters and functions useful in rhinologic practice. Additionally, a questionnaire was developed in order to ascertain the expectations and habits of ENT doctors in relation to DICOM browsers and CT scan evaluation. RESULTS AND CONCLUSIONS: Among the hundreds of browsers, 17 programs were chosen to be included in the final comparison. The outcomes of the survey proved that many free DICOM tools are effective alternatives to commercially available programs. However, the results do not enable us to predict precisely which tool will meet the needs of each physician. The survey among ENT doctors highlighted their limited awareness of software with MPR functions, in particular those that scored best in the test.

The usefulness of free dicom viewers in rhinologic practice.

Indroduction: The planning of the course of surgery in patients with paranasal sinus disorders requires the meticulous evaluation of computed tomography (CT) scans. However, ENT doctors still often receive unsatisfactory DICOM images, which require multiplanar reconstruction (MPR). THE AIM: The objective of the present study was to evaluate and test DICOM viewers with MPR function currently available on the Internet for free. MATERIAL AND METHODS: Detailed Internet searches and analysis of databases were carried out to find the maximum number of browsers. Available software was downloaded to assess, qualitatively and quantitatively, the parameters and functions useful in rhinologic practice. Additionally, a questionnaire was developed in order to ascertain the expectations and habits of ENT doctors in relation to DICOM browsers and CT scan evaluation. RESULTS AND CONCLUSIONS: Among the hundreds of browsers, 17 programs were chosen to be included in the final comparison. The outcomes of the survey proved that many free DICOM tools are effective alternatives to commercially available programs. However, the results do not enable us to predict precisely which tool will meet the needs of each physician. The survey among ENT doctors highlighted their limited awareness of software with MPR functions, in particular those that scored best in the test.

IMPACT OF GENISTEIN AND PHYTIC ACID ON THE VIABILITY AND PROLIFERATION ACTIVITY OF NASAL POLYPS' CELLS IN AN IN VITRO MODEL.

In developed countries, chronic rhinosinusitis with nasal polyps is one of the diseases that diminish patients' quality of life most significantly. Treatment of that often incurable disease is based on the steroids and surgery in patients who had failed thorough conservative management. It appears that the introduction of new treatment agents suppressing inflammation process and inhibiting cells' proliferation would be a valuable therapeutic option. The aim of the present study was to evaluate the in vitro effect of genistein and phytic acid on the viability and growth rate of fibroblasts derived from nasal polyps. Cells were incubated with various concentrations of genistein (5-500 µM) and phytic acid (100-20,000 µM). After 72 h incubation, cells survivability and cells' growth rate were estimated by combination of WST-1 and LDH methods. QRT-PCR technique was used to determine the expression of histone H3, BCL-2, BAX and P53 genes. Caspase-8 and -9 expressions were evaluated by ELISA assay. Genistein and phytic acid significantly and in dose-specific manner decreased nasal polyps fibroblasts survivability and growth rate. Both agents in similar way decreased cell proliferation as measured by the expression of histone H3. They induce apoptotic machinery by modulating the expression of BCL-2, BAX and caspase-8 activity. Genistein and phytic acid have significant potential for a therapeutic role in the treatment of chronic rhinosinusitis.

[Bilateral external auditory canal cholesteatoma - a case report]. / Obustronny perlak przewodu sluchowego zewnetrznego - opis przypadku.

The external auditory canal cholesteatoma is a rare and difficult to diagnose disease. Symptoms are similar to the external ear canal inflammation and can be masked by retained cerumen. In the article we described a case of 22 year old, mentally impairment women with bilateral otorrhea, in the past treated for external ear canal inflammation. The otoscopic examination showed bilateral congenital auditory canal stenosis, with masses obstructing ear canals. Imaging and histopathologic studies revealed bilateral external ear canal cholesteatoma. The patient was qualified for surgery, which, together with a guardian, did not consent. Presented case indicates the necessity for widening the diagnostic of recurrent external ear canal inflammation.

[Bilateral squamous carcinoma of the external auditory canal--a case report]. / Obustronny rak plaskonablonkowy przewodu sluchowego zewnetrznego--opis przypadku.

