Serum levels of selected adipocytokines in benign and malignant parotid gland tumor patients.

OBJECTIVES: The aim of this study was to evaluate serum levels of adiponectin, leptin, visfatin and IL-6 in patients with pleomorphic adenoma, Warthin's tumor and acinic cell carcinoma of the parotid gland. MATERIALS AND METHODS: Venous blood samples were collected from 30 patients with pleomorphic adenoma, 21 patients with Warthin's tumor and 8 patients with acinic cell carcinoma. Serum adiponectin, leptin, visfatin, IL-6 and CRP concentrations were determined. RESULTS: Our results revealed significantly lower adiponectin serum levels in patients with malignant tumors compared to benign tumor individuals. Moreover, in benign cases the level was significantly higher compared to controls. Furthermore, serum leptin concentrations of benign tumor patients were higher compared to controls. Those differences, however, were observed only in males. The serum visfatin level was elevated in all tumor subjects compared to healthy individuals, whereas the serum IL-6 concentration was similar. CONCLUSIONS: We anticipate that adiponectin may play a potential protective role in salivary gland tumors. Also leptin and visfatin seem to play an important role in salivary gland tumor pathology, although in males and females leptin may act or be regulated in a different manner. The influence of visfatin on salivary gland tumors is probably independent of IL-6 production.

[Usefulness of laser arytenoidectomy and laterofixation in treatment of bilateral vocal cord paralysis]. / Przydatnosc arytenoidektomii laserowej i laterofiksacji w leczeniu obustronnego porazenia faldów glosowych.

INTRODUCTION: Bilateral vocal cord paralysis is caused by the damage of both recurrent laryngeal nerves. Such a pathology is not commonplace in the ordinary medical practice. It most often occurs as a complication after the thyroid gland surgery or thyroid re-surgery. In the case of bilateral vocal cord paralysis the treatment of the patient includes performing immediate tracheotomy or one of the surgeries aiming at widening the glottis because of dyspnea caused by the upper respiratory tract obstruction on the glottis level. AIM: The comparison of efficacy and usefulness of two surgical techniques performed to widen the glottis ­ laser arytenoidectomy with posterior cordectomy and laterofixation. MATERIAL AND METHODS: The research was carried out on the group of 57 patients suffering from bilateral vocal cord paralysis who, in the period of 1997­2009, underwent treatment in ENT Department in Zabrze Medical University of Silesia in Katowice. The first group included 36 patients who underwent laser arytenoidectomy with posterior chordectomy. The second group included 21 patients who underwent laterofixation. All of the patients treated with the laser arytenoidectomy with posterior cordectomy and laterofixation were subjected to respiratory system ventilation examinations before the procedure of widening the glottis and after the healing, at least 4 months after the surgery. Making self-evaluation, each of the patients answered a question concerning the improvement of their breathing comfort after the surgery. The patients from both groups underwent the vocal apparatus examination which included: subjective perceptive voice analysis according to GRBAS scale, videolaryngostroboscopy, evaluation of the maximum phonation time, self-evaluation survey of the post-surgical voice quality. RESULTS: Among 57 patients suffering from bilateral vocal cord paralysis and operated by arytenoidectomy with posterior cordectomy (group I) and laterofixation (group II), a subjective improvement of the comfort of living was achieved which resulted in the possibility of making more physical activities. From the first group, 35 out of 36 patients were decannulated. In the second group, both patients who had previously undergone tracheotomy were successfully decannulated. There were no statistically significant differences in the increase of selected ventilation markers between the patients who underwent laser arytenoidectomy and those who underwent laterofixation. There were no substantial discrepancies in the perceptive voice analysis in GRBAS scale between the patients after laser arytenoidectomy and those treated with the technique of laterofixation. When asked about their post-surgical voice quality, the patients of the first and the second group rated their voice as worse than before the surgery. CONCLUSION: Both surgical techniques, laser arytenoidectomy with posterior cordectomy and laterofixation, are efficient and useful in widening the glottis in the case of bilateral vocal cord paralysis. The improvement of the ventilation markers allows the growth in the comfort of living, restoration of the physiological respiratory tract and decannulation of the patients who had undergone tracheotomy. The deterioration of the voice quality is characteristic of both surgical techniques.

[The quality of voice in coal-miners after burn/inhalation injury due to methane explosion]. / Jakosc glosu u górników po urazie inhalacyjnym górnych dróg oddechowych w wyniku wybuchu metanu.

