[Estimation of quality of voice after removal of neoplasms T1 and T2 of glottis with simultaneous reconstruction of vocal fold with pedunculated sterno-thyroid muscle flap]. / Ocena jakosci glosu po usunieciu nowotworów T1 i T2 glosni z jednoczesna rekonstrukcja faldu glosowego uszypulowanym platem z miesnia mostkowo-tarczowego.

INTRODUCTION: In recent years there has been an increasing number of cases of cancer, including cancer of the larynx. The choice of treatment should be primarily dictated by the complete elimination of cancer, but from the point of view of the patient, an important factor to keep in mind, is the quality of the voice that will be created at the end of the therapeutic process. AIM: The aim of this study was to evaluate the voice quality of patients after partial surgery of the larynx with vocal fold reconstruction pedunculated sterno-thyroid muscle flap. MATERIALS AND METHODS: The study included 30 men aged 53-72 years who were treated at the Clinic of Otorhinolaryngology Department of Medical-Dental Medical University of Warsaw on account of cancer of the larynx, qualified according to the TNM classification T1 or T2. The radical removal of cancer was associated with resection of one vocal fold, laryngeal pouches and ventricular fold. In 15 patients, included to the group I at the end of phase oncology surgery, a reconstruction of "vocal fold" pedunculated sterno-thyroid muscle flap were performed simultaneously. The group II consisted of 15 patients who underwent surgery that removed only the cancerous lesions. Impact assessments arising after surgery of voice disorders on quality of life were made using the self-test failure of the voice (Voice Handicap Index in the Pruszewicz modification). The nature of the created voice was studied using GRBAS scale. All patients performed the laryngostroboscope examination. With "IRIS" program, prepared by a team at Wroclaw University of Technology, the voice was recorded, and then was subjected to acoustic analysis. In addition, noise level and the maximum phonation time was measured. RESULTS: The results indicate that the patients of group I gained a better voice confirming the values of objective acoustic analysis. The assessment made by the scale GRBAS patients who supplemented the resulting loss after tumour removal, with much less hoarseness of voice, did not have the hyperkinesis and there was no puff character. They had the better flow of voice and phonation time of vowels "a" was much longer. The assessment of quality of life of patients in group I made in a test of the VHI was higher than in group II. The laryngostroboscope examination confirmed a good phonatory occlusion and a nearly regular, healthy vocal fold vibration in patients who had received flap of muscle. CONCLUSIONS: Evaluation of the quality of voice after removing the tumor multiplicity in the glottis with simultaneous reconstruction "vocal fold" has confirmed that this is a very good surgical technique, which allows radically curing cancer for the simultaneous preservation of a good voice. The operation has limited indications for radiotherapy because of the desire to preserve the phonatory function of the larynx, and thus avoids the negative effects of radiation.

[The application of KTP laser in otolaryngology - 3 years experience]. / Zastosowanie lasera KTP w otolaryngologii - 3 lata doswiadczen

INTRODUCTION: The KTP laser is popularly called the green laser is a type of Nd: YAG laser zawdzieczajacy its name from the additional element of KTP crystal which is a wavelength of 532 nm. AIM: The aim of this paper is to present our 3-year experience in the application of KTP laser in otolaryngology. MATERIAL: In the Department of Otolaryngology, CSK MON Military Medical Institute in Warsaw from 2008, performed 211 operations using the green laser. The study group was 89 women and 122 men aged 12 to 94 years (mean age 53.2 years). METHODS: The surgery was performed 15-watt KTP Aura laser. All guestrooms are fibers with a diameter of 0.2, 0.4 and 0.6 mm, and guides for inserting the fiber ends are not. Results: In 3-year period have made a 211 KTP laser surgery including the nasal cavity, mouth, larynx and trachea, and the outer ear. In the procedure adopted one day 76 people, and at least 111 patients stayed in hospital for 4 days. RESULTS: In our material patients after UPPP tonsillectomy and operations, in addition to a negligible bleeding during surgery, rarely also had late bleeding (5%). In our clinic konchoplastyki performed based on the so-called. technique of "cross-hatching". The laryngeal endoscopic surgery is used micromanipulator, if we are to remove a large tumor of the larynx much better to use the guide laryngeal. CONCLUSIONS: The KTP laser is an important tool in the operational procedures in otolaryngology in large part due to the high activity and its complexity hemostatycznemu assistant. Become familiar with the operation of the laser and improvement of surgical techniques allows patients to propose a modern surgical procedures. Improves the possibility of radical treatment of tumors of the larynx endoscopic method.