Squamous cell carcinoma of the external auditory canal is a very rare and unusual malignancy, representing less than 0.2% of all head and neck cancers. The authors present a case of 78-year-old patient with bilateral squamous cell carcinoma of the external auditory canal-cT4N0M0 G2, pT4N2bM0, initially treated as a chronic otitis external. The patient was qualifies for the one-step removal of cancer of the earlobe and the external auditory canal. Because of complications during the operation, the plan of treatment was changed. The patient is under oncological control for 13 months.

Biological calibration for web-based hearing tests: evaluation of the methods.

BACKGROUND: Online hearing tests conducted in home settings on a personal computer (PC) require prior calibration. Biological calibration consists of approximating the reference sound level via the hearing threshold of a person with normal hearing. OBJECTIVE: The objective of this study was to identify the error of the proposed methods of biological calibration, their duration, and the subjective difficulty in conducting these tests via PC. METHODS: Seven methods have been proposed for measuring the calibration coefficients. All measurements were performed in reference to the hearing threshold of a normal-hearing person. Three methods were proposed for determining the reference sound level on the basis of these calibration coefficients. Methods were compared for the estimated error, duration, and difficulty of the calibration. Web-based self-assessed measurements of the calibration coefficients were carried out in 3 series: (1) at a otolaryngology clinic, (2) at the participant's home, and (3) again at the clinic. Additionally, in series 1 and 3, pure-tone audiometry was conducted and series 3 was followed by an offline questionnaire concerning the difficulty of the calibration. Participants were recruited offline from coworkers of the Department and Clinic of Otolaryngology, Wroclaw Medical University, Poland. RESULTS: All 25 participants, aged 22-35 years (median 27) completed all tests and filled in the questionnaire. The smallest standard deviation of the calibration coefficient in the test-retest measurement was obtained at the level of 3.87 dB (95% CI 3.52-4.29) for the modulated signal presented in accordance with the rules of Bekesy's audiometry. The method is characterized by moderate duration time and a relatively simple procedure. The simplest and shortest method was the method of self-adjustment of the sound volume to the barely audible level. In the test-retest measurement, the deviation of this method equaled 4.97 dB (95% CI 4.53-5.51). Among methods determining the reference sound level, the levels determined independently for each frequency revealed the smallest error. The estimated standard deviations of the difference in the hearing threshold between the examination conducted on a biologically calibrated PC and pure-tone audiometry varied from 7.27 dB (95% CI 6.71-7.93) to 10.38 dB (95% CI 9.11-12.03), depending on the calibration method. CONCLUSIONS: In this study, an analysis of biological calibration was performed and the presented results included calibration error, calibration time, and calibration difficulty. These values determine potential applications of Web-based hearing tests conducted in home settings and are decisive factors when selecting the calibration method. If there are no substantial time limitations, it is advisable to use Bekesy method and determine the reference sound level independently at each frequency because this approach is characterized by the lowest error.

Self-test web-based pure-tone audiometry: validity evaluation and measurement error analysis.

BACKGROUND: Potential methods of application of self-administered Web-based pure-tone audiometry conducted at home on a PC with a sound card and ordinary headphones depend on the value of measurement error in such tests. OBJECTIVE: The aim of this research was to determine the measurement error of the hearing threshold determined in the way described above and to identify and analyze factors influencing its value. METHODS: The evaluation of the hearing threshold was made in three series: (1) tests on a clinical audiometer, (2) self-tests done on a specially calibrated computer under the supervision of an audiologist, and (3) self-tests conducted at home. The research was carried out on the group of 51 participants selected from patients of an audiology outpatient clinic. From the group of 51 patients examined in the first two series, the third series was self-administered at home by 37 subjects (73%). RESULTS: The average difference between the value of the hearing threshold determined in series 1 and in series 2 was -1.54dB with standard deviation of 7.88dB and a Pearson correlation coefficient of .90. Between the first and third series, these values were -1.35dB±10.66dB and .84, respectively. In series 3, the standard deviation was most influenced by the error connected with the procedure of hearing threshold identification (6.64dB), calibration error (6.19dB), and additionally at the frequency of 250Hz by frequency nonlinearity error (7.28dB). CONCLUSIONS: The obtained results confirm the possibility of applying Web-based pure-tone audiometry in screening tests. In the future, modifications of the method leading to the decrease in measurement error can broaden the scope of Web-based pure-tone audiometry application.

