The influence of Slim Modiolar electrode on residual hearing in pediatric patients.

PURPOSE: Hearing preservation cochlear implantation is an established procedure in patients with low-frequency residual hearing, especially in pediatric cochlear implantation. More delicate, thin electrode arrays can minimize damage in the inner ear and enhance the possibility for residual hearing preservation. The Cochlear® CI532 electrode has been reported as an electrode with the potential for residual hearing preservation. No similar studies pertaining to hearing preservation in pediatric patients have appeared to date. The aim of this study was to investigate whether the Cochlear® CI532 Slim Modiolar electrode allows the preservation of low-frequency residual hearing in children undergoing cochlear implantation. METHODS: In this multicenter, nonrandomized, prospective clinical cohort study, medical data of 14 pediatric patients implanted with the CI532 were collected. All patients had residual low-frequency hearing (preoperative audiogram or ABR with at least one threshold better than 90 dB HL at 125, 250, 500, or 1000 Hz). Postoperative thresholds were obtained 1, 3, 6, and 12 months after cochlear implantation. RESULTS: Based on the HEARRING classification, 78.6% of children (11/14) had complete hearing preservation at the last follow-up visit (12 months after CI, or if not available, 6 months). A total of 21.4% (3/14) had partial hearing preservation. At the last follow-up visit, neither minimal hearing preservation nor loss of hearing was observed. Functional low-frequency hearing was preserved in 13 out of 14 patients (93%). CONCLUSIONS: The residual hearing preservation results in children were superior to the results previously reported in adults.

The significance of selected prognostic factors in pediatric tympanoplasty.

OBJECTIVES: The aim of this study was to determine the importance of selected prognostic factors on outcomes of tympanoplasty in children. MATERIALS AND METHODS: 241 children classified into three age groups (3-7, 8-12 and 13-18), had undergone tympanoplasty between 2001 and 2007 and were subsequently observed for at least 2 years. Prognostic factors were assessed with regard to their impact on the functional and anatomical outcome of the tympanoplasty defined, respectively, as postoperative air-bone gap and state of the middle ear. RESULTS: In 85% of children, a tympanic membrane reconstruction was performed. An unchanged TM was achieved in 85% of the patients in early results and in 76% in later results. Air-bone gap closure was observed in 66% of cases. The earlier preventive retraction pocket tympanoplasty was performed, the better anatomical results were obtained-ranging from 91% in the 3-7 age group versus 75-70% in 8-12 and 13-18 age groups. The results of total or subtotal perforation reconstructions were worse than for small perforation with closure rates of 76.5% vs 94.5%, respectively. CONCLUSION: Age is not a factor determining the success rate in pediatric tympanoplasty. A better surgical outcome can be achieved in children with a dry ear, and better middle ear condition, because of previously performed surgeries. Preventive tympanoplasty is also advantageous. The hearing results in type 2 and 3 tympanoplasty are similar, but type 1 tympanoplasty has superior efficacy to the former two types.

Different clinical presentation and management of temporal bone fibrous dysplasia in children.

BACKGROUND: Fibrous dysplasia is a slowly progressive benign fibro-osseous disorder that involves one or multiple bones with a unilateral distribution in most cases. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. Temporal bone involvement is the least frequently reported type, especially in children. We reviewed available articles regarding fibrous dysplasia with temporal bone involvement in children and added four patients aged 7 to 17 years who were diagnosed and treated in our institution from 2006 to 2017. The patients' clinical picture comprised head deformity, external canal stenosis, headache, progressive conductive and/or sensorineural hearing loss, tinnitus, and sudden deafness. Two patients had experienced severe episodic vertigo with nausea and vomiting. Two were referred to us with external canal obstruction and secondary cholesteatoma formation with broad middle ear destruction. One was diagnosed with acute mastoiditis and intracranial complications. Optimal management of fibrous dysplasia is unclear and can be challenging, especially in children. In our two patients with disease expansion and involvement of important structures, surgical treatment was abandoned and a "wait-and-scan" policy was applied. The other two were qualified for surgical treatment. One patient underwent two surgeries: modified lateral petrosectomy (canal left open) with pathological tissue removal, cavity obliteration, and subsequent tympanoplasty. Another patient with extensive destruction of the left temporal bone underwent canal wall down mastoidectomy with perisinus abscess drainage and revision 12 months later. Tympanoplasty was unsatisfactory in both patients because of slow progression of the middle ear pathology. None of our patients underwent pharmacological treatment. CONCLUSIONS: In younger patients, observation and a "wait-and-scan" protocol is relevant until significant function, or cosmetic deficits are obvious. Surgery is not preferred and should be delayed until puberty because fibrous dysplasia has a tendency to stabilize after adolescence. In patients with severe symptoms medical treatment can be implemented, but safety of this treatment in children remain controversial.

