What may surprise a rhinologist in everyday clinical practice: silent sinus syndrome or pneumosinus dilatans/pneumocele? Literature review and own experience.

BACKGROUND: The aim of the study was to present rare sinus syndromes known as silent sinus syndrome (SSS) and frontal sinus syndrome with excessive pneumatization and bone defects in the wall (pneumocele). The available literature describing pneumocele cases was reviewed. METHODOLOGY: PubMed and Science Direct databases were searched by two independent reviewers. The primary outcome was finding descriptions of the sinus pneumocele. In the end, papers on frontal sinus pneumocele that was not the result of trauma, congenital defects or comorbidities were selected. Moreover, the authors presented their own cases of SSS and pneumocele. RESULTS: Twelve case reports of frontal sinus pneumocele were found, one own case was presented. In addition, 8 subjects with SSS, diagnosed and treated in the period from September 2017 to May 2022, were described. CONCLUSIONS: With the increasing number of patients suffering from sinus diseases and the growing number of endoscopic surgeries, the knowledge of rare sinus syndromes will increase the safety of the procedures performed.

Bacteriological analysis of selected phenotypes of chronic rhinosinusitis with co-existing asthma, allergy and hypersensitivity to non-steroidal anti-inflammatory drugs.

INTRODUCTION: Chronic rhinosinusitis (CRS) is one of the commonest chronic diseases. It is a systemic disease caused by many factors, including bacterial infections. There are two main types of CRS phenotypes: with polyps (CRSwNP) and without polyps (CRSsNP). AIM: Analysis of sinus mucosal microbiome in patients with CRS depending on the phenotype. Investigating a possible link between the type of bacterial flora and the coexistence of diseases present in the CRS (asthma, allergy or hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) as well as the number of performed operations. MATERIAL AND METHODS: The authors conducted a retrospective study of the bacterial flora of the nasal cavity in patients with CRS operated endoscopically from March 2016 to June 2017. The study consisted od 222 women and 248 men. On the basis of an endoscopic examination, patients were qualified for the phenotype with or without polyps. Based on the medical interview patients were divided into group with asthma, allergy, NSAID hypersensitivity, first and repeated operations. The statistical analysis was made. RESULTS: There is no statistically significant relationship (p = 0.8519) between the CRS penotypes. In the group with CRSsNP, a statistically significant relationship was found between the observed flora and the coexistence of asthma (p = 0.0409), a trend towards significance was also noticed in the case of allergy (p = 0.0947). There was no relationship between the flora and NSAID hypersensitivity (p = 0.7356). In the group of CRSwNP patients, no statistically significant relationship was found between the observed bacterial flora and the presence of asthma (p = 0.7393), hypersensitivity to drugs (p = 0.1509) or allergy (p = 0.7427). There is no statistical significance between the occurrence of particular flora and the multiplicity of operations in both the CRSwNP (p = 0.4609) and CRSsNP phenotypes (p = 0.2469). CONCLUSIONS: Gram-positive cocci were equally common in CRSwNP and CRSsNP. In the CRSsNP, there was a correlation between the coexistence of asthma and allergy, and the presence of Gram-positive cocci. There was no statistical significance between the occurrence of particular flora and the multiplicity of operations in both CRS phenotypes.

Inflammatory lesions in the paranasal sinuses in patients with ischemic stroke who underwent mechanical thrombectomy.