[Respiratory papillomatosis--new methods of treatment]. / Brodawczaki górnych dróg oddechowych--nowe metody leczenia.

BACKGROUND: Respiratory papillomatosis is caused by HPV. The most common location in head and neck is larynx, palatine tonsils and arches of palate, uvula and mucosa oral and nasal cavity. The disease is benign but recurrent. The aim of this study was to estimate new methods of treatment respiratory papillomatosis based on intralesional injection of cidofovir into sites where papillomas had just been excised. METHODS: The purpose of the study were 59 patients treating in Otolaryngology Clinic Stomatology Department Medical University of Warsaw. The treatment was based on surgical excision of papilloma and after it intralesional injection of cidofovir in after 4-5 weeks. RESULTS: We observed the patients during 28 months. 41 patients had 4 times intralesional injection of cidofovir. 18 patients had increased number of injection of ciodofovir because of recurrent papilloma. Rest of this group of the patients clinical studies showed remission disease. CONCLUSION: Surgery with intralesional cidofovir injection in the place after removal of papilloma is very effective methods. We observed that this treatment caused long lasting remission of papilloma recurrence.

[Influence of handicapped of patency nose on quality created of voice]. / Wplyw uposledzonej droznosci nosa na jakosc tworzonego glosu.

AIM: The aim of researches was estimation of quality of voice after operations correcting of the nasal septum deviation. MATERIALS AND METHODS: With researches one embraced 40 men in two groups (group I: 20-30 of years old, group II--above 50 of year old). Voice one priced before operation of corrective nose and 6 of months after executed intervention. In researches one used with scale GRBAS, with estimation laryngostroboskopy of function of vocal folds, with acoustic analysis created of voice, with measurement of maximum phonation time and with Polish version of VHI. Patency of nose priced patients at subjective help of five--gradual of scale. RESULTS: After 6 months all ill favourably priced effect executed of operation improving patency of nose. In scale GRBAS in group I examined voice one priced as normal at 12 ill (60%), instead in group II only at 3 men (15%). Above--regularity refers also of roughness of voice. In stroboscope research executed before operation at almost all ill one ascertained diminution of amplitude of twitches of folds vocal and mucosal wave. After 6 months after operation in group I both amplitude of twitches of vocal folds as and mucosal wave at mostly examined surrendered of normalization. In group II profitable changes we observed only at several of persons. Maximum phonation time of vowel "a" after operation of nose surrendered to extension in both groups examined, however men of group I reached significantly better results, with average value approaching to norms. In acoustic analysis to distinct improvement, but only in group I examined surrendered parameter NHR. In estimation with test VHI six months after operation sense of disturbances of voice in both groups surrendered to diminution, in proportion to qualities created of voice. CONCLUSIONS: Operating--restoration physiological air passage at all ill causes diminution or liquidation earlier stepping out of disturbances of voice. From passed researches results, that improvement of health, manifesting itself voice euphonious is in considerable percentage possible only at young persons. At ill in middle age and older to entire liquidation of disturbances of voice will reach in single chances.

[Application of lasers in treatment of larynx diseases]. / Zastosowanie laserów w leczeniu chorób krtani.