Head and neck lipoblastoma in children: A case report and systematic review.

BACKGROUND: Lipoblastoma is a rare and benign tumor arising from embryonal fat cells. It develops primarily in infancy and early childhood. We present a case study of a 10-month-old child treated for an extensive tumor of the infratemporal fossa and parapharyngeal space. The systematic review of 60 reports in 80 children with lipoblastoma of the head and neck is also reported. MATERIAL AND METHODS: Systematic review of all articles included lipoblastomas of the head and neck area in children published from 1964 to 2022 in the PubMed database was conducted. Clinical presentation of extensive lipoblastoma of the head and neck in a child. RESULTS: On the basis of all inclusion criteria 83 articles were identified concerning pediatric lipoblastoma. There were 36 F (45%) and 39 M (48%), in 6 patients, (7%) gender was not specified. Ages ranged from 0mth (6h) to 15 yo (180mth). The tumor was located in the head in 22 (27%) cases, while the neck area accounted for 53 (65%) cases. General description without precise location was shown in 6 (7%) cases. All patients underwent complete surgical excision. Post surgical recurrence was noted in 6% clinical cases in the analyzed articles. CONCLUSIONS: Lipoblastoma is characterized by a rapidly growing predominantly adipose mass. The treatment of choice is complete surgical excision. In selected cases when the pathology is hard to reach, as a consequence of the extensive penetration of the mass, we recommend performing the procedure with an interdisciplinary team. Endoscopy assistance and microdebrider significantly facilitated the removal of pathology in the described advanced case of lipoblastoma. This is the only case reported in the pediatric literature of a head and neck lipoblastoma, where due to extensive involvement and location of the disease the cranial nerves V2 and inferior alveolar branch of V3 could not be spared. Long-term follow-up even to 10 years is required because there is a reported tendency for these tumors to recur.

Polish national guidelines for the diagnosis and treatment of chronic otitis media with effusion in children.

Otitis media with effusion (OME), is a common childhood disease and is characterized by long-term fluid retention in the middle ear spaces without signs of acute infection. Surgical treatment of OME in the form of a tympanostomy is one of the most commonly performed medical procedures by pediatric ENT surgeons worldwide. In February 2022, the Journal of Otolaryngology - Head and Neck Surgery published updated guidelines from the American Academy of Otolaryngology - Head and Neck Surgery for tympanostomy tuba in children between 6 months and 12 years of age. They are aimed at both otolaryngologists and pediatricians, as well as other medical personnel who are directly involved in the care of patients with tympanostomy tuba or are candidates for the procedure. The previous version of the guidelines was developed in 2013. With the cooperation of the Board of Expert chaired by the National Consultant in Pediatric Otorhinolaryngology, Prof. Wieslaw Konopka, PhD, during the VII International Conference "Otology, 2022" which took place on September 15-17, 2022 in Torun, the previously published recommendations and consensuses from other countries, both European and non-European, were analyzed and the task of developing new national diagnostic and therapeutic recommendations for OME was undertaken.

The zone-based approach for selection of tympanoplasty technique.

At the outset of surgery, the extent of a tympanic membrane defect is judged including any additional loss of area that may result from disease extirpation or removal of the mucocutaneous junction. There are, three tiers of complexity when deciding upon which technique should be used for repair. Limited central perforations are defects amenable to a standard underlay technique. The Zone Based Approach is applied for marginal perforations whereby the specific technique is selected based on the zone of the defect. The zones and specific techniques are detailed. There are however, still a significant number of patients who have scarce residual tympanic membrane, or keratin matrix adherently involving the undersurface requiring sacrifice. These situations prove poor for either standard underlay or the zone based techniques. The total tympanic membrane reconstruction (TT MR) technique was developed specifically to avoid these complications as well as facilitate extirpation of the more extensive inflammatory and neoplastic pathologies commonly encountered, yet still amenable to intact canal wall mastoidectomy approaches.

Sphenochoanal polyps in children - a systematic review (1995‒2021).

