Challenging the gold standard: methods of sampling for microbial culture in patients with chronic rhinosinusitis.

PURPOSE: Chronic rhinosinusitis (CRS) is a highly prevalent multifactorial disorder. Culture-directed antibiotics are frequently prescribed to patients with CRS and the middle nasal meatus (MM) is traditionally believed to be a representative sampling site of the sinuses as a whole. The purpose of our study was to reevaluate the reliability of the MM as a sampling site in patients with CRS who suffer from impaired drainage from the sinuses to the MM. METHODS: Swabs and tissue biopsies were collected from the MM, maxillary sinus and frontal sinus from 50 patients with CRS. The results of bacterial culture were compared between sampling methods and sites in relation to the patency of the sinus ostia. RESULTS: 782 bacterial isolates were cultured from the samples. Concordant results between the MM and the sinus cavity were noted in 80% of patients for the maxillary sinus, but only 66% for the frontal sinus and 76% for the sinuses a whole. The differences were similarly prevalent in patients with open and occluded sinus ostia. Notably, swabs from all three sites provided representative information in 92% of patients and tissue biopsies did not provide additional information compared to multiple swabs. CONCLUSION: The traditional method of sampling from the middle meatus provides inadequate information in 24% of patients with CRS, which may result in inadequate antibiotic therapy and contribute to increasing antibiotic resistance. Additional sampling from the sinuses should be recommended whenever possible, while invasive sampling is not necessary.

[Evaluation of the impact of symptomatic gastroesophageal reflux disease on the result of surgical treatment with the use of endoscopic techniques and postoperative pharmacological treatment in patients with chronic sinusitis]. / Ocena wplywu objawowego refluksu zoladkowo-przelykowego na wyniki chirurgii endoskopowej i pooperacyjnej farmakoterapii u chorych z PZZP.

It is estimated that in Europe 10% of adults suffer from chronic sinusitis. Chronic sinusitis can be caused by many different diseases that share chronic inflammation of the sinuses as a common symptom. Rhinitis can be caused by stomach acid coming up from the stomach into the esophagus, which successively can result in chronic sinusitis. The current gold standard for diagnosing GERD is--bothersome for the patient--24 h esophageal pH monitoring. This method can be unpleasant for the patients, which makes it less acceptable. Because of that the criteria for symptomatic GERD were made an alternative diagnostic way. We acknowledge that the presence of heartburn and stomach acid coming up from the stomach into the esophagus at least once a week can be diagnosed as symptomatic GERD. The aim of the study is the assessment of the frequency of symptomatic GERD in patients operated because of chronic sinusitis and impact of symptomatic GERD on the follow-up treatment up to 12 months after endoscopic nasal surgery. The authors analysed 144 patients operated at the JUCM Otolaryngological Clinic in Kraków between 2011 and 2013 because of sinusitis. The inclusion criteria were: diagnosed chronic sinusitis, indications for endoscopic sinus surgery, and a written consent for the research. Each patient was examined laryngologically and surveyed. Patients were divided into two groups: with and without symptomatic GERD. We analysed the symptoms in patients treated for sinusitis with or without GERD before, between 3 and 6 as well as in the 12th month after endonasal surgery. Moreover, we analysed the intensity of the global symptoms (expressed in the VAS scale) and separately for each of the 13 symptoms of chronic sinusitis (expressed on a scale 0 - 3). We established that 33 out of the 144 patients (22.9%) qualified for the first survey reported the symptoms of GERD. In the second survey, which was conducted between 3 and 6 month after ESS, 24 out of 119 (20%) people reported the symptoms and in the third survey, which took place in the 12th month after ESS, 14 out of 52 patients reported symptomatic GERD. The intensity of global symptoms rated in the VAS scale in patients with chronic sinusitis during the first survey was 7.8 and in the second and third survey the intensity was 4.2 and 4.3 respectively. But in patients without any symptoms they were 7.4, 2.8, 3.2. We also analysed 13 symptoms of chronic sinusitis rated on a scale 0 - 3. The result of the research was that in patients with symptomatic GERD, even after FESS and the appropriate follow-up, we can still suspect such symptoms as streaming the fluid over the back side of the throat, cough, pain or the feeling of fullness in the ear, headache or halitosis. We should take it under consideration during qualification for the surgery as well as predicting the results of the treatment. Further research is required to state if and how different methods and procedures used in case of patients with symptomatic GERD can reduce the uncomfortable influence of this disease on the effects of chronic sinusitis treatment.