In otolaryngology, CO2 laser is the first and most commonly applied device. Such lasers as Ny:YAG generating visible light having wavelength 532 nm referred to as KTP laser due to the Name of the crystal where infrared light is converted to visible light. Such wavelenght, having green colour, due to strong absorption in haemoglobin is applied in treatments on tissues having dense blood vessels. The object of the work is to analyze larynx microsurgery laser treatments performer between 1994-2008 in the Otolaryngology Department of the Military Medical Institute CSK MON in Warsaw. The examination covered 445 patients including 142 women (31.9%) and 303 men (68.1%) aged between 12 and 80 (the average age of 48.2 year olds) who Were qualified in 1994-2003 for endoscopic laser surgery of the larynx. The operations field was watched using OPMI-11 operating microscope (Zeiss, Germany) allowing 4-16 times blow-up. Larynx laser microsurgery was performer using white laser beam: CO2 Illumina 40 (Heraeus LaserSonics, Germany) and green laser beam using KTP AURA XP laser (AMS, USA). The total of 445 larynx laser microsurgeries were performer. In recent years our clinic has seen an increase in the number of operations using this technique. The largest group were patients with recognized precancerous conditions (33.0%) and larynx carcinoma (26.4%). The next group in terms of the number of patients were 114 patients (20.6%) with recognized juvenile papilloma. Complications were observed in 180 patients. Table III show the type of recognized complications. The most commonly observed was swelling of the mucous membrane (48.3%), the rarest type was subcutaneous emphysema (3.3%). It was concluded that larynx laser microsurgery is a safe method and a valuable tool in treatment of larynx diseases, especially precancerous conditions and early forms of larynx carcinoma; that complications following procedure are relatively rare, usually mild, not life-threatening, and most often subsiding after a few days.

[The cytokines at maxillary sinuses washings as inflammatory process expression]. / Cytokiny w popluczynach z zatok szczekowych jako wykladnik stanu zapalnego.

INTRODUCTION: In a pathogenetic chain of chronic sinusitis there is a set of cellular and humoral factors that are accepted as characteristic of a chronic inflammatory process. These include mast cells, granulocytes (basophilic and acidophilic), macrophages, lymphocytes, leucotriens (leukotrieny), and some pro-inflammatory cytokines. In the majority of cases these are effector factors that finalise pathogenetic immunological response. By determining concentration of pro-anti-inflammatory and immunoregulatory cytokines present in the place where the disease process is in progress we can distinguish the type of inflammatory condition and thus select the type and duration of treatment. MATERIAL AND METHODS: The subject of the study was a group of 75 patients aged 18-60 with clinically confirmed chronic sinusitis; the diagnosis was made on the basis of history, physical examination as well as otolaryngological and imaging (CT scans) examination. Measurement of cytokines' activity was based on establishing concentration of cytokines in 1 ml (millilitre) of liquid recovered from puncture of maxillary sinus and subjected to centrifugation (lavage of maxillary sinuses) using ELISA (an immuno-enzymatic method) and kits produced by R&D company (Minneapolis, USA.) The following levels were examined: IL-1beta, IL-1ra, IL-4, IL-6, IL-10. RESULTS: Depending on the type of inflammatory process (allergic or bacterial), a difference in the level of IL-1beta/IL-1ra and IL-4 i IL-10 concentration was discovered in patients examined. The static analysis focused on how progression of the disease influenced the results obtained. CONCLUSIONS: Determining the amount of cytokines in maxillary washings allows differentiating chronic sinusitis.

[Results of rehabilitation of voice and speeches after implantation of valve vocal prosthesis at ill after total removal of larynx]. / Wyniki rehabilitacji glosu i mowy po wszczepieniu wentylowych protez glosowych u chorych po calkowitym usunieciu krtani.