OBJECTIVES: Nasal polyps that originate from the sphenoid sinus and reach the nasopharynx are called sphenochoanal polyps. Reports on sphenochoanal polyps in children have thus far been limited only to case reports. This review aims to describe and summarize clinical presentation, diagnosis, management, surgical approaches to the sphenochoanal polyps with recurrence rate after surgery in pediatric patients reported in the literature. METHODS: A systematic literature review was performed using PubMed, MEDLINE and Cochrane Library Databases for articles published prior to December 2021 to identify all studies reporting on pediatric patients with sphenochoanal polyps. Clinical presentation, management options, surgical approaches and outcomes of applied management were extracted from included studies. RESULTS: 9 articles provided data on 11 eligible patients with an age range 3 years and 8 months-16 years. The commonest symptoms included: nasal obstruction, nasal discharge, and headache respectively. All patients were subjected to surgical treatment. No recurrences after the endoscopic sphenoidotomy were reported. CONCLUSION: Sphenochoanal polyps should be kept in mind in the differential diagnosis of unilateral nasal cavity or paranasal sinuses masses. Misdiagnosis can result in recurrences in patients with sphenochoanal polyp, who can be mistakenly diagnosed with antrochoanal polyp and underwent inadequate treatment not involving sphenoidotomy and exact identification of the site of implantation. The symptoms of sphenochoanal polyps are nonspecific.

The role of preoperative imaging for auditory implants in children.

<b>Introduction:</b> Preoperative imaging, besides audiological evaluation, plays a major role in evaluation of candidacy for auditory implants, and in particular cochlear implants. It is essential to assess whether the basic criteria necessary for implantation are met. Diagnostic imaging is crucial not only in determining candidacy, but also determining the feasibility of cochlear implantation as it allow to anticipate surgical difficulties which could preclude or complicate the implantation of the device. The aim of the study is to present the protocol for the evaluation of preoperative imaging studies with particular focus on the factors potentially affecting clinical decisions in children qualified for cochlear implantation. <br><b>Material and method:</b> Preoperative imaging studies of 111 children performed prior to cochlear implantation were analyzed: high-resolution computed tomography (HRCT) of temporal bones and MRI. The assessment was made according to the presented protocol. <br><b>Results:</b> Pathologies and anomalies identified during the assessment of preoperative imaging studies significantly altered clinical decisions in 30% of patients. In the study group, in 17% of patients inner ear malformations were identified. 2.7% of children were disqualified from a cochlear implantation due to severe congenital inner ear malformations. 9% of the patients have had bacterial meningitis. In 50% of them difficulties related to complete or progressive cochlear ossification occurred. In 4.5% of patients less common surgical approaches other than mastoidectomy with a posterior tympanotomy were applied. <br><b>Discussion:</b> Preoperative imaging allow for the identification of significant pathologies and anomalies affecting qualification decisions and further treatment. HRCT and MRI are complementary to each other for preoperative imaging. The two modalities in combination allow accurate and optimal evaluation of the anatomical structures prior to implantation. Inner ear malformations and cochlear ossification following meningitis are relatively frequently encountered in children qualified for a cochlear implant.

Qualification of unilateral cochlear implant recipients for a second device.

INTRODUCTION: Although it is recommended to perform cochlear implantation in both ears at the same time for management of profound hearing loss in children, many centers prefer to perform sequential implantation. There are many reasons as to why a simultaneous bilateral implantation is not commonly accepted and performed. The major risk is the possibility of bilateral vestibular organ impairment. However, it is beyond doubt that children who received the first implant should be given a chance for binaural hearing and associated benefits. In the literature, there are no homogenous criteria for bilateral implantation, and it is hard to find uniform and convincing algorithms for second cochlear implantation. The aim of this study is an attempt to identify a safe way of qualifying for second cochlear implantation in children. MATERIAL AND METHODS: Forty children with one cochlear implant were qualified for the second implantation. During qualification, the following were taken into account: time of the first implantation, audiometry results, use of the hearing aid in the ear without an implant and benefit of the device, speech and hearing development, and vestibular organ function. R esults: Fifteen out of forty children (38%) were qualified for the second implantation. In 35% of children, the decision was delayed with possible second implantation in the future. Eleven children (27%) were disqualified from the second surgery. DISCUSSION: During evaluation according to the protocol presented in our study, 38% of children with a single cochlear implant were qualified for the second implantation with a chance for an optimal development and effective use of the second cochlear implant. We are convinced that sequential implantation with a short interval between surgeries and with an examination of the vestibular organ, hearing and speech development as well as an assessment of potential benefits from the second implant (bimodal stimulation) before the second implantation is the safest and most beneficial solution for children with severe hearing loss.