[Hearing and balance in metabolic bone diseases]. / Sluch i równowaga w chorobach metabolicznych kosci.

There are reports that hearing loss is one of the clinical manifestations of metabolic bone diseases. Demineralization can lead to a reduction in ossicular mass. Paget's disease can reveal loss of mineral density of the cochlear bone. Ear bone remodeling in osteoporosis is similar to the changes in otosclerosis. Moreover, osteoporosis, osteogenesis imperfecta and otosclerosis have a similar genetic mechanism. According to some researchers osteopenia and osteoporosis may well be associated with idiopathic benign positional vertigo (BPV). Dysfunction of the organ of hearing and balance in patients with renal insufficiency may be due to disturbances in calcium phosphate balance and renal osteodystrophy in the course of the disease. Proving the presence of hearing loss in patients with metabolic bone diseases may lead to determining the new indications for bone densitometry in some patients with hearing impairment. Furthermore, audiological examination in patients with osteoporosis may be important because of the impact of hearing loss on prognosis for patients with metabolic bone diseases.

[Brachial cleft cyst]. / Torbiel boczna szyi.

Brachial cleft cyst is a congenital anomaly arising from persistent elements of branchial apparatus. It may assume the form of cyst, sinus or fistula and constitutes 30% of all congenital anomalies of the neck region. Brachial cleft cyst is usually recognized in patients before the 5th year of age, but it may appear in patients between 20 and 40, when it enlarges owing to infection. It reveals then as a smooth, resilient tumor in lateral region of the neck. Ultrasonography, computerized tomography and magnetic resonance may be used to evaluate and differentiate these lesions as well as to reveal the presence of fistula, which is important to plan the proper surgical treatment. The only effective treatment is total surgical excision. The lack of treatment puts a patient at risk of infections, while incomplete removal might result in recurrence.

[Endovascular treatment of recurrent hemorrhage after tonsillectomy]. / Embolizacja wewnatrznaczyniowa w nawracajacym krwawieniu po tonsillektomii.

Bleeding from the lodge after tonsillectomy is a rare complication--approximately 3% of all cases. In most cases pharmacological treatment or reoperation is effective. In unique situ. ations, when particular severe bleeding is observed, it is necessary to perform endovascular therapy. We present a case of efficient endo-vascular embolization in 31-year-old patient with a recurrent bleeding after tonsillectomy. Superselective embolization of the ascending palatine artery can be an effective therapeutic method in severe bleeding after tonsillectomy

Evaluation of temporal bone computed tomography and paranasal sinuses magnetic resonance images in acromegalic patients.

OBJECTIVE: Acromegaly is a rare disease, which symptoms are caused by excess secretion of a growth hormone (GH) from the anterior pituitary benign tumor - adenoma. Authors present an evaluation of computed tomography (CT) and magnetic resonance (MR) images of temporal bone and paranasal sinuses of patients with acromegaly. CONCLUSIONS: 1. In all patients with acromegaly, morphological changes in paranasal sinuses were shown. They were mostly pronounced within the maxillary sinuses including the mucosa thickening up to 6 mm and encysted fluid occurrence. 2. CT of temporal bone did not reveal structural changes of internal and median ear. 3. There is a need for further studies on hearing impairment in patients with acromegaly.

[Laryngeal tuberculosis in the patients of otholaryngology department--case reports]. / Gruzlica krtani u pacjentów leczonych w klinice otolaryngologii --opis dwóch przypadków.

Tubercular infection is still one of the most serious health and social problems. It's been estimated that one-third of the population is infected with Koch's bacillus. More than 90% of overall morbidity of tuberculosis in Poland pose pulmonary tuberculosis, in the worldwide level the percentage reaches 80. The most popular causes that spread the disease are famine, malnutrition, homelessness, limited availability to medical care, alcohol abuse, drug addiction, ageing of the society and more intensive migration. Among the cases of extrapulmonary tuberculosis the most common were certified as tuberculous empyema. Head and neck tuberculosis is diagnosed rarely nowadays. Its symptoms aren't pathognomonic and natural history of the disease is different from those described in medical books. It is essential to enclose laryngeal carcinosis in differential diagnosis. In 2002 two cases of laryngeal tuberculosis were diagnosed in the Department of Otolaryngology Head and Neck Surgery of Medical University of Wroclaw. Both patients had sustained hoarseness. Biopsy confirmed the diagnose of tuberculosis. Both patients underwent the tuberculostatic treatment. Videolaryngoscopic examination showed complete withdrawal of the infiltration in the larynx.