Ill applying with extensive infiltration of new-growth within of larynx will demand radical therapeutic procedure, which is operation completely removals of organ. Aim of work was estimation of voice and speeches ill with vocal fistula in comparison with oesophageal voice and speech and with physiological. With research one embraced 81 men in age 42-75 of years. Group I--32 ill with cancer of larynx, to which executed total laryngectomy and placed the voice prosthesis Provox 2. Group II--30 ill after operation total removals of larynx, whiches used oesophageal speech. The control group III--19 persons with physiological voice. Research one began from subjective estimation of replacement voices. Then one executed measurements maximum phonation time of vowel "a". To objective estimation of voice one used polish programme "IRIS". One compared: maximum intensities of voices for colloquial speech, F0, Jitter, Shimmer and NHR. In subjective estimation voice of the patients with voice prostheses was greater freedom of production and voice of the patients with voice prostheses appeared to be more loud in relation to oesophageal voice. Greatest statistical essential differences one obtained between maximum phonation times of vowels "a" where clearly is visible, that values obtained for voices of the patients with voice prostheses are to nearer values for physiological voices. Obtained averages values of acoustic analysis: F0, Jitter, Shimmer and NHR did not show statistical of essential differences between voices supplementary, though parameters of voice of the patients with voice prostheses one was to nearer parameters of physiological voice. Characterization perceptive and acoustic speech of the patients with voice prostheses in comparison with oesophageal speech is to nearer characterization of physiological speech. Lack of satisfactory effects of rehabilitation of oesophageal speech, should be effective secondary implantation vocal prosthesis.

[Role of psychological factors in pathogenesis of disturbances of voice caused with vocal nodules]. / Rola czynników psychologicznych w patogenezie zaburzen glosu spowodowanych guzkami glosowymi.

INTRODUCTION: Hoarseness is most frequent complaint notified by ill in phoniatric outpatient clinics. Looking of causes notified of disturbances of voice often we ascertain in larynx existence of vocal nodules. Changes these come into being in consequence of excessive or irregular phonations. Single incident of disturbances of voice caused with oedema changes nascent of in consequence of inappropriate work with voice does not wake of our trouble, instead returns this of type of complaint provoke to other researches coexisting of etiological factors this diseases. AIM: Estimation of influence of individual personality trait of ill on formation of vocal nodules. MATERIAL AND METHODS: One examined 20 patients with vocal nodules classified to treatments operating and 20 without disturbances of voice. All patients were subjected to otolaryngological and stroboscopic examinations. Character created of voice one examined at help of scale GRBAS, instead influence of disturbances of voice on quality of life ill at help of test VHI. Psychological examinations one executed using questionnaire State-Trait-Anxiety-Inventory (STAI), questionnaire NEO-FFI and questionnaire of aggression Buss-Perry. RESULTS: Obtained results showed, that persons with returning vocal nodules, both during of research as in different situations everyday lives characterizes with higher level of fear and have greater inclination to worry oneself. Ill from groups examined in greater degree are extroverts, show greater activity and more are contagious socially in comparison to persons of comparative group. Attitude this in situations extorting rivalry will be able to be ruthless, are well organized guided, scrupulous and consistently endeavour to aim. CONCLUSIONS: Wanting efficiently to treat persons with returning vocal nodules we should subject to ill psychological examination and in once of ascertainment of irregularity to correct it, what at simultaneous correct treatment of organic changes should diminish frequency or to eliminate returns of disease. Skill psychological looks on patient by therapists treating disturbances of voice and speeches in case not large emotional instabilities probably would be able to improve results of treatment ill not only with functional disturbances of voice but also with disturbances of voice caused with organic changes in larynx.

[Submucosal arytenoidectomy with laterofixation in the treatment of bilateral vocal fold paralysis following lung cancer]. / Arytenoidektomia podsluzôwkowa z laterofiksacja jako leczenie z wyboru w obustronnym porazeniu faldów glosowych spowodowanym guzem pluca.

INTRODUCTION: Submucosal arytenoidectomy is one of many surgical techniques used in the treatment of the median bilateral vocal fold paralysis. The technique evolved from the large extralaryngeal operation to the endoscopic, intralaryngeal procedure. Gradually it excluded tracheostomy from the methods of treatment of dyspnoea caused by bilateral vocal fold paralysis. MATERIALS AND METHODS: We present two patients with bilateral vocal fold paralysis with dyspnoea, caused by the neoplastic mass primarily localised in the left lung. In both cases the nonmicrocellular carcinoma was diagnosed. Both patients had the left recurrent laryngeal nerve palsy for more than 18 months and the right nerve palsy for 10-14 days before admission, with concomitant dyspnoea. RESULTS: Both patients were successfully extubated, 24 hours after the operation. The breathing improved significantly. None of the patients had to be reintubated or tracheotomized. CONCLUSIONS: The Authors conclude, that the arytenoidectomy with laterofixation should be the method of choice in the treatment of the bilateral vocal fold paralysis caused by the lung cancer. The method does not exclude the upper airway from the respiratory tract which is of special importance for the patients with the lung problems.

