Facial nerve paresis in the course of masked mastoiditis as a revelator of GPA.

PURPOSE: The aim of this study was to present a series of 6 patients with facial nerve palsy and masked mastoiditis which constituted as revelators of localized granulomatosis with polyangiitis (GPA) and to evaluate the utility of the ACR/EULAR 2017 provisional classification criteria for GPA in such cases. METHODS: Study group included 58 patients with GPA. Cases with facial nerve palsy and masked mastoiditis were thoroughly analyzed. RESULTS: The mean age of patients was 37 years. All manifested unilateral facial nerve palsy and hearing loss, while only 2 reported aural complaints suggesting inflammatory cause of the disease. All cases were qualified for surgical intervention. Intraoperative findings were similar: granulation tissue in tympanic cavity and/or pneumatic spaces of the mastoid process. Only 50% of histopathological results suggested vasculitis. In all cases, elevated levels of antineutrophil cytoplasmic antibodies (ANCA) against peroxidase 3 (PR3-ANCA) were determined. Two patients presented rapid progression of the disease and died within 1 week and 2 months, respectively. Four other patients manifested gradual improvement of hearing and facial nerve function after treatment. CONCLUSION: GPA should be included into differential diagnosis in all cases of persistent facial nerve palsy especially when otological symptoms coexist. Even localized GPA could be very aggressive, revelating generalized form of the disease. Rapid systemic treatment of GPA can protect hearing and facial nerve from permanent severe dysfunction. The ACR/EULAR 2017 provisional classification criteria for GPA seem to be valuable tool in diagnosing ENT patients with localized otological form of the disease.

Is Facial Nerve Decompression Justified in Malignant External Otitis? Literature Review and Own Experience.

OBJECTIVE: The aim of the study was to present the indications for facial nerve decompression in malignant external otitis, to analyze the results of such treatment, and to describe own experience in that field. METHODS: A search in the PubMed and Google Scholar databases for English language articles published between 1968 and May 2022 was performed. We focused on papers describing patients with malignant external otitis and facial nerve palsy treated by decompression. Moreover, retrospective analysis of 24 consecutive patients with malignant external otitis hospitalized in our department in the past 10 years was performed. RESULTS: In the literature, 48 cases with malignant external otitis and facial nerve paresis treated by decompression were identified. In total, 41 patients recovered (85.42%), 4 died (1 due to exacerbation of the disease, 2 for pneumonia, and 1 for heart failure), and in 3 cases the final outcome was not presented. In most cases (24; 50%), facial nerve function did not improve after decompression, in 8 patients (16.67%) partial recovery was observed, in 11 cases (22.92%) full improvement was observed, and data were not given for 5 patients. In only one case, the spread of infection and deterioration of local and general patient states were noted. In our material, we identified 13 patients with malignant external otitis and facial nerve palsy. Two of them were treated surgically, of which only one had facial nerve decompression. Partial improvement of facial nerve function was observed after 6 months of rehabilitation. CONCLUSION: The management of malignant external otitis is still difficult and not well defined. Facial nerve decompression seems justified in selected cases of malignant external otitis not responding to conservative treatment.

Irreversible facial nerve palsy as a revelator ofparotid gland cancer.

<br><b>Introduction:</b> Bell's palsy is still the diagnosis of exclusion. In most patients it does not progress, it is unilateral, and selflimiting. Additionally, the majority of patients recover spontaneously within 3 weeks. It is well known that all patients with irreversible facial nerve paresis (FNP) need further examinations to exclude the organic, infectious, metabolic, and autoimmunological causes of the palsy. The goal of the study was to assess the frequency of malignancies hidden under the diagnosis of "Bell's palsy".</br> <br><b>Aim:</b> We aimed to create a diagnostic algorithm to avoid failures concerning patients whose only symptom of parotid gland cancer was irreversible FNP.</br> <br><b>Material and methods:</b> We analyzed 253 consecutive patients with FNP treated in our department in the last 5 years. The subject of the study was "Bell's palsy" cases. All patients with irreversible FNP were reassessed in 6-12 months. We underlined all shortcomings in the diagnostics of those in whom malignancies were found in MRI of the neck and presented the proposal for a diagnostic algorithm to avoid missing such an entity.</br> <br><b>Results:</b> Bell's palsy was observed in 157/253 patients (62.06%), in 36/157 (22.92%) it remained permanent. In 4/36 patients (11.11%) with irreversible FNP, which constituted 2.54% of all "Bell's palsy" cases, parotid gland deep lobe mass was found in MRI. In one patient, infiltration of the skull base was diagnosed. Adenoid cystic carcinoma was confirmed in final histopathology in all cases.</br> <br><b>Conclusions:</b> Our experience has shown that irreversible FNP can be a revelator of the malignant tumor located in the deep lobe of the parotid gland. Contrast-enhanced MRI covering intra- and extracranial segments of the facial nerve should be ordered in all cases of FNP without recovery after 4 months. Repeated imaging should be considered in undiagnosed cases. The main point of our study is to underline that the assessment of the deep lobe of the parotid gland with MRI should be included in the standard diagnostic protocol in all irreversible "Bell's palsy" cases.</br>.