[Prognostic significance of cyclin D1 and cyclin B expression in laryngeal squamous cell carcinomas treated with radiotherapy]. / Znaczenie prognostyczne ekspresji cykliny D1 i cykliny B u pacjentów z rakiem krtani leczonych radioterapia.

UNLABELLED: Cyclin B1 and cyclin D1 playing the role of regulatory subunits of cyclin-dependent kinases responsible for progression of cell cycle are involved in carcinogenesis of head and neck tumors. The aim of this study is to investigate their value for predicting clinical outcome after radiotherapy of laryngeal squamous cell cancer (LSCC). MATERIAL AND METHODS: The study included 50 patients with LSCC treated between the years 1998 and 2003 with radiotherapy. Tissue samples were studied immunohistochemically for detection of cyclin B1 and cyclin D1 and their expression were correlated with clinicopathological factors, local tumor control and patient survival. RESULTS: Accumulation of cyclin D1 and cyclin B1 were detected in 36% and 48% of tumors respectively. No relationship was observed between immunostaining for analyzed proteins and clinicopathologic factors. Cyclin B1 overexpression was associated with higher rate of locoregional recurrence. Five-year disease free survival rate for patients with cyclin B1 positive tumors was 73% v. 84% for cyclin B1 negative patients (p=0.005). CONCLUSION: The expression of cyclin D1 in LSCC does not seem to have a prognostic significance. Overexpression of cyclin B1 may be an indicator of the risk of locoregional recurrence in patient receiving radiotherapy. Thus cyclin B1 detected by immunohistochemistry can be useful for predicting outcome of radiotherapy in patients with LSCC.

[Relation between epidermal growth factor receptor (EGFR) and p53 expression and radiocurability of laryngeal squamous cell cancer]. / Ocena zwiazku pomiedzy ekspresja receptora dla naskórkowego czynnika wzrostu (EGFR) i bialka p53 a promieniowrazliwscia raka krtani.

UNLABELLED: Radiotherapy and surgery are the most important treatment modalities for the majority of laryngeal cancers. Because of high efficacy and better organ preservation radiotherapy is generally preferred for early and intermediate stage of the disease. Some of patients with more locally advanced cancers can still be cured by means of radiotherapy, but we have not got reliable prognostics factors for predicting radiocurability. THE AIM OF MY STUDY: was to investigate the value of p53 and EGFR expression for predicting clinical outcomes of laryngeal cancer patients treated with radiotherapy. METHODS AND MATERIALS: The study included 50 patients with laryngeal cancer treated in Department of Radiotherapy of Silesian Oncology Center between the years 1998 and 2003. Paraffin sections from archival material were studied immunohistochemically for detection p53 and EGFR and correlated with clinical parameters and local tumor control and patient survival. RESULTS: Accumulation of p53 and EGFR were detected in 65% and 50% of tumor respectively. No relationship was observed between immunostaining for investigated proteins and clinicopathologic factors. The TNM tumor stage was the most significant prognostic factor for local control and overall survival. p53 was favorable prognostic factor with 5-years disease free survival rate 82% for patients p53-positive and 75% for p53-negative patients (p = 0.04). CONCLUSION: The TNM tumor stage is the most important prognostic factor for laryngeal cancer. Tumors accumulating p53 have better prognosis what indicates possibly role for p53 immunohistochemical analysis for predicting outcomes of radiotherapy in patients with laryngeal cancer.

The evaluation of the sense of hearing in patients with carotid artery stenosis within the extracranial segments.