[Prognostic factors in patients operated on eardrum perforation with intact ossicular chain]. / Czynniki prognostyczne u chorych leczonych operacyjnie z powodu perforacji blony bebenkowej przy nieuszkodzonym lancuchu kosteczek sluchowych.

BACKGROUND: Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. AIM: This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. MATERIAL AND METHODS: Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. RESULTS: 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. CONCLUSIONS: The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operator's preferences, as well as the availability of given material for transplanting.

Hearing Screening among First-Grade Children in Rural Areas and Small Towns in Malopolskie Voivodeship, Poland.

Undiagnosed hearing deficits hamper a child's ability to learn. Hearing screening in school aged children helps detect educationally significant hearing loss and prevents negative impacts on academic achievement. The main purpose of this study was to improve early detection and assess the incidence of hearing disorders in first-graders from rural areas and small towns in the Malopolskie Voivodeship of Poland. There were 5029 children aged 6-7 years. Hearing thresholds were measured over the frequency range 0.5-8 kHz. A result was considered positive (abnormal) if the hearing threshold was worse than 20 dB HL at one or more frequencies. The prevalence of hearing loss was estimated in terms of four-frequency hearing loss, high-frequency hearing loss, and low-frequency hearing loss. Parents filled in a brief audiological questionnaire. The analysis was performed using IBM SPSS Statistics, version 24. Of all the children, 20.5% returned a positive result and were referred for further audiological diagnoses. The estimated prevalence of hearing loss was 11.6%, made up of 6.5% with FFHL, 7.6% with HFHL, and 8.2% with LFHL. This study showed that large numbers of children in the district had hearing problems. Adoption of hearing screening in primary schools is recommended as a routine procedure within preventive pediatric health care.

[Quality of life in patients treated for cancer of paranasal sinus and other area at head and neck]. / Wplyw dysfagii na jakosc zycia chorych z nowotworami zatok przynosowych i w innych lokalizacjach glowy i szyi.

AIM: The oncology efficiency and quality of life are both important for patients with head and neck cancer in every-day life. MATERIAL AND METHODS: Evaluation of the dysphagia discomfort was made of 240 patients (190 male and 50 female). The primary location of the tumor was: paranasal sinuses, oral cavity, oropharynx, hypopharynx and larynx. The treatment was surgical or sugical and radiotherapy. Patient's quality of life was evaluated according to the self-administered questionnaire (M.D. Anderson Dysphagia Inventory MDADI). RESULTS: The comparison of the influence of dysphagia on the quality of life was made in two groups of patients. The first group consist of maxillectomy patients wearing obturator protheses, the second one were treated for cancer located in other mentioned area. Patients with primary tumors of the oral cavity, oropharynx, hypopharynx and larynx had significantly greater swallowing disability with an adverse impact on their quality of life compared with patients after maxillectomy. Method of treatment and stage of head and neck cancer greatly affected dysphagia-related quality of life. The longer the interval between completion of treatment and assessment by the MDADI, the higher the total score, thus reflecting a higher quality of life and funcional status as related to swallowing. CONCLUSION: The MDADI is the validated and reliable self-administered questionnaire designed specifically for evaluating the impact of dysphagia on the quality of life of patients with head and neck cancer.

Stability of ABR Wave V Threshold in Early Hearing Diagnostics in Children from Selected Groups at Risk of Congenital Hearing Loss.