[The existence vomeronasal organ in adult humans]. / Wystepowanie narzadu lemieszowo-nosowego u ludzi doroslych.

The influence of chemical substances (feromones) on human emotional and physical condition has fascinated psychologists, sexuologists and laryngologists since centurie. Literature conveys inconsistent information on vomeronasal organ (VNO) occurrence in humans. This organ is often called Jacobson's, and 2 symmetrical openings leading into it, located on both sides of septum, are called Ruyasch's ducts. The aim of the study was to analyze vomeronasal organ occurrence in humans in relation to age and sex. The study was conducted in a group of 634 patients, aged 18-80 years. All patients underwent routine ENT examination including rhinoscopy, nasal cavity examination with usage of 2.5x magnification lens (surgical glasses) and surgical microscope with 10x magnification. All persons had nasal cavities examined endoscopically. Every time presence of vomeronasal organ openings, along with localization, size and symmetry of these was noted. Subjects, who presented Jacobson's organ, were asked to fill a questionnaire concerning influence of smells on erotic sensations. Vomeronasal organ was fund in 312 persons, that is 49.21%. In 83.65% of cases vomeronasal organ opening size was smaller than 0.2 mm, what restricted its visibility to usage of magnifying lens, microscope, or endoscope. In 16.34% of cases only vomeronasal organ ducts openings were well visible in routine rhinoscopy without magnification. Vomeronasal organ was found more often in men than women. VNO was significantly more rare in patients with nasal septal deviation. In these cases, vomeronasal organ was usually found unilaterally, in all the cases on the concave side of deviated nasal septum.

[Influence executed of occupation on self-evaluation disorders of voice]. / Wplyw wykonywanego zawodu na samoocene zaburzen glosu.

INTRODUCTION: Loud speech is essential element everyday lives of man. Aim of researches was comparison of self-evaluation existing disorders of voice about averages degree intensifications at ill executing different jobs. MATERIAL AND METHODS: With research one embraced 60 of persons with similar disturbances of voice caused vocal folds hypertrophy changes. In first group was 30 of persons working with voice, whereas second group embraced 30 ill workers in factories on positions immediately connected with production this institution. Estimations of influence of disorders of voice on quality of life ill one executed by means of self-evaluation polish test. RESULTS AND CONCLUSIONS: Detailed analysis of tests showed, that exist significant differences among groups in estimation both qualitative as and quantitative. Hoarseness about averages degree intensifications at persons, of which occupation will demand usages of voice in estimation ill has indeed negative influence on their family life, professional and sociable. Patients, of which occupation will not demand in work of voice in spite of bad self-evaluation physical frame of mind did not feel of significantly negative influence of hoarseness on their functional and emotional frame of mind. Part from them noticed worse understanding their speeches in rooms, in of which reigns noise. Is this probably connected with specificity of place of work, and also with heedless articulation and with lack to known of bases of correct emission of voice. Lack of essential influence of disorders of voice on existence examined ill causes unfortunately too often behind time proper treatments, what can have dangerous for their lives of result, if reason talked over dysfunction is neoplasm of larynx. Above-mentioned conclusions are following evidence indicating on necessity of realizing reliable and of exact preventive researches in places of employment, and thanks ago early to detect and efficiently to treat even neoplastic diseases.

[The hearing organ men assessment on basis of judgments of committee recruits in 2001-2003 years]. / Ocena narzadu sluchu mezczyzn na podstawie orzeczen komisji poborowych w latach 2001-2003.