Stenosis of arteries that supplies blood to the brain is one of the main causes of ischemic stroke which is the third most common cause of deaths in Europe. Atherosclerosis of carotid and vertebral arteries is responsible for 20% of the ischemic stroke cases. Stenosis may be either asymptomatic or manifested with typical neurological symptoms including motor and sensory disturbances as well as disturbances in vision and speech. However, discrete non-specific symptoms of ischemia, including headaches and vertigo, tinnitus and hearing loss, are also quite common. These symptoms may be indicative of a clinically significant stenosis of carotid and vertebral arteries, particularly within the internal carotid artery region, as well as of a risk of ischemic stroke. To date, research reports were unable to provide exact explanation of correlations between impaired hearing and the stenosis of carotid and vertebral arteries. Despite this, numerous articles list these symptoms as one of the first non-specific symptoms of this disorder. The ischemic mechanism within the inner ear region may lead to early symptoms of atherosclerosis of large vessels. However, no evidence of relationship and no explanation could be provided with this regard. The objective of the study was to assess the effect of carotid and vertebral artery stenosis on the function of the hearing and equilibrium organ on the basis of diagnostic audiological examinations including pure-tone threshold audiometry, impedance audiometry, otoacoustic emission tests and brainstem auditory evoked potential tests. The study was conducted in 63 patients (32 males, 31 females) aged 45-75 years, presenting with carotid and vertebral artery stenosis and treated at the Vascular Surgery Clinic of the University Clinical Hospital in Wroclaw. Patients were stratified into two subgroups according to their age (45-60 years, 61-75 years). Patients were also divided into subgroups according to the stenotic arteries and to the symptomatic/asymptomatic status of the disorder. All patients were homogeneous in terms of the degree of artery stenosis. The control group consisted of 32 healthy persons (14 males, 18 females) aged 48-75 years. Patients qualified to the control group reported no history of middle or inner ear disorders, disturbed hearing, vertigo and balance disorders, as well as cardiovascular diseases; they also presented with unremarkable ultrasound scans of the arteries. All patients were subjected to precise audiological examinations. Prior to being qualified for the study, patients were subjected to the assessment of arteries by means of Doppler ultrasonography. The hearing organ function was assessed by means of pure-tone threshold audiometry, impedance audiometry, otoacoustic emission tests and brainstem auditory evoked potential tests. Reduction of the flow through the carotid arteries causes problems in the organ of hearing; abnormalities are reported especially in tone threshold audiometry, examinations of the stapedius muscle reflexes and brainstem auditory evoked potentials, which prove the presence of receptive cochlear-extracochlear hearing damage. Disturbances of the organ of hearing have similar severity in stenosis of the internal carotid artery and vertebral artery. Abnormalities found in audiologic examinations in patients with carotid artery stenosis are not always explicitly clinically expressed in patients with hearing loss; we should consider diagnostics for carotid artery stenosis.

The anatomical relation of the extracranial internal carotid artery in the parapharyngeal space.

BACKGROUND: The proximity of the internal carotid artery to the pharyngeal wall poses a risk of injury during nasopharyngeal surgery. OBJECTIVES: The aim of this study was to assess the distances between the extracranial internal carotid artery (ICA) and the pharyngeal wall. MATERIAL AND METHODS: Measurements were taken on certain levels of the pharynx using computed tomography angiography (angio-CT) scans of 97 patients. One-tailed Student's t-test for independent variables and a comparison of expected values for dependent pairs of observations were applied. RESULTS: The shortest distance between the ICA and the pharyngeal wall was 1.1 mm. The ICA is closer to the pharyngeal wall at the epiglottis apex level (16.46 ±0.89 mm) than to the Eustachian tube (ET) (19.8 ±0.62 mm) (p < 0.0005). In women, the ICA is closer to the ET (19.44 ±0.78 mm) than in men (20.17 ±0.96 mm) (p = 0.04). In women, the right ICA is closer to the pharyngeal wall than the left ICA at the level of the lower margin of the 2nd cervical corpus vertebra (C2) (right: 17.6 ±1.8 mm; left: 20.7 ±1.7 mm) (p = 0.002) and at the level of the epiglottis apex (right: 15.2 ±1.7 mm; left: 17.4 ±1.4 mm) (p = 0.028). The bifurcation of the common carotid artery (CCA) is higher in men (19.48 ±2.19 mm below the C2) than in women (21.82 ±1.02 mm) (p < 0.001). When the bifurcation is at the level of the epiglottis apex, the ICA is closer to the pharyngeal wall (12.3 ±1.69 mm) than in other cases (16.46 ±0.89 mm) (p = 0.005). In men, the higher the bifurcation is, the closer the ICA is to the pharyngeal wall at the level of the lower margin of the C2 (p = 0.003). CONCLUSIONS: The risk of ICA incision during surgery differs between the pharyngeal levels, genders and sides of the neck. The ICA may be much closer to the pharyngeal wall than described in the literature.