INTRODUCTION: Chronic rhinosinusitis is one of the most widespread chronic diseases in the world, whereas stroke is the leading cause of death and disability. There are numerous reports on the relationship between chronic inflammatory diseases and cardio­cerebrovascular diseases. OBJECTIVES: The study aimed to assess whether inflammatory lesions in the sinuses can be a risk factor for stroke, similar to other known risk factors such as arterial hypertension, atrial fibrillation, atherosclerosis, diabetes, or cigarette smoking. PATIENTS AND METHODS: We analyzed the results of head computed tomography performed in 163 patients with ischemic stroke (79 men) at a mean (SD) age of 68.5 (12.7) years who were deemed eligible for mechanical thrombectomy. The control group included 75 patients (31 men) with neurological diseases of nonvascular origin. RESULTS: Among patients with stroke, inflammatory lesions in the sinuses were found in 95 individuals (58.3%), with a frequency comparable to that of atrial fibrillation (77 [47.2%]). Chronic rhinosinusitis occurred more often than diabetes (33 [20.2%]; P <0.001) and self­reported nicotinism (18 [11%]; P <0.001), yet less frequently than arterial hypertension and generalized atherosclerosis (124 [76.1%]; P <0.001 and 116 [71.2%]; P = 0.02, respectively). Inflammatory sinus lesions of moderate or high severity were more often observed in patients with stroke than in the control group and they mainly involved the ethmoid sinuses. CONCLUSION: Moderate­to­severe inflammatory lesions indicating chronic rhinosinusitis are common in patients with stroke, which suggests the role of local inflammation in inducing acute cerebral ischemia.

Allergies, asthma or hypersensitivity to NSAIDs - are they an equally important risk factor for the development of a specific CRS phenotype?

INTRODUCTION: CRS is a complex systemic disease affecting more than 10% of the population. There are two main types of CRS phenotypes: CRSwNP and CRSsNP. In the Caucasian population, the prevalence of inflammation markers typical of the Th1 profile is observed in CRSsNP, whereas Th2 and Th17 in CRSwNP. Th2 inflammation is observed in the CRSwNP phenotype with concomitant allergies, asthma or hypersensitivity to NSAIDs. OBJECTIVES: The aim of the study was to evaluate, based on the authors' own material, whether allergies, asthma or hypersensitivity to NSAIDs were a risk factor for the development of a specific CRS phenotype. An attempt was also made to investigate the influence of comorbidities on the extent of sinus endoscopic procedures, which depended on the severity of inflammation. METHODS: In the years 2006-2015, ESS was performed on 2217 patients with different CRS phenotypes. Patients with an allergy, bronchial asthma and hypersensitivity to NSAIDs were subjected to analysis. RESULTS: Based on logistic regression, it was found that among the mentioned comorbidities, only asthma (P < 0.0001) and hypersensitivity to NSAIDs (P = 0.0007) significantly affect the occurrence of the phenotype with polyps, whereas the impact of allergies is statistically insignificant (P = 0.1909). The relationship between the type of ESS and CRS phenotypes is statistically significant (P < 0.0001). CONCLUSIONS: Bronchial asthma and hypersensitivity to NSAIDs have a statistically significant effect on the occurrence of the CRSwNP phenotype. This effect was not observed in allergies. The impact of allergies, asthma and hypersensitivity on the phenotype was observed in the group of patients subjected to the most extensive surgery (ESS 4).

Bacteriological analysis of isolated chronic sinusitis without polyps.

INTRODUCTION: Chronic sinusitis (CRS) is phenotypically divided into inflammation with polyps (CRSwNP) or without polyps (CRSsNP). AIM: To try to explain the reasons for isolated sinusitis by analysing medical history as well as anatomical and bacteriological data. MATERIAL AND METHODS: In 2016, endoscopic surgery was performed in 103 patients with CRSsNP within 6 months. The authors evaluated 28 patients with lesions in one sinus. RESULTS: The patients did not report any previous facial trauma, dental procedures, there were no odontogenic causes of the disease. They had not been treated with antibiotics within 30 days prior to admission to hospital. Ninety-seven bacterial strains were grown, of which 32 in patients with isolated nasal sinusitis. Statistical analysis has shown that there is a trend toward a statistically significant (p = 0.0868) relationship between the presence of Staphylococcus aureus and the type of inflammation. CONCLUSIONS: There is an indication that the presence of Staphylococcus aureus is associated with isolated sinusitis, especially in women.