The job as a coal-miner exposes to the greatest risk. One of the most dangerous health hazard is a burn/inhalation injury during the methane explosion. The victims undergo physical trauma, effect of high temperature and inhalation of toxic gases and products of incomplete combustion, As a result of inhalation injury both, upper and lower airways are affected. The aim of the study was to analyse the relationship between burn/inhalation injury and quality of voice in affected coal-miners. A group of 23 patients (men) in age from 28 to 59 (mean 38.5) 3 years after burn/inhalation injury participated in this study. The voice evaluation based on ENT examination, videlaryngostroboscopy, acoustic analysis, MPT parameter and GRBAS analysis was performed. The special control group of coal-miners served as a control. On the basis of the subjective evaluation and the objective acoustic analysis, aerodynamic parameter and videlaryngostroboscopy the worse quality of voice in the group of injured coalminers was shown in comparison to the control group. No substantial correlation between the acoustic parameters, MPT parameter and ventilating rates was found.

Analysis of the Effectiveness of Arytenoidectomy and Posterior Cordectomy with the Use of CFD Airflow Measurements in Patients with BVFP: A Retrospective Study.

Purpose: Bilateral vocal fold paralysis (BVFP) is a rare larynx disease manifested by dyspnea, which often requires surgical treatment. The aim of the study is to determine the effectiveness of unilateral arytenoidectomy with posterior cordectomy in the treatment of BVFP using the computational fluid dynamics (CFD) method. Methods: This study included 33 patients with BVFP who underwent unilateral laser arytenoidectomy with posterior cordectomy. Glottis area measurements and spirometry, as well as a self-assessment of respiratory efficiency were performed before the surgery and after the recovery period. Using the CFD method, computer models of the glottis were made. Then, changes in air pressure gradient and maximum air velocity at the level of glottis were calculated, and local fields of pressure and air velocities were obtained. Results: The values of glottal surface area (S), spirometry parameters (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF)), inlet air velocity at the glottal level as well as patients self-assessment of respiratory efficiency turned out to be significantly higher after the operation. The values of maximum velocity at the glottal level, pressure gradient at the glottal level turned out to be significantly lower after the surgery. We observed that the greater the increase in glottal surface area, the greater the decrease in self-assessment scales (visual analogue scale (VAS) and Medical Research Council (MRC)). Increased levels of spirometry parameters after the surgery correlated with smaller decrease of PEF-dependent pressure gradient at the glottal level (PEFΔP CFD). Conclusion: Unilateral laser arytenoidectomy with posterior cordectomy is an effective method for the treatment of BVFP. CFD is a useful tool to determine and visualize the effectiveness of surgical treatment in BVFP.

[Efferent suppression test--sensitivity and specificity]. / Test eferentny slimaka--czulosc i swoistosc metody.

INTRODUCTION: The amplitude of click evoked otoacoustic emissions can be suppressed (reduced) with contralateral acoustic stimulation (CAS). This is thought to be due to the inhibitory control that the medial efferent auditory nerve exerts on outer hair cell function. One commonly used test of medial olivocochlear (MOC) function in humans involves measuring the degree of suppression of ipsilateral otoacoustic emissions (OAEs) by CAS. This effect is called contralateral suppression, efferent effect or olivocochlear reflex. Aim of the study. The objective of this study was to measure cut-off level of contralateral suppression, sensitivity and specificity of the efferent test. MATERIAL AND METHODS: To evaluate the function of MOC system click evoked otoacoustic emissions (CEOAEs) with and without continuous contralateral broadband noise (BBN) stimulation were recorded in 14 patients with multiple sclerosis, 16 patients with unilateral cerebello-pontine angle tumor and control group matched for age and gender. BBN was presented at 50 dB SL and otoacoustic emissions were recorded in response to nonlinear clicks at 70 +/- 3 dB SPL. RESULTS: The cut-off level was established at -1.4 dB. For 1.4 dB cut-off level of contralateral suppression the sensitivity of the efferent test was 90% and specificity was 70%. CONCLUSIONS: To conclude, assessment of efferent suppression may be a useful addition to the battery test employed in the investigation of multiple sclerosis and cerebello-pontine angle tumors. The MOC suppression test may provide a tool for an early diagnosis of the brainstem pathology.

[The influence of aging on otoacoustic emissions in normally hearing subjects]. / Wplyw wieku na poziom emisji otoakustycznych u osób z prawidlowym sluchem.