Clinicopathologic significance and prognostic role of cyclin E and cyclin A expression in laryngeal epithelial lesions.

CONCLUSIONS: The determination of cyclin A expression might be helpful in the identification of laryngeal squamous cell cancer (LSCC) patients with increased risk of metastases. The results suggest that cyclin A may be a more informative marker for cell proliferation than Ki-67. Abnormalities of cyclin E and cyclin A may play an important role in LSCC development and progression; however, the expression of cyclin E does not seem to have prognostic significance. OBJECTIVE: The aim of the study was to elucidate a possible association between cyclin E and cyclin A expression and clinicopathologic factors and their potential role as prognostic markers for patients with laryngeal epithelial lesions. MATERIALS AND METHODS: Expression of cyclins E and A, and Ki-67 was examined immunohistochemically in a formalin-fixed, paraffin-embedded series of 46 LSCC; 23 epithelial dysplasias (ED); and 21 normal mucosae (NM). RESULTS: The mean labeling indices (LIs) for cyclin E in LSCC, ED, and NM were 10.6%, 4.9%, and 0%, and for cyclin A 27.2%, 17.5%, and 7%, respectively. In LSCC, a statistically significant correlation was found between enhanced cyclin A expression and a higher incidence of locoregional lymph node metastasis (p0.01). The enhanced expression of cyclin A was linked with cell proliferation in LSCC, ED, and NM. No association was observed between cyclin E and A and other clinicopathologic parameters or applied treatments. The prognostic significance of cyclin E, cyclin A, and Ki-67 in determining overall survival time showed no statistically significant differences.

Hearing Tests Based on Biologically Calibrated Mobile Devices: Comparison With Pure-Tone Audiometry.

BACKGROUND: Hearing screening tests based on pure-tone audiometry may be conducted on mobile devices, provided that the devices are specially calibrated for the purpose. Calibration consists of determining the reference sound level and can be performed in relation to the hearing threshold of normal-hearing persons. In the case of devices provided by the manufacturer, together with bundled headphones, the reference sound level can be calculated once for all devices of the same model. OBJECTIVE: This study aimed to compare the hearing threshold measured by a mobile device that was calibrated using a model-specific, biologically determined reference sound level with the hearing threshold obtained in pure-tone audiometry. METHODS: Trial participants were recruited offline using face-to-face prompting from among Otolaryngology Clinic patients, who own Android-based mobile devices with bundled headphones. The hearing threshold was obtained on a mobile device by means of an open access app, Hearing Test, with incorporated model-specific reference sound levels. These reference sound levels were previously determined in uncontrolled conditions in relation to the hearing threshold of normal-hearing persons. An audiologist-assisted self-measurement was conducted by the participants in a sound booth, and it involved determining the lowest audible sound generated by the device within the frequency range of 250 Hz to 8 kHz. The results were compared with pure-tone audiometry. RESULTS: A total of 70 subjects, 34 men and 36 women, aged 18-71 years (mean 36, standard deviation [SD] 11) participated in the trial. The hearing threshold obtained on mobile devices was significantly different from the one determined by pure-tone audiometry with a mean difference of 2.6 dB (95% CI 2.0-3.1) and SD of 8.3 dB (95% CI 7.9-8.7). The number of differences not greater than 10 dB reached 89% (95% CI 88-91), whereas the mean absolute difference was obtained at 6.5 dB (95% CI 6.2-6.9). Sensitivity and specificity for a mobile-based screening method were calculated at 98% (95% CI 93-100.0) and 79% (95% CI 71-87), respectively. CONCLUSIONS: The method of hearing self-test carried out on mobile devices with bundled headphones demonstrates high compatibility with pure-tone audiometry, which confirms its potential application in hearing monitoring, screening tests, or epidemiological examinations on a large scale.