Fungal sinusitis among patients with chronic rhinosinusitis who underwent endoscopic sinus surgery.

INTRODUCTION: Fungal paranasal sinusitis can be either invasive or non-invasive. Saprophytic infections, fungus balls (FB) and allergic fungal rhinosinusitis are non-invasive (AFR). MATERIALS AND METHODS: The present study examined 521 patients who underwent endoscopic sinus surgery between January 2016 and April 2017 due to chronic paranasal sinusitis at the Department of Laryngology and Laryngological Oncology of the Upper Silesian Medical Centre in Katowice. The aim of the study was to analyse the histopathological and microbiological material collected intraoperatively and to determine the incidence and type of fungal infections among patients treated for chronic sinusitis. RESULTS: Chronic fungal sinusitis was confirmed in 10 of 521 operated patients. The study group consisted of 9 females and 1 male. Histopathological examination revealed dead mycelium in 5 patients and colonies of Aspergillus spp. in 4, while microbiological examination revealed Candida albicans infection in 1 case. Allergy to inhalant allergens of fungal spores of Alternaria and Penicillinum was confirmed in a 73-year-old patient, which, based on the whole clinical presentation, enabled to diagnose chronic allergic fungal sinusitis. The most common location of mycelium was the maxillary sinus, followed by the sphenoid sinus. DISCUSSION: The most common form of non-invasive fungal sinusitis is the so-called fungus ball, which was also confirmed in our report (95% of the test subjects). AFRS is more likely to occur in warm, moist climates that favour the growth of fungi.

Giant fronto-ethmoidal osteoma - selection of an optimal surgical procedure / Osteoma fronto-etmoidal gigante - escolha do procedimento cirúrgico ideal

Abstract Introduction Osteomas of the paranasal sinuses are benign bone tumours that produce clinical signs depending on their size and location. In most reported cases large tumours are excised by an external approach or in conjunction with an endoscopic technique. Endoscopic treatment of such tumours is a huge challenge for the operator. Objective Determine the optimal surgical approach by analysing giant osteomas of the frontal and ethmoidal sinuses in the literature. Methods Group of 37 osteomas obtained from the literature review. A group of osteomas removed only by endoscopy was compared with a group in which an external approach (lateral rhynotomy or craniotomy) or combined external and endoscopic approach was applied. Results The authors, based on the statistical analysis of the literature data, have found that the average size of osteomas excised endoscopically and those removed by external approaches does not differ statistically, when the osteomas are located in the ethmoidal cells (p = 0.2691) and the frontal sinuses (p = 0.5891). Conclusion The choice of surgical method appears to be independent of the osteoma size and the decision is likely to be taken based on the experience of the surgeon, available equipment and knowledge of different surgical techniques.

Resumo Introdução Osteomas dos seios paranasais são tumores ósseos benignos cujas manifestações clínicas ocorrem em função de seu tamanho e localização. Na maioria dos casos relatados os tumores grandes são excisados por uma abordagem externa ou associada a uma técnica endoscópica. O tratamento endoscópico destes tumores ainda é um grande desafio para o cirurgião. Objetivo Determinar a abordagem cirúrgica ideal ao analisar osteomas gigantes dos seios frontal e etmoidal na literatura. Método Um total de 38 osteomas foram avaliados a partir da revisão da literatura. Um grupo de osteomas removidos apenas por cirurgia endoscópica foi comparado com um grupo para o qual foi utilizado uma abordagem externa (rinotomia lateral ou craniotomia) ou uma abordagem combinada, externa e endoscópica. Resultados Os autores, com base na análise estatística dos dados da literatura, observaram que o tamanho médio dos osteomas excisados endoscopicamente e daqueles que foram removidos através de uma abordagem externa não diferiram estatisticamente, tanto para osteomas localizados no seio etmoidal (p = 0.2691) quanto para os localizados no seio frontal (p = 0.5891). Conclusão A escolha do método cirúrgico parece ser independente do tamanho do osteoma e a decisão provavelmente será tomada com base na experiência prévia do cirurgião, nos equipamentos disponíveis e conhecimento de diferentes técnicas cirúrgicas.