<b>Introduction:</b> Upon hearing that the "little" patient has trouble with hearing, we are mostly interested in the level of his hearing threshold. When the child is in the first year of life, results can only be achieved by means of ABR test. Subsequent control tests, especially in children from the hearing loss risk groups selected in this study, show that the obtained outcomes are subject to fluctuations. Their fluctuating nature is manifested by the instability of wave V threshold in subsequent diagnostic periods. Such variability often delays the implementation of the appropriate proceeding. Knowledge of the dissimilarity of behavior of the wave V threshold occurring in individual groups at risk of hearing loss allows for the correct interpretation of the obtained results, and thus, effective therapeutic measures. <br><b>Aim:</b> The aim of the paper is to analyze the stability of wave V threshold during the first year of life in children from selected risk groups for congenital hearing disorders. <br><b>Material and methods:</b> From the patient population of 2,114 individuals examined in 2015-2016 at a reference center participating in the Universal Neonatal Hearing Screening Program in 2015-2016, the results of 250 children were subjected to retrospective analysis. Furthermore, 4 groups of little patients were formed (children with Down syndrome; children with other diseases or damage to the nervous system; children with cleft palate or cleft lip and cleft palate; children with congenital cytomegaly) in whom diagnostic practice revealed variable results of the wave V threshold. We analyzed the results of tests obtained during the first year of the child's life divided into 4 diagnostic periods. <br><b>Results:</b> The highest percentage of instability in the established threshold of wave V between individual diagnostic periods occurred in the group of children with cleft palate or cleft lip and cleft palate. In the group of children with Down syndrome, it was observed that the instability of the ABR test results decreased over time. In the group of children with other diseases or damage of the nervous system, the highest percentage of the lack of stable ABR wave V thresholds was observed between the 1st and 2nd as well the 1st and 4th diagnostic periods. On the other hand, in the group of children with congenital CMV, there was a relatively low percentage of instability of results. <br><b>Conclusions:</b> (1) Although the ABR test is a diagnostic standard, in particular groups of patients the study is burdened with high variability of measurement results in subsequent diagnostic periods. Such a group of patients are children with cleft palate or cleft lip and cleft palate; therefore, it must receive particular attention in treatment planning; (2) in selected groups at risk of hearing loss, due to the high percentage of children with hearing impairment (70%), the validity of performing newborn hearing screening tests was confirmed.

Analysis of diagnostic-therapeutic results after the first year of life in children of hearing disturbance risk groups.

INTRODUCTION: It is assumed that the critical period for diagnosis of hearing disorders is the baby's first three months of life and that appropriate course and implementation of treatment and/or rehabilitation should begin before a child is six months old. However various kinds of problems may occur during auditory screening of a child may exceed this interval. AIM: The aim of this study was an evaluation of auditory screening results for children over 12 months old with congenital hearing loss. MATERIAL AND METHODS: Results from 250 children were analyzed retrospectively. The study group consisted of children between one and three months old observed between 2015-2016. For the purpose of this analysis we divided the patients into four groups: children with Down Syndrome, children with nervous system disorders , children with cleft palate or both cleft palate and lip and children with congenital CMV. To discuss performed diagnostics and treatment two groups of children were esteblished: • with implementation of appropriate course of treatment • without instituted treatment Results: 250 children were examined in Level III NICUs in the years 2015 - 2016. The highest proportion of children with the implemented course of proceedings, was in groups with children with congenital CMV (71.1%). The highest proportion of children substituted with a hearing prosthesis was observed in the group of children with Down Syndrome. The lowest proportion of children with the implemented course of proceedings, was in groups with children with cleft palate or both cleft palate and lip (41.6%). CONCLUSIONS: • Early implementation of treatment and/or rehabilitation in children with hearing disorders is crucial to prevent depression of speech and psychological development. I t is important in children with cleft palate or both cleft palate and lip even if surgical correction is discussed. • The highest proportion of children with the implemented course of proceedings, was in groups with children with congenital CMV. This children should be observed despite of right results of hearing tests. • In children with nervous system disorders 1 year period of observation is too short to exclude problems with hearing.