INTRODUCTION: The objective of this study was to measure age-related changes of otoacoustic emissions level in subjects with normal hearing in tonal audiometry. MATERIAL AND METHODS: Click evoked otoacoustic emissions (CEOAEs) and distortion-product otoacoustic emissions (DPOAEs) were recorded in 146 (n = 292 ears) subjects. Otoacoustic emissions were recorded in response to nonlinear clicks and two different primary tones (L1 = 65, L2 = 55 dB SPL; f2/f1 = 1.22) from 1 to 5 kHz. Subjects were divided into three age groups: young (19.8 +/- 4.6 years), middle-age (31.2 +/- 4.3 years) and old (48.2 +/- 5.9 years). All subjects had normal hearing and middle-ear function based upon standard audiometric criteria. RESULTS: The principal findings were that CEOAEs and DPOAEs levels were smaller in the old group compared to the young and middle-aged groups, especially at the higher frequencies. CONCLUSION: The influence of age on the level of otoacoustic emissions was found.

[The influence of gender on otoacoustic emissions in normally hearing subjects]. / Wplyw plci na poziom emisji otoakustycznych u osób z prawidlowym sluchem.

INTRODUCTION: The objective of this study was to measure gender-related changes of otoacoustic emissions level in subjects with normal hearing in tonal audiometry. MATERIAL AND METHODS: Click evoked otoacoustic emissions (CEOAEs) and distortion-product otoacoustic emissions (DPOAEs) were recorded in 146 (n = 292 ears) subjects. Otoacoustic emissions were recorded in response to nonlinear clicks and two different primary tones (L1 = 65, L2 = 55 dB SPL; f2/f1 = 1.22) from 1 to 5 kHz. Subjects were divided into two groups: female (29.4 +/- 12.2 years) and male (27.5 +/- 10.1 years). All subjects had normal hearing and middle-ear function based upon standard audiometric criteria. RESULTS: The principal findings were that CEOAEs and DPOAEs levels were smaller in the male group compared to the female group, especially at the higher frequencies of DPOAEs. CONCLUSION: The influence of gender on the level of otoacoustic emissions was found.

[Surgical treatment of patients suffering from allergic chronic sinusitis with nasal polyps]. / Leczenie operacyjne chorych z przewleklym alergicznym zapaleniem zatok przynosowych z polipami nosa.

INTRODUCTION: Chronic sinusitis with nasal polyps is very often associated with allergy. The results of surgical treatment (Functional Endoscopic Sinus Surgery--FESS) in this group of patients are different and rather poor, especially in long term observations. THE AIM: of our study was to evaluate the results of surgical treatment (FESS) in patients suffering from chronic sinusitis with nasal polyps associated with allergy. MATERIAL AND METHODS: We study the group of 33 patients with allergy-related polypoid lesions in the nasal cavity and paranasal sinuses. The patients with allergy-related disorder were previously under the control of allergologists and pulmonologists. All the patients underwent functional endoscopic sinus surgery. The patients were evaluated in postoperative period 4-6 years after the surgical treatment. The effectiveness of FESS was assessed on the basis of the nasal cavity endoscopic state and amelioration of symptoms. RESULTS: The most frequent symptoms were postnasal drip and breathing disturbance through the nose. In 37.5% of patients the recurrence of symptoms was observed in the 4-6 years follow-up period. When we assessed aspirin intolerance syndrome patients this ratio increased to 64.7%. CONCLUSION: In the allergy-related patients high rate of recurrence after the FESS treatment is stated in the long term observations.

[Functional results after the treatment of laryngeal stenosis]. / Wyniki czynnosciowe po leczeniu zmian zwezajacych swiatlo krtani.

UNLABELLED: Six subjects before and after surgery because of the laryngeal stenosis were presented. In 3 cases laryngeal web was recognised which arises after endoscopical removal of infant papilloma. The scar after laser chordectomy due to carcinoma of the larynx occurred in remaining 3 patients. All presented patients simultaneously were undergoing removal of the lesion endoscopically and insertion of silastic separator. AIM: Respiratory and phonatory function assessment in patients who were operated because of the laryngeal stenosis was the aim of this study. METHODS: Treatment effectiveness was estimate on the basis of pre- and postoperative spirometry with flow--volume loop and postoperative phoniatric examination. Ventilatory function was analysis on the basis of the following parameters: PIF, FEV1, FIV1, PEF, FVC. Phoniatric examination was performed after 2 months of outpatient observation and rehabilitation. It consisted of subjective voice assessment using GRBAS scale, videolaryngostroboscopy and assessment of the phonation time. RESULTS: Some of the analysed parameters especially in patients with posterior stenosis were significantly better after surgery. Phoniatric rehabilitation after surgery caused improvement of voice quality and phonatory function of the larynx. CONCLUSION: Thanks to insertion of silastic separator good phoniatric function and ventilation efficiency are possible.