Giant fronto-ethmoidal osteoma - selection of an optimal surgical procedure.

INTRODUCTION: Osteomas of the paranasal sinuses are benign bone tumours that produce clinical signs depending on their size and location. In most reported cases large tumours are excised by an external approach or in conjunction with an endoscopic technique. Endoscopic treatment of such tumours is a huge challenge for the operator. OBJECTIVE: Determine the optimal surgical approach by analysing giant osteomas of the frontal and ethmoidal sinuses in the literature. METHODS: Group of 37 osteomas obtained from the literature review. A group of osteomas removed only by endoscopy was compared with a group in which an external approach (lateral rhynotomy or craniotomy) or combined external and endoscopic approach was applied. RESULTS: The authors, based on the statistical analysis of the literature data, have found that the average size of osteomas excised endoscopically and those removed by external approaches does not differ statistically, when the osteomas are located in the ethmoidal cells (p=0.2691) and the frontal sinuses (p=0.5891). CONCLUSION: The choice of surgical method appears to be independent of the osteoma size and the decision is likely to be taken based on the experience of the surgeon, available equipment and knowledge of different surgical techniques.

Increase in the incidence of parotid gland tumors in the years 2005-2014.

INTRODUCTION: Salivary gland tumours account for 3-6% of tumours of the head and neck. About 80% of salivary gland tumors occur in parotid glands, 10-17% of which are malignant The aim of the study was to assess whether there is an upward trend in cancer incidence within the parotid glands, with particular emphasis on cancers. MATERIALS AND METHODS: 322 patients underwent surgery and 328 parotid gland tumours were removed in the years 2005-2014 at the Department of Laryngology and Laryngological Oncology of the Upper Silesian Medical Centre in Katowice-Ochojec. Clinical, histopathological and statistical analyses of the removed parotid gland tumours were performed. RESULTS AND DISCUSSION: A significant increase in the incidence of benign tumours, especially mixed and Warthin tumours, was demonstrated. There was no significant increase in the number of malignant tumours over the analysed period of time.

Head and neck lymphomas - a retrospective ten-year observation.

AIM OF THE STUDY: Lymphomas are a heterogeneous group of tumours of lymphoid tissue in which there is an abnormal proliferation of cells of the lymphatic system. The literature notes a gradual increase in the incidence of this type of cancer in the whole population. The aim of the study was to evaluate whether the above tendency occurs in the head and neck area. MATERIAL AND METHODS: In the years 2005-2014, at the Otolaryngology and Laryngological Oncology Department of the Upper Silesian Medical Centre in Katowice, 77 cases of lymphoma were recorded, 58 of which were analysed in terms of location, histological type, age and sex of the patient, and the presence of risk factors. RESULTS: The vast majority of them were non-Hodgkin's lymphomas (NHL) - 67.53%. Hodgkin's lymphomas (HL) accounted for only a small fraction of diagnoses (7.79%). In terms of histopathological types, in most cases of NHL, there occurred diffuse large B-cell lymphomas (DLBCL) - 51.92%. The most common location was the lymph nodes, representing the location of the primary lesion in more than half of the cases. As regards the extranodal location, the Waldeyer ring dominated (54.54%) along with the palatal tonsil (40.90%). There has been a significant upward trend, especially in the incidence of NHL.

Cell-cycle gene expression analysis using real time PCR in locally advanced squamous-cell head and neck cancer.