The Baha® Attract System Implantations Significantly Improve the Quality of Life of Hearing-Impaired Patients in Long-Term Observations.

BACKGROUND: The aim of this study was to assess the impact of the Baha® Attract system implantation on the quality of life of hearing-impaired patients, who were qualified for surgery due to various audiological indications. METHODS: A total of 96 patients implanted with the Baha® Attract system were asked to fill in the set of questionnaires: the Glasgow Benefit Inventory, the Abbreviated Profile of Hearing-Aid Benefit, and the BAHA Aesthetic, Hygiene, and Use. Totally 79 patients responded and were then analyzed. Patients were divided into 4 groups: A: with bilateral mixed or conductive hearing loss, B: with single-sided deafness, C: with unilateral mixed or conductive hearing loss, and D: others. RESULTS: There was a significant improvement in quality of life measured by the Glasgow Benefit Inventory in all the analyzed groups, with a mean total score of 29.4 points (P < .001). Similarly, the evaluation by the Abbreviated Profile of Hearing Aid Benefit questionnaire showed a significant improvement in terms of the global score in all the analyzed groups, with a mean gain of 38.6% (P < .001). There were no differences between the groups. More than 90% of patients found the Baha® Attract system easy to place on their heads and maintain good hygiene. Of all the implant users, 81% were satisfied with the final aesthetic effect. CONCLUSION: The implantation of the Baha® Attract system significantly improves the quality of life of hearing-impaired patients in all subjec- tive scales used. The system is effective for all audiological indications when strictly adhered to. The majority of patients are very satisfied with the aesthetic, hygienic, and utility aspects of the device.

The evaluation of a surgery and the short-term benefits of a new active bone conduction hearing implant - the Osia®.

INTRODUCTION: Modern medicine offers a wide spectrum of different hearing devices, and bone conduction implants can be found among them. OBJECTIVE: The presentation of the outcomes of the implantation of a new active bone conduction hearing implant - the Osia®, and its comparison with the well-known passive transcutaneous system - the Baha® Attract. METHODS: Eight adult patients with bilateral mixed hearing loss were randomly divided into two groups. Group 1 was implanted with the Osia®, and group 2 was implanted with the Baha® Attract. The details of the surgery were analyzed, along with the functional and audiological results. RESULTS: In all the cases, the surgery was successful, and the healing uneventful. In both groups, it was observed that pure tone audiometry and speech audiometry in free field improved significantly after the implantation (mean gain in pure tone audiometry for the Osia group 42.8 dB SPL and for the Baha group 38.8 dB SPL). In the Osia group, the results after the surgery were much better than with the Baha® 5 Power processor on the Softband. The patients implanted with the Osia® evaluated the quality of their hearing as being superior to those implanted with the Baha® Attract. There was an evident improvement in the abbreviated profile of hearing aid benefit questionnaire and in the speech, spatial and qualities of hearing scale for both systems. In the abbreviated profile of hearing aid benefit, changes were more evident in the Osia group (in global score 49% vs. 37.2%). CONCLUSION: Implantation of the Osia® is an effective treatment option for the patients with bilateral mixed hearing loss. The surgery is safe but more complex and time-consuming than the Baha® Attract implantation. The preliminary audiological results as well as the overall quality of life indicate that the Osia® is a better solution than the Baha® Attract. However, future studies should be carried out to make further observations in a larger group of patients, and with longer follow-up.

Efficacy of surgical treatment in patients with post-traumatic facial nerve palsy.

INTRODUCTION: The most common mechanism of post-traumatic facial nerve palsy are road accidents and falls. Treatment schemes as well as proper timing of surgery are still controversial. <br/><br/>Aim: The aim of the study was the evaluation of the effects of surgical treatment in patients with post-traumatic facial nerve palsy. Treatment results were correlated with epidemiological factors, mechanism of injury, level of nerve damage, time of surgery and its extent. <br/><br/>Material and methods: 9 patients with facial nerve palsy after head trauma were analyzed. In all patients complete paresis of the VII nerve occurred immediately after the injury. In 5 patients the nerve was damaged in the course of the longitudinal fracture of the temporal bone, in 3 as a result of its transverse fracture while in one woman there was no evident fracture line. In all cases, surgical treatment was performed between 4 days and 13 weeks after the trauma. In all cases transmastoid approach was used. Edema lesions of the nerve dominated in 6 patients, in two cases a bone fragment was noted along its course, in one person nerve was disrupted but primary reconstruction was not possible - the man was excluded from further analysis. The results of treatment were assessed by House-Brackmann (HB) scale 12 months after the procedure. <br/><br/>Results: Very good (HBI) or good (HBII) recovery of facial nerve function was achieved in 2 and 4 out of 8 patients respectively. Surgical timing, the extent of surgery, patient's age, mechanism of injury and level of nerve damage had no effect on the final outcome. <br/><br/>Conclusions: The management of post-traumatic facial nerve palsy should be individual. The commonly accepted recommendation on surgical treatment is to undertake it in patients with immediate-onset and complete paralysis. Patients who, due to their severe general condition, cannot undergo early facial nerve decompression may benefit from delayed treatment for up to 3 months after the injury.