[Strategy of the sinonasal tumors treatment]. / Strategia leczenia guzów masywu szczekowo-sitowego.

INTRODUCTION: The sinonasal tumors belong to rare diseases. They state 0.2-0.8% of all the malignant neoplasms and about 3% of head and neck tumors. These tumors are two times frequent observed in men than in women, mainly between 50 and 70 years old. In the sinonasal complex besides the primary are seen also the metastatic tumors. They state about 1% of all tumors (kidney, testum, breast, pulmonary). AIM: The aim of our study was to retrospective analysis of the sinonasal tumors, treated in the ENT Department Silesian Medical University in Zabrze. The special attention was carried on the preoperative diagnostics and proper qualification to the surgical treatment. MATERIAL AND METHODS: 26 patients treated in the ENT Department Silesian Medical University in Zabrze between 2000 and 2006 suffered from the sinonasal tumors were retrospectively analyzed. RESULTS: In the histological examination in 4 patients the benign neoplasm and in 22 patients malignant tumors were diagnosed. 24 patients were surgically treated (2 patients were not qualify to surgery because of the general diseases). On the basis of the CT and MRI examination as well as the description of the surgical procedure we stated that in 13 cases the primary localization of neoplasm was the maxillary sinus, in 5 cases ethmoidal cells, in 3 nasal cavity. In one patient the estimation of primary tumor localization was not possible, because of the very large extension of the neoplasm. The choice of the surgical procedure was depend on the tumor extension and localization. In 19 cases lateral rhinotomy with different modifications was performed. In one case the cranial incision was done. In 8 patients with the infiltration of lateral nasal wall the medial maxillectomy were performed. In 8 other patients upper maxillary resection were done. In two cases the total maxillectomy were performed, in the next two lower maxillary resection. All the patients were postoperatively treated by radiotherapy.

[Surgical treatment of chronic sinusitis in children]. / Leczenie chirurgiczne przewleklego zapalenia zatok przynosowych u dzieci.

INTRODUCTION: Chronic sinusitis presents important problem in children. General approach in chronic sinusitis in children consists of: findings the proper diagnosis, optimal pharmacotherapy (oral or intravenous antibiotics), treatment coexisting allergic or systemic diseases and considering employing surgical treatment. The main surgical procedures in the treatment of chronic sinusitis in children are adenoidectomy and functional endoscopic sinus surgery (FESS). MATERIAL AND METHODS: 32 children with chronic sinusitis treated in ENT Department Silesian Medical University in Zabrze in the years 2000-2005 were presented in this study. 26 patients were treated surgically and 6 children by pharmacotherapy. In the surgically treated patients we performed 10 Functional Endoscopic Sinus Surgery, 4 unilateral and 8 bilateral sinusoscopy of maxillary sinus, and in 4 cases we removed choanal polyps. RESULTS: In the group of 26 surgically treated children we did not observed the recurrence of symptoms in the 24 months follow-up period.

[Study of selected biomaterials for reconstruction of septal nasal perforation]. / Ocena wybranych biomaterialów do rekonstrukcji perforacji przegrody nosa.