In spite of a considerable progress in research techniques, assessment of health state of large social groups still poses a problem. The most extensive and complete information can be obtained from examinations of recruits. 1 092 506 recruits were examined by medical boards between 2001 and 2003. There were analyzed health certificates with the clause 21 comprising various disorders of the hearing organ (excluding inflammatory illnesses) and defining the recruits' health categories as "D"--unqualified for military service at peace as well as the category "E"--unqualified for military service at peace and in the case of mobilization or at war referring to the level of hearing. 6836 certificates of laryngological illnesses, 5057 certificates with the clause 21, 2684 certificates of the "D" category and 2088 certificates of the "E" category were issued. The certificates given by recruitment commissions refer to a homogeneous group as regards sex and age. They are issued for a short period of time and based on equal criteria. This also refers to laryngological illnesses including estimation of the hearing organ.

[Subjective and objective assessment of voice quality after surgical treatment of overgrowth changes in vocal folds]. / Subiektywna i obiektywna ocena jakosci glosu chorych po chirurgicznym leczeniu przerostowych zmian faldów glosowych.

OBJECTIVES: Complex estimation of results of treatment micro surgically of ill larynx with overgrowth changes of vocal folds and comparison of usefulness different methods of research phonation function of larynx, and also estimation of influence disturbances of voice on functional state, emotional and physical ill applying to Clinics. MATERIAL AND METHOD: With researches embraced group 40 ill with hoarseness, of which reason one was organic changes of vocal folds under form of polyps, of vocal nodes, of cyst and of swellings Reincke, attended operational (microsurgery with method Kleinsasser). Voice priced twice before intervention surgical and 3 months after operation. In researches used with scale GRBAS, with estimation laryngostroboscopy of function of vocal folds, analysis acoustic created of voice and Polish version of Voice Handicap Index (VHI). RESULTS: Values p = 0.001 for "G" and p = 0.002 for "B" testify about special usefulness these two values of scale GRBAS in estimation of efficiency used treatments. Value p = 0.0004 obtained in research VHI proves distinct statistical symptomatic between estimation one's own voice and his of influence on life ill before and after operation and about good result of treatment. Statistical analysis examined of acoustic parameters showed on indeed statistical symptomatic difference only in chance of variable RAP (p = 0.03). Greatly usefulness for estimations used treatments showed stroboscope research, where especially character close of glottis (p = 0.003) and changes of mucosal wave (p = 0.008) show distinct dependence statistical difference before and after operation. CONCLUSIONS: In complex estimation of voice ill after operation overgrowth changes of vocal folds greatest usefulness showed research of laryngostroboscopy, Voice Handicap Index (VHI) and qualification of grade-G and breathiness-B in scale GRBAS. Thanks used to method VHI ill oneself priced efficiency effect treatments, and doctor knowing answers of patient on each questions canned properly to steer further treatment.

[Techniques of intranasal drug use]. / Technika podawania leków donosowych.

The aim of the study was to assess the incidence of changes in nasal mucosa in patients treated with long term intranasal corticosteroids and to determinate reasonability of intranasal drops administration in symptomatic treatment of nasal catarrh. The study included the total of 1962 patients. Within this group, 612 patients treated with intranasal corticosteroids underwent full laryngological examination to evaluate the status of nasal mucosa. In the group of 1350 users of web-based Allergologic Courier, who had used intranasal drops because of "runny nose" within last 3 months before the examination, a questionnaire survey was performed. The study results reflect poor knowledge the methods of nasal drops administration among patients, as well as low effectiveness of educational initiatives led by physicians and pharmacists. In 25 persons from 367 examined (6.81%) who used steroid spray locally, and who showed up in laryngological outpatient clinic, nasal mucosal damage was diagnosed for the first time. Mucosal damage was most frequently located in the right nasal septal mucosa--in 21 patients (5.72% of total patients) that was connected with improper nasal inhaler positioning and right hand movements directing it towards septum in the right nasal meatus. Among patients, who have remained under regular laryngological care in outpatient clinic (all of them are instructed of drug administration technique), only 5 persons (2.04%) out from 245 in the study group presented changes in nasal mucosa. No differences between changes occurrence on each side of nasal septum were found. Without proper training, only 8.52% from 1350 examined persons had been taking nasal drops in a proper manner to achieve its effectiveness.