Piezoelectric bone conduction hearing implant Osia® - audiological and quality of life benefits.

<b>Introduction:</b> Nowadays, there are many options to treat hearing-impaired patients: tympanoplastic surgery, hearing aids and a wide range of implantable devices.</br></br> <b>Aim:</b> The aim of this study is to present the mid-term audiological and quality of life benefits after the implantation of Osia®, an active piezoelectric bone conduction hearing implant. </br></br> <b>Material and methods:</b> The state of the tissues in the implanted area, as well as audiological and quality of life results were analyzed at six, nine and twelve months after implantation in a group of four adult patients with bilateral mixed hearing loss (1 after bilateral canal-wall-down mastoidectomy, 2 with chronic simple otitis media and after myringoplasty in the opposite ear, 1 with bilateral otosclerosis and after stapedotomy in the opposite ear). </br></br> <b>Results:</b> No postoperative complications were found in any of the cases. One year after surgery the mean audiological gain in FF PTA4 (pure tone average for 0.5, 1, 2, and 4 kHz) was 52.2 ± 3.5 dB in comparison to the unaided situation, the mean speech understanding with Osia® in quiet was 90 ± 8.2% for 50 dB SPL, 98.8 ± 2.5% for 65 dB SPL and 100 ± 0% for 80 dB SPL, and the mean speech understanding with Osia® in noise was 37.5% ± 23.6 for 50 dB SPL, 93.8 ± 4.8% for 65 dB SPL and 98.8 ± 2.5% for 80 dB SPL. There was also an evident improvement in the quality of hearing as well as in the quality of life, measured by APHAB (Abbreviated Profile of Hearing Aid Benefit) and SSQ (Speech, Spatial and Qualities of Hearing Scale). </br></br> <b>Conclusions:</b> The Osia® is an effective treatment option for patients with bilateral mixed hearing loss. The mid-term audiological and quality of life results are excellent, but further observations including bigger groups of patients and a longer follow- -up are required.

Assessing Various Control Samples for Microarray Gene Expression Profiling of Laryngeal Squamous Cell Carcinoma.

Selection of optimal control samples is crucial in expression profiling tumor samples. To address this issue, we performed microarray expression profiling of control samples routinely used in head and neck squamous cell carcinoma studies: human bronchial and tracheal epithelial cells, squamous cells obtained by laser uvulopalatoplasty and tumor surgical margins. We compared the results using multidimensional scaling and hierarchical clustering versus tumor samples and laryngeal squamous cell carcinoma cell lines. A general observation from our study is that the analyzed cohorts separated according to two dominant factors: "malignancy", which separated controls from malignant samples and "cell culture-microenvironment" which reflected the differences between cultured and non-cultured samples. In conclusion, we advocate the use of cultured epithelial cells as controls for gene expression profiling of cancer cell lines. In contrast, comparisons of gene expression profiles of cancer cell lines versus surgical margin controls should be treated with caution, whereas fresh frozen surgical margins seem to be appropriate for gene expression profiling of tumor samples.

The bioactivity of plasma factors in focal segmental glomerulosclerosis.

Focal segmental glomerulosclerosis (FSGS) is a devastating form of nephrotic syndrome, often leading to end-stage renal failure after the failure of a succession of highly toxic therapies. It has long been thought to be caused by a circulating factor(s) that may be produced by cells of the immune system. Much research has focused on identifying such factor(s), including the development of a promising in vitro assay, which estimates glomerular permeability based on the swelling of isolated glomeruli in response to patients' plasma. This assay has also been used as the basis of testing plasma fractions for permeability activity, with no specific factor yet identified. Other studies have attempted to replicate proteinuria in whole animals, by injecting plasma or plasma fractions from focal segmental glomerulosclerosis patients, with inconsistent results. More recently there has been evidence that there may be either inhibitory or missing factor(s) in plasma, with respect to permeability. An additional major biological advance is a growing appreciation of the podocyte as the target cell in this disease, and an understanding of the key molecules involved. Putting together this knowledge, with the latest technological advances in protein identification, provides promising avenues towards finally solving the basis of this enigmatic disease.