INTRODUCTION: The septal nasal perforation is an important problem for the laryngologists and plastic surgeons. The reasons of septal nasal perforations are injuries, neoplasm, self-mutilation, chronic rhinitis, allergy, Wegener granuloma, sarcoidosis, tuberculosis, toxic metals (arsenic, chrome), some drugs (steroids), narcotizing agents (cocaine) and complications after endoscopic and septal nasal operations. The surgical treatment, especially in the cases of large septal perforation, is often difficult because of the atrophy of nasal mucosa and lack of suitable material for reconstruction. In the surgical treatment many of methods and reconstructive materials have been used. The following autogenous tissues were used in the reconstruction of septal perforation: alloderm, temporal fascia, septal and auricle cartilage, cranial periosteum, perichondrium, ethmoidal and hip bone. The defect of such materials is progressive resorption. For many years the suitable synthetic material for septal nasal reconstruction has been searched for. Among the biomaterials the following have been used without success: Dacron, porous polyethylene, dolomite, bioglass. The rejection of synthetic material was the reason of failure. The aim of our study was to evaluate two different biomaterials with proper mechanical and biological features for nasal cartilage replacement. MATERIAL AND METHODS: We studied two types of biomaterials: biostable terpolymer PTFE/PVDF/PP and resorbable copolymer of glycolide and L-lactide (PGLA). The pilot studies were performed on two experimental animals (rabbits). The animals were operated in the general anesthesia. The biomaterials were implanted in the rabbit auricular cartilage because of its similarity to the septum and easy surgical access. Subperichondrically 1 x 1 cm fragment of the cartilage was removed. This fragment was then replaced with the biomaterial. The rabbits were painlessly sacrificed after 4 months of observation. RESULTS: A very good integration of PGLA implant with auricular cartilage was observed. In the histological examination the lack of excessive inflammatory reaction as well as no cartilage necrosis were observed. CONCLUSIONS: 4 months after implantation of PGLA in the rabbit auricular cartilage very good macroscopic and histological results were achieved.

Computational fluid dynamics in the assessment of patients' postoperative status after glottis-widening surgery.

BACKGROUND: Computational fluid dynamics (CFD), a rapidly developing instrument with a number of practical applications, allows calculation and visualization of the changing parameters of airflow in the upper respiratory tract. OBJECTIVES: The aim of this study was to demonstrate the advantages of CFD as an instrument for noninvasive tests of the larynx in patients who had undergone surgical treatment due to bilateral vocal fold paralysis. MATERIAL AND METHODS: Surface measurements of the glottic space were made during maximum adduction of the vocal folds. Additionally, the following spirometric parameters were determined: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and peak expiratory flow (PEF) rate. Based on the measurements, commercial mesh generation software was used to develop a geometrical model of the glottic space. The computations were carried out using a general purpose CFD code. The analysis included patients who were surgically treated for BVFP in the authors' department between 1999 and 2012. The study group consisted of 22 women (91.67%) and 2 men (8.33%). RESULTS: It was observed that the pressure drop calculated for free breathing depends on the area of the glottis and is independent of its shape. Importantly, for areas below approx. 40 mm2, a sudden rise occurred in the resistance to flow; for the smallest glottic areas studied, the pressure drop was almost 6 times higher than for an area of 40 mm2. Consequently, in cases of areas below 40 mm2 even minor enlargement of the glottic opening can lead to a marked improvement in breathing comfort. CONCLUSIONS: Computational fluid dynamics is a useful method for calculating and visualizing the changing parameters of airflow in the upper respiratory tract.

[Perceptual method and videostroboscopy in patients with vocal fold hypertrophy underwent microsurgery]. / Zastosowanie metody percepcyjnej i wideostroboskopii w przewleklych stanach przerostowych krtani leczonych chirurgicznie.

INTRODUCTION: Chronic hypertrophic laryngitis concerns many people in our population. Their etiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. Organic voice disorders of the larynx, particularly concerning vocal folds are the cause of dysphonia. Both surgical and conservative methods in the treatment of patients with laryngeal hypertrophy are applied. Objective assessment of the voice improvement after microsurgery is the subject of discussion of many authors. The problem of voice improvement is rarely approached to in the comprehensive way, that is with reference to activity and anatomy of the larynx. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of subjective and videostroboscopic voice analysis. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. MATERIAL AND METHOD: The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Voice quality examinations were done just before microsurgery and 3 months after the operation. On the basis of histopathological results, following diagnosis were established: vocal fold polyps (oedematosus, teleangiectaticus and inflammatorius), oedema Reincke, laryngeal papilloma, laryngeal granuloma and cyst. The research methodology included: perceptual voice examination based on GRBAS scale (G--grade; R--roughness; B--breathiness; A--asthenicity; S--strain) and assessment of vibrations of vocal folds in videostroboscopy. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. RESULTS: In both groups (with minor and extensive vocal fold lesions) significant improvement in perceptual and videostroboscopic voice parameters was observed. The results in the group with minor vocal fold lesions were better after microsurgery. CONCLUSIONS: The methodology based on the application of the two methods of voice examination could be an objective rate in the estimation of the treatment progress.

Gender-related voice problems in transsexuals - therapeutical demands.