Analysis of difficulties occurring during the early auditory screening in children.

INTRODUCTION: It is assumed that the critical period for diagnosis of hearing disorders is the baby's first three months of life and that appropriate course and implementation of treatment and/or rehabilitation should begin before a child is six months old. However various kinds of problems may occur during auditory screening of a child may exceed this interval. This problem is particularly pronounced among children with development and health problems and leads to unreliable and varied results. AIM: The aim of this study was an analysis of prevalence of difficulties occurring during the first year of auditory screening among groups of children with congenital hearing impairment. MATERIAL AND METHODS: Patients were examined in The Universal Newborn Hearing Screening Program in the years 2012 - 2013 in Level III NICUs in Krakow. Results from 250 cases were analyzed retrospectively. Medical exam results of patients with high risk of hearing loss were also included in our analysis. The groups of children included in our study were: children with Down Syndrome, children with nervous system disorders , children with cleft palate or both cleft palate and lip and children with congenital CMV. RESULTS: In the group of children with cleft palate or both cleft palate and lip the most frequent cause of not conducting objective audiometric tests was bad health condition of a child which precluded his arrival for administering the tests. The most common cause of difficulties in performing hearing tests was the emotional state of children from groups with Down Syndrome. In the group of children with congenital CMV the most common cause of difficulties was a lack of availability of their parents. CONCLUSIONS: 1. We encountered the greatest diagnostic difficulties during the child's first year of life in chosen high-risk groups of children with congenital hearing loss in children with cleft palate or both cleft palate and lip. 2. The highest prevalence of not finished tests was in III and IV interval for all chosen high-risk groups with congenital hearing loss.

Incidence of aspirin hypersensitivity in patients with chronic rhinosinusitis and diagnostic value of urinary leukotriene E4.

INTRODUCTION: Chronic rhinosinusitis (CRS) with nasal polyposis (NP) may be associated with hypersensitivity to nonsteroidal anti-inflammatory drugs, representing a syndrome of aspirin-exacerbated respiratory disease (AERD). OBJECTIVES: The aim of the study was to validate a simple measurement of urinary leukotriene E4 (uLTE4) excretion for the diagnosis of AERD in patients with CRS and indication for surgery. PATIENTS AND METHODS: Subjects requiring functional endoscopic sinus surgery (FESS) were recruited from the Department of Otolaryngology (n = 24). Before surgery, a standard oral placebo-controlled aspirin challenge was performed to diagnose aspirin hypersensitivity. Urine samples were collected on the placebo day and both before and within 2 to 4 hours after aspirin challenge for uLTE4 measurement. RESULTS: All patients with CRS had sinusitis confirmed by computed tomography. Previous ear, nose, and throat surgery was performed in 70% of the patients, NP was present in 86%, and asthma was diagnosed in 62.5%. AERD was diagnosed in 8 subjects (7 women and 1 man). Five of those patients had bronchoconstriction. At baseline, median uLTE4 was 7.5-times higher in AERD subjects than in the remaining patients. It increased almost 6-fold following the challenge, while remained unchanged in patients without aspirin hypersensitivity. Pretest uLTE4 had a sensitivity of 87.5% and specificity of 93.75% to diagnose aspirin hypersensitivity in patients with CRS. After the challenge, the values improved to 100% sensitivity and 93% specificity. CONCLUSIONS: Among CRS subjects requiring FESS, as many as 33.3% may have AERD and respond to a small provocative dose of aspirin with bronchoconstriction and/or mucosal and skin edema. A simple and inexpensive measurement of uLTE4 can help diagnose AERD in patients with CRS with sensitivity of 87.5%, but its specificity is limited and depends on the arbitrary threshold of uLTE4.