[Isolated inverted papilloma of the sphenoid sinus - case report]. / Izolowany brodawczak odwrócony zatoki klinowej - opis przypadku.

BACKGROUND: Primary inverted papilloma of the sphenoid sinus is rare. The tumor is considered locally aggressive. In selected cases inverted papilloma can be associated with squamous cell carcinoma. Radiologic imaging is a key to an accurate diagnosis. AIM: We analyzed patient with inverted papilloma in sphenoid sinus which was removed with endoscopic surgery. MATERIAL AND METHODS: We discuss patient with isolated inverted papilloma located in the sphenoid sinus. RESULTS: Performed endoscopic treatment enabled removal of tumour with no complications. CONCLUSIONS: Transnasal endoscopic large sphenoidotomy remains an effective modality for management of patients with inverted papilloma. This method does not require external approach and it is performed with no scars, with minimal injury of tissues.

[Meningeal empyema--still actual topic]. / Ropniaki opon mózgowo-rdzeniowych --problem nadal aktualny.

Pus collection between dura matterand arachnoidis not an abscess but an empyema. Complains of severe headache, a lack of cooperation is observed, sometimes high fever, seizures, which may lead to an epileptic like condition. Patient gives an impression of a severely ill person. We report four different cases of intracranial complications, in the form of dural empyema diagnosed and treated in our Department. In the pre antibiotic therapy era, cerebrospinal meningeal empyema inevitably led to paralysis, paresis and death.

[Preemptive analgesia in postoperative pain for children in otolaryngological department]. / Zastosowanie analgezji z wyprzedzeniem w leczeniu bólu pooperacyjnego u dzieci w oddziale otolaryngologicznym.

Although much more about the safe and effective management of pain in children is now known, this knowledge has not been widely or effectively translated into routine clinical practice. Pain in children is still a big problem even thought available many possibilities to cure it. Malpractice during postoperative period influence not only for recovery, but also causes long lasting consequences (emotional changes). The most common applied method for treatment postoperative pain in children is still pharmacotherapy. One of the most effective form of it is preemptive analgesia. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy. Practical in the pediatric patients in laryngological ward seems to be one of the most effective method of pain therapy in postoperative period. Laryngological procedures in children cause a severe pain. The most common procedure in children in laryngological practice is adenotomy. There is a pressing need for further research and clinical development in the management of pain in children.

[Response changes of inner ear observed after middle ear surgery]. / Zmiana odpowiedzi ucha wewnetrznego obserwowana po operacjach na uchu srodkowym.

BACKGROUND: Relationship beetwen middle ear surgery and function of the inner ear is known. This problem is often discussed in determination of hearing improvement after otosurgery. AIM: Usefulness of the click evoked otoacoustic emissions (CEOAE) in evaluation of the inner ear function and effectiveness of tympanoplasties is discussed. MATERIAL AND METHODS: Prospective analysis of 70 individuals operated on middle ear problems was performed. Patients were divided into four groups of otosurgeries: stapedoplasty, myringoplasty, type II tympanoplasty, type III tympanoplasty. Otoacoustic emissions and pure tones audiometry were performed before middle ear surgery and 3 months after ear operation. RESULTS: In all established groups improvement in ABG (air bone gap) was observed. Improvement of bone conduction thresholds in the ranges of 5dB was observed in individuals with otosclerosis and type I and type III tympanoplasty. Patients with type II tympanoplasty developed no changes of bone conduction threashold after otosurgery. CONCLUSIONS: Behind routine audiometric diagnostics otoacoustic emissions can be useful in postoperative evaluation of effectiveness of middle ear surgery (especially in patients operated on otosclerosis and in individuals with chronic otitis media with intact ossicular chain).

[Skull base defects in the middle and posterior cranial fossa with unchanged mucous lining middle ear spaces]. / Ubytki kosci podstawy srodkowego i tylnego dolu czaszki przy niezmienionej wysciólce ucha srodkowego.

BACKGROUND: Skull bone defects in the region of middle ear are usually observed in the cases of chronic otitis media. Such loses can also be congenital, posttraumatic, iatrogenic or due to hyperplasia. They can potentially lead to development of otogenic intracranial complications. AIM: We present the patients who were not observed during otosurgery to have any pathological changes to the mucous of the middle ear and were diagnosed as having bone defects in the middle and/or posterior cranial fossa. We discuss also methods of reconstruction during otosurgery. MATERIAL AND METHODS: The prospective analysis involves the patients operated on middle ear in the Department of Otolaryngology at the Jagiellonian University of Krakow in the years 2007-2011. 495 first-time otosurgeries were performed in this period of time. RESULTS: Skull bone defects were diagnosed in 46 patients who had undergone surgery and 25% of these patients had no changes to the middle ear mucous. This points to congenital etiology of the defects. In this group the most common cause for otosurgery was chronic otitis media (10 patients). In 1 patient, bone defect occurred along with otosclerosis. In patients with congenital skull bone defects otogenic intracranial complications were described in 4 cases. CONCLUSIONS: Nearly 80% of skull bone defects remain asymptomatic; they are revealed incidentally during the surgery of the middle ear. The above observations emphasize the significant role of preoperative imaging diagnostics. The methods of bone defects reconstruction using the fascia, strengthened with the pedicle muscle flap where larger defects occurred, as well as with either bone lamella or cartilage in particular cases, proved successful.