PURPOSE: The analysis of gene expression, especially those involved in cell cycle control, can help to discover mechanisms determining the outcome of radiation treatment. The main purpose of this study was to examine the expression level of genes responsible for cell cycle regulation in samples of the head and neck cancer, obtained during surgery. METHODS: Postsurgical samples of SCC of head and neck region were collected. Over 80 genes were analysed using cell cycle quantitative real-time RT-PCR Array method. Presence of 14 high-risk HPV types DNA in frozen or paraffin-embedded tumour pathological samples was also assessed. To correlate gene expression with selected pathological features and clinical outcome we used different hierarchical clustering method. RESULTS: Hierarchical clustering demonstrated the association between gene expression within certain clusters and gender, tumour site, T stage, N stage, grade, pathological subtype or tumour recurrence. CONCLUSIONS: Despite some limitations we were able to identify gene clusters that allowed to classify patients according to selected clinical features and occurrence of tumour recurrence. The results of the analysis also confirm that the incidence of HPV infection among the patients from Upper Silesia is relatively low, whereas HPV negative tumours, likely associated with smoking, appeared dominant.

The influence of selected preoperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis.

BACKGROUND: Epidemiological data shows the increasing prevalence of chronic rhinosinusitis which poses significant health, social and economic problems in today's world. Endoscopic paranasal sinus surgery is currently the method of choice in the treatment of chronic rhinosinusitis when conservative treatment methods fail. Therefore, maintaining a high percentage of therapeutic success with a constantly growing number of surgical procedures poses the major challenge to otolaryngologists. Appropriate surgical conditions have a great influence on the course of surgical procedure, the risk of complications and postoperative outcomes. OBJECTIVES: The aim of this study was to analyse the influence of selected perioperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis. MATERIAL AND METHODS: A group of 212 patients (105 women and 107 men) aged 19 to 74 (mean age 46.5) diagnosed with chronic rhinosinusitis were enrolled in the retrospective study. All patients underwent endoscopic sinus surgery. The analysis was concerned with the impact of such factors and clinical parameters as gender and age of patients, disease progression, previous (conservative and surgical) treatment, comorbidities, detrimental external factors, the scope of surgical treatment influencing the duration of surgery, bleeding in the surgical field and the total blood loss during surgery. CONCLUSIONS: It was found that the mean duration of surgery in the study group was 40.2 min, the mean blood loss was 312.17 mL and the mean degree of intraoperative bleeding scale reached 2.15. The intraoperative conditions deteriorate together with the increasing age of patients. Selected factors and clinical parameters, such as impaired nasal patency, olfactory disorders, the occurrence of nasal polyps, prior surgical treatment, the presence of aspirin-induced asthma and cardiovascular diseases, intranasal glucocorticoid therapy, a high degree of inflammatory changes in the sinuses and a large extent of surgery substantially influence the deterioration in intraoperative conditions. Knowledge of these factors and their impact on surgery enables more thorough, multidisciplinary preparation of patients for surgery, and thus enables the optimisation of surgical conditions.

[Emergency endoscopical orbital decompression in case of Graves-Basedov disease]. / Endoskopowa dekompresja oczodolów przeprowadzona w trybie pilnym u chorego z choroba Gravesa-Basedowa.

Graves' disease may result in significant proptosis that causes visual loss. This has been traditionally managed surgically by external bony skeleton decompression. Tran nasal endoscopic orbital decompression is as a new technique that avoids the need for cutaneous or gingival incisions. Decompression of the medial orbital wall can be performed up to the anterior wall of the sphenoid sinus. This technique produces decompression which is comparable to external techniques. The authors present an emergency case of endoscopic orbital decompression in Graves'-Basedov patient with loss of vision. Vision recovery was immediately after endoscopic transnasal decompression. Endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques.

[Cervico-facial actinomycosis--case reports]. / Postac twarzowo-szyjna promienicy--opis przypadków.

In the article the authors made the review of actinomycosis bibliography. They also presented characteristic features infections enter ways, course of the disease, diagnostic tests and treatment methods. Two cases of face and neck actinomycosis were presented. All of them treated in Katowice-Ochojec Hospital ENT ward in last five years. Abnormal clinic symptoms made difficulty to put the diagnosis. Satisfactory results were achieved after set up final diagnosis and proper treatment.