The paper presents a case study of a transsexual patient who underwent a voice pitch elevation surgery performed in Poland for the first time. The human voice is a reflection of the working of hormones and human psyche. This fact is of particular importance in transsexualism, a disorder consisting in incongruence between the individual's biological sex and their identified gender. For many transsexual people, especially of the MTF (male to female) type, who have undergone hormonal and surgical sex change, the voice still presents a major problem, causing difficulties in everyday life. Hormonal treatment does not influence feminisation of the larynx. In the described MTF case, the patient's low androphonic voice was perceived as a male voice. In order to feminise the patient's voice a phonosurgical procedure was performed: the length of the vibrating portion of the vocal folds was shortened by over 50% of their total length by means of suturing of the anterior part of the vocal fold. As a result of the surgical treatment the pitch of voice was raised considerably, with F0 of spoken voice increased from 109 Hz to 209 Hz. The voice range also changed towards female tones, from 59-146 Hz to 148-343 Hz. Pitch elevation positively influenced the patient's subjective voice assessment: total score of the Voice Handicap Index (VHI) improved from 99 to 19 points, and the score of its emotional sub-scale: 39 and 2 points, respectively. The described case of a surgical male-to-female voice change presents one of the dilemmas faced by modern medicine. (Endokrynol Pol 2016; 67 (4): 452-455).

[Videostroboscopy assessment in patients with vocal fold hypertrophy underwent microsurgery]. / Ocena wideostraboskopowa w przewleklych stanach przerostowych krtani leczonych chirurgicznie.

Chronic hypertrophic laryngitis concerns many people in our population. Their aetiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of videostroboscopy examination. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Videostroboscopy examination was done just before microsurgery and 3 months after operation. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The first group consist of patients with minor vocal fold lesions (limited to I of vocal fold length), the second group consist of patients with extensive vocal fold lesions (above I of vocal fold length). The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. In both groups (with minor and extensive vocal fold lesions) significant improvement in videostroboscopy parameters was observed. The functional results in the group with minor vocal fold lesions were better after microsurgery, but it turned out that results were not statistically significant.

[Treatment of otosclerosis in children]. / Leczenie otosklerozy u dzieci.

Between 1994 and 2004 in the ENT Department Silesian Medical University Zabrze 330 stapedotomy were performed in patients suffered from otosclerosis. In this group of patient's 16 stapedotomies in 13 children aged from 9 to 17 years were performed. 4.85% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedotomies in children. The postoperative evaluations were performed in the period from 6 months to 8 years after the surgical treatment. In the hearing state evaluation we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedotomy was successful (postoperative air bone gap within 10 dB) in 62.5% of the cases. In 5 cases the air bone gap was lower than 20 dB (31.25%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 4.39 dB level. The results were comparable with the other authors. Stapedotomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

[Sialolithiasis of the parotid gland--case report]. / Kamica slinianki przyusznej (opis przypadku).

In this study the very rare case of a parotid gland sialolithiasis was presented. The authors described opinions concerned with symptomatology, localization, diagnostics and methods of treatment in parotid sialolithiasis. The 12 months follow-up period was free of symptoms.

[The case of extensive fungal sinusitis in a 72 years old man]. / Przypadek rozleglej grzybicy zatok przynosowych u 72-letniego mezczyzny.

The case of extensive, invasive fungal sinusitis in 72 years old man was presented in this paper. The surgical treatment was performed in this patient--rightsided maxillectomy with orbitotomy. Results of histological and mycological examinations of postoperative material shoved evidence of Aspergillus Fumigatus. The additional pharmacotherapy with Amphotericin B and Orungal was attached. Despite of such aggressive treatment patient died 9 months after the last operation.

[Evaluation of ventilation parameters based on flow volume loop in patients with unilateral vocal cord paralysis]. / Ocena parametrów wentylacyjnych na podstawie krzywej przeplyw-objetosc u chorych z jednostronnym porazeniem struny glosowej.

The vocal cord paralysis as a multidisciplinary problem requires commitment of different medical specialities. The diagnostic difficulties and necessity of laryngoscopic evaluation in cases suspected of vocal cord paralysis were pointed out. The analysis of ventilation parameters (flow-volume loop) was presented. The significant usefulness of inspiratory parameters, especially in upper airway obstruction was emphasized. The most useful parameters and coefficients were shown. Based on another authors data the criteria of airway obstruction classification were presented. The flow volume loop was found as a uniquely suited to the examination of upper airway obstruction. According to this examinations the unilateral vocal cord paralysis was defined as a variable extrathoracic obstruction which does not influence ventilation significantly.