Therapeutic approach to pediatric acute mastoiditis - an update.

INTRODUCTION: Acute mastoiditis remains the most common complication of acute otitis media. It may rarely appear also in cochlear implant patients. However, the treatment recommendations for this disease are not precisely defined or employed, and in the current literature the differences regarding both the diagnosis and management are relatively substantial. OBJECTIVE: The aim of this study was to determine a standard and safe procedure to be applied in case of pediatric acute mastoiditis. METHODS: A retrospective chart review of 73 patients with 83 episodes of acute mastoiditis hospitalized at our tertiary-care center between 2001 and 2016 was conducted. Bacteriology, methods of treatment, hospital course, complications, and otologic history were analyzed. Based on our experience and literature data, a protocol was established in order to standardize management of pediatric acute mastoiditis. RESULTS: All the patients treated for acute mastoiditis were submitted to an intravenous antibiotic regimen. In the analyzed group pharmacological treatment only was applied in 11% of children, in 12% myringotomy/tympanostomy was added, and in the vast majority of patients (77%) mastoidectomy was performed. In our study recurrent mastoiditis was noted in 8% of the patients. We also experienced acute mastoiditis in a cochlear implant child, and in this case, a minimal surgical procedure, in order to protect the device, was recommended. CONCLUSIONS: The main points of the management protocol are: initiate a broad-spectrum intravenous antibiotic treatment; mastoidectomy should be performed if the infection fails to be controlled after 48h of administering intravenous antibiotic therapy. We believe that early mastoidectomy prevents serious complications, and our initial observation is that by performing broad mastoidectomy with posterior attic and facial recess exposure, recurrence of acute mastoiditis can be prevented.

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.

[Spontaneous temporal bone meningo-encephalocele]. / Samoistna przepuklina oponowo-mózgowa kosci skroniowej.

INTRODUCTION: Spontaneous meningocele or meningoencephalocele of the temporal bone are very rare. Mostly they are result from otologic surgery or head trauma. Spontaneous meningoencephalocele may occur mostly in the epitympanum or mastoid antrum. It could be a result of pathologic obesity. Often it could be misdiagnosed because of less symptomatic. The most expected symptoms could be: unilateral conductive hearing loss with meddle ear effusion, pulsatile tinnitus or CSF leak. MATERIAL AND METHODS: We present a case of 61 year old, obese woman with spontaneous meningoencephalocele of the left temporal bone. The patient presented symptoms of conductive hearing loss with fullness in the left ear and pulsatile tinnitus. The imagine study such as CT scan and MRI showed a dehiscent areas in the tegmen at the right side and meningoencephalocele protruding into the left mastoid cavity on the left side. RESULTS: After complete diagnosis we preformed surgery. A mastoidectomy of the left temporal bone was done and the meningoencephalocele tissue was encountered. The bony defect and CSF leak was closure. The patient was released from pulsatile tinnitus and fullness in the ear, but a component of hearing dysfunction is still present. CONCLUSIONS: Spontaneous meningoencephalocele of the temporal bone may occur in an obese patient. The most finding will be a middle ear effusion and conductive hearing loss with pulsatile tinnitus. The combination of CT and MRI will help in proper preoperative diagnosis. The operation include transmastoid, middle cranial fossa repair or combination of both. The multi layer closure of bony defect is very important to avid CSF leak.

Diagnosis and management of pediatric cervical vagal schwannoma.

Schwannomas arising from the vagus nerve are extremely rare in children, with only 15 cases reported in the world literature. We describe a pediatric case of cervical vagal nerve schwannoma successfully treated with cranial nerve-sparing surgery. Our patient presented extensive mass in the right side of the neck with ipsilateral Horner's syndrome. Her first sign, anisocoria, was diagnosed at the age of 1.5 y, making her the youngest vagal schwannoma case ever reported. Using an ultrasonic surgical aspirator and nerve monitoring, a multidisciplinary team successfully removed the mass with no recurrence after 2 years of follow-up.

Pediatric recurrent acute mastoiditis: Risk factors and insights into pathogenesis.

OBJECTIVES: Recurrent acute mastoiditis is repeatedly reported in the literature, but data to understand the pathogenesis, update treatment recommendations and inform future trials are sparse due to the infrequency of the disease. METHODS: A retrospective chart review from 2001 to 2016 was conducted including 73 children treated for acute mastoiditis. A follow-up survey was attempted for each patient. Bacteriology, method of treatment, hospital course, complications, and otologic history were analyzed. A chi-squared test, Fisher's exact test and Mann-Whitney U test compared recurrent acute mastoiditis to single acute mastoiditis cases. Additionally, a comprehensive PubMed search and review of world literature addressing recurrent pediatric acute mastoiditis was performed for comparative purposes. RESULTS: Among 73 children with acute mastoiditis, six (8%) experienced recurrent acute mastoiditis. Streptococcus pneumoniae was the only bacteria isolated in this group. History of recurrent acute otitis media (>4 per year) prior to the first episode of acute mastoiditis was identified in 24% with single episode of acute mastoiditis and 83% with recurrent mastoiditis (p < 0.05). Fewer intracranial/intratemporal complications were identified among recurrent mastoiditis patients (p < 0.05). In a group of patients treated with more extensive surgical communication during mastoidectomy for primary acute mastoiditis (wide mastoidectomy with broad attic exposure and posterior tympanotomy) no recurrence was observed. CONCLUSION: We identify multiple risk factors associated with recurrence and provide early data supporting anatomic predisposition to the development of recurrent acute mastoiditis. More aggressive opening between the mastoid cavity and middle ear may prevent recurrent acute mastoiditis episodes.

Application of "banana cochleostomy" and looped electrode insertion for cochlear implantation in children with common cavity malformation and cystic forms of cochlear hypoplasia.

OBJECTIVES: Patients with profound hearing loss due to inner ear malformations may benefit from cochlear implantation; however, the surgery may present a substantial problem for the cochlear implant surgeon due to anatomical variations. The authors describe a new surgical and technical advancement for implantation in patients with small inner ear cavities that make the surgery easier and safer. On the basis of experience involving five consecutive surgeries performed in four patients with inner ear malformations, we present the advantages and application possibilities of the technique. METHODS: The technique does not change the surgical approach in general; however, modification of the cochleostomy shape and looping of the cochlear implant electrode enables safe advancement of the electrode with optimal positioning in the cavity. Additionally, these modifications protect against the insertion of the electrode into the internal auditory canal minimizing the risk of gushing and extracochlear stimulation. RESULTS: The present technique has been used in five cases of cystic implantable inner ear spaces in three independent institutions by different surgeons. It has proven to be a reliable, relatively easy and safe procedure performed with very good anatomic and initially functional effects (positive intraoperative neural response telemetry measurements). CONCLUSIONS: We hope that utilization of the "banana cochleostomy" and insertion of the looped cochlear implant electrode in the implantable cystic spaces of children with malformed inner ears will facilitate and simplify the surgical technique in this difficult procedure and additionally, in revision surgical cases. To our knowledge, the looped insertion and banana-shaped cochleostomy have not been reported previously.

Benign paroxysmal vertigo of childhood.

OBJECTIVE: To relate the authors' experience to the diagnosis and follow-up of patients with benign paroxysmal vertigo of childhood (BPV) who were followed-up at the Children's Hospital of Bydgoszcz between 1999 and 2004, and to review and discuss controversial issues regarding the disease. METHODS: Among 124 children suffering from vertigo 14 were classified as having BPV. All the children were submitted to differential diagnosis protocol which consisted of meticulous history, otolaryngological, ophthalmological, psychological, neurological examination, biochemical tests and standard neurootological examination including caloric tests. The children were followed-up and the tests were repeated if no improvement was observed. RESULTS: All the children suffered from episodic vertigo of variable intensity and frequency. All of them were neurologically intact. In 8 patients pathologic ENG results were found, only 1 patient with canal paresis could be considered as having peripheral lesion, 7 patients had central/mixed pathology. The follow-up was favorable in majority of patients. Six of them recovered completely, in 6 an improvement was noted and in 2 no improvement was observed. Three patients after remission of BPV attacks developed migraine. One child before development of BPV attacks suffered from paroxysmal torticollis of infancy. CONCLUSIONS: Childhood BPV is a disorder of vestibular system with the onset occurring mainly in preschoolers aged 1-7. Older children with the onset of BPV - like symptoms should be suspected for functional background of the disease. There are no typical ENG features for BPV. The only objective evidence of vestibular dysfunction is the presence of nystagmus during the attack. The disease is probably of vascular origin and there is strong evidence for close relationship between spasmodic torticollis, BPV and migraine.

[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.

[Perilymphatic fistula: diagnosis and treatment]. / Przetoka perylimfatyczna jako problem diagnostyczny i leczniczy.

INTRODUCTION: Diagnosis and management of perilymphatic fistula (PLF) is a controversial topic in the international neurotologic literature. An illustrative case of post traumatic PLF with clear surgical indications is presented. This manuscript also reviews the various clinical presentations, pathogenesis, diagnostic examinations, and management options of PLF. MATERIALS AND METHODS: Case report and literature review. RESULTS: A 40 y/o female presented with paroxysmal vertigo, imbalance and severe sensorineural hearing loss (SNHL) following minor occipital head trauma from a fall six months prior to presentation. Laboratory examination included intermittently positive fistula sign on video-nystagmography. Patient failed to respond to trials of pharmacologic treatment and bedrest and ultimately underwent surgical exploration and repair. Patient had earlobe fat placed in the round and oval windows. Postoperatively, she had prompt resolution of vestibulopathy and ultimate full return of sensorineural function. CONCLUSIONS: Patients with appropriate antecedent history demonstrating fluctuating SNHL and vestibulopathy, failing to respond to conservative medical treatments, should be considered for exploratory tympanotomy. In the absence of any other violations of labyrinthine integrity, connective tissue grafting of the round and oval windows should be performed even if no obvious flow of fluid is observed. This management protocol is safe and effective in properly selected patients.

[A simple-irrigating system for endoscopic sinus surgery]. / Zastosowanie prostego systemu pluczacego w chirurgii endoskopowej nosa i zatok przynosowych.

INTRODUCTION: The most troublesome problem during endoscopic surgery is fouling of the endoscope lens (tip) with blood. Irrigating systems are available on the market but they are relatively very expensive. We present our own simple irrigating system, very effective and inexpensive. MATERIAL AND METHODS: The system consists of: polyethylene catheter No 6, sterile intravenous line with interposed stopcock, 500 ml saline solution, endoscope. The catheter is fixed to the endoscope with sterile sticks and connected to the bottle of saline solution with intravenous line. During the operation the irrigant solution flow is controlled with interposed stopcock. CONCLUSIONS: A simple irrigating system allows cleaning of blood from the endoscope obviating the need for frequent removal of the endoscope from the nose. This allows more rapid and safer endoscopic surgery. It is very simple and cheap.

[Rotation suction-knife (shaver) in otorhinolaryngological surgery]. / Zastosowanie noza obrotowo-ssacego (shaver) w chirurgii otorynolaryngologicznej.

INTRODUCTION: Rotation suction knife (shaver or microdebridor) was developed in beginning 1985 in orthopedic surgery. In the field of otolaryngology it was used in 1992-1994. Shaver is a combination of suction and cutting round knife working together. Knives of different shapes are put into handpiece. They have outer sheath with window, which protect the inner rotating blade. The blade is connected to suction and cutting tissue is removed from the operation field. In otolaryngology surgery we mostly used the oscillation cutting mode which is the most sufficient. Shaver surgery is precise in soft tissue resection, so the most advantages to powered the system is in rhinosurgery, polypectomy with extension to pansinus surgery. Microdebridor can be also used for nasopharynx-adenoidectomy, chonanal atresia surgery, turbinoplasty, dacryocystorhinostomy, sella turcica tumor resection or laryngeal surgery. MATERIAL AND METHODS: We used the Storz's shaver system with a handpiece with a motor in the vertical part of the T-shaped handle. Suction and transport of rejected material does not pass through the motor system. The suction channel is straight and clogging is minimized. We performed shaver surgery during functional endonasal endoscopic surgery (FESS) for polypectomy in 15 cases, medial antrostomy (uncinectomy for "swinging door" procedure) in 10 cases, nasopharyngeal-adenoidectomy in 3 cases and turbinoplasty (inferior turbinectomy) in 10 cases. RESULTS: In our material we did not observe any complications during and after surgery. The healing process is very good without obstruction and crusting. The shaver system has an excellent protection for surrounding tissue and minimalized the tissue destruction. CONCLUSIONS: Shaver is an excellent powered instruments for rhinosurgery especially massive polyps of nose and sinuses. It is very sufficient to prevent normal tissue and remove pathological one, this can be achieved in no bleeding area.