Efficacy of petrosectomy in malignant invasion of the temporal bone.

We present the outcomes of lateral, subtotal, and total petrosectomies in patients with invasion of the temporal bone by specific primary cancers, with particular emphasis on survival in the advanced stages of disease. We made a retrospective study of 20 consecutive patients (squamous cell carcinoma of the temporal bone, n=11, and primary cancer of the parotid gland with infiltration of the lateral skull base, n=9) treated by total, subtotal, or lateral petrosectomy at the University Department of Otolaryngology, a tertiary referral centre, between June 2006 and December 2010. Fourteen of the 20 patients were alive at the time of analysis, and follow-up ranged from 36-60 months. Six of seven patients whose disease relapsed (4 local and 3 distant metastases) died. The three-year, disease-free survival was 65% and the overall survival 68%. Survival between those with temporal bone and parotid tumours did not differ significantly. The combined group survival was affected by involvement of invaded resection margins (n=6, p=0.03). Involved margins were significant in the development of recurrence (p=0.03). Tumour stage, nodal involvement, type of operation, sex, age, skin involvement, facial palsy, and previous history of disease had no impact on prognosis. There was a significant difference in the survival curves of patients with carcinoma of the temporal bone with and without facial paresis (n=6 compared with n=5; p=0.046). Two of 11 free flaps required revision of the anastomoses, but none was lost.

The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology.

OBJECTIVE: To determine the long-term efficacy of submucosal corticosteroid injection plus dilatation for subglottic stenosis as a single modality treatment in granulomatosis with polyangiitis and relapsing polychondritis, as compared with idiopathic subglottic stenosis and traumatic subglottic stenosis. METHOD: Patients who underwent dilatation for autoimmune causes were identified. Corticosteroid injection into the submucosa of a stenotic segment was followed by serial dilatation. Definitive improvement was defined as good airway patency for more than 24 months with no further procedures needed. Clinical, demographic and procedural data were recorded. RESULTS: Patients (n = 45) were divided into three subglottic stenosis groups: traumatic (n = 24), idiopathic (n = 9) and autoimmune (n = 12). Patients were treated with dilatations, with a median follow-up time of 76 months. Six patients were tracheostomy-dependent. There were no statistical differences in the number of final improvements between autoimmune, idiopathic and traumatic groups, with values of 75, 56 and 71 per cent, respectively. There was no statistical difference between granulomatosis with polyangiitis plus relapsing polychondritis and idiopathic subglottic stenosis in terms of decannulation rates. CONCLUSION: Granulomatosis with polyangiitis and relapsing polychondritis patients have better improvement rates than patients with other subglottic stenosis types.

Cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery salvaged with regional and free flaps.

BACKGROUND AND PURPOSE: The object of the study was to present our own experience in the management of cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery. MATERIAL AND METHODS: The study group consists of 5 patients treated in Department of Otolaryngology Poznan University of Medical Sciences in 2009-2011. Different materials and techniques were used to repair the perforations: infrahyoid flap, primary sutures supported by sternocleidomastoid muscle flap, thigh flap and forearm flap in two cases. RESULTS: Four out of 5 patients were referred to our department in a poor general condition, with infected neck fistulas, three patients after prolonged conservative treatment, and three patients after initial attempts to repair the perforation outside our institution. One-stage reconstructive surgery was successful in three cases, while in two others secondary interventions were necessary. Total hospital stay ranged in the analysed group from 23 to 191 days, hospital stay in our department from 1 to 62 days, hospital stay from the final procedure from 18 to 26 days. Swallowing function was within normal limits in all cases 12-14 days after the surgery. CONCLUSIONS: The authors' experience shows that in long-lasting and infected cervical oesophageal and hypopharyngeal perforations following anterior cervical spine surgery distant flaps should be primarily used as a source of a well-vascularized and unchanged tissue. It seems to be crucial to repair the perforations immediately after the first symptoms appear - such an approach significantly reduces total hospital stay and improves the prognosis.

Polymorphisms of DNA repair genes and risk of squamous cell carcinoma of the head and neck in young adults.

Squamous cell carcinoma of the head and neck (HNSCC) most frequently arise in the epithelial tissues of the upper aerodigestive tract. Patients with HNSCC, aged <45 years are categorized as young adults (YA). They are characterized by more severe form of this disease and often lack of classical, causative risk factors (tobacco smoking, alcohol abusing) in comparison to older (typical) patients (OP). The study purpose was to establish an anticipated protective role of DNA repair genes polymorphisms against cancer-causing agents. It was assumed that the polymorphisms in these genes may have a significant role in the etiology of HNSCC in YA. Studies were carried out on three groups: YA group with HNSCC (n = 90), young healthy group without cancer (YH, n = 160) and OP with HNSCC (n = 205). Three polymorphisms in DNA repair genes were analyzed: XPD ex23: A35931C, XRCC1 ex10: G28152A, and XRCC3 ex7: C18067T. The choice of these genes was connected with their involvement in three different DNA repair pathways. Genotyping was carried out by polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP) technique. Statistical analysis included: calculation of odds ratio (ORs), 95 % confidence intervals (CIs) and p value. There was no significant difference in the distribution of XPD genotypes in YA compared to OP or YH. The XRCC1 AA genotype variant was observed less frequently in HNSCC YA (4.7 %) than in YH and in OP group (17.1 and 10.8 %, respectively). XRCC3 CT genotype variant was observed more frequently in HNSCC YA (61.8 %) than in YH (36.3 %) and this result is statistically significant. This variant was associated with the borderline increased risk of HNSCC development in an early age, however, a similar tendency was not observed in case of double mutated TT variant. The established differences of genotypes distribution do not seem to differentiate substantially YA and OP in head and neck cancer risk.

[Rare case of the cervical vagal neurinoma]. / Rzadki przypadek nerwiaka odcinka szyjnego nerwu blednego.

Neurinoma is the most common tumor of the neurogenic origin. Primary location in the neck with the vagal nerve as a source is very rare clinical situation (less than 100 cases published in the literature). The authors would like to present a case of 35 old men with vagal neurinoma. Main symptoms included painless neck tumor found on palpation. Differential diagnosis included the pedicled cyst and metastatic neck mass. The ultrasound picture was unclear. The intraoperative findings suggested the tumor arising from the vagal nerve. In first day after the surgery hoarseness appeared with paresis of the right vocal cord in the examination. The final histological evaluation revealed neurinoma.

Distortion product otoacoustic emission (DPOAE) in tinnitus patients.

The aim of this study was to determine the effect of tinnitus (experiment I) and the combined effect of tinnitus and sensorineural hearing loss (experiment II) on the distortion product otoacoustic emission (DPOAE) for two age groups of tinnitus patients. Tinnitus patients with normal earing, along with normal-hearing control subjects, participated in experiment I. They were divided into two age groups, below 50 and above 50 years. Experiment I showed that the DPOAE levels in the tinnitus patients were lower than those in the normal-hearing (nontinnitus) subjects. The differences depended on the frequency and the age of the patients, suggesting the confounding influence of presbyacusis. The second group of tinnitus patients with increasing and notch-like hearing loss participated in experiment II. They were also divided into two age groups, below 50 and above 50 years. The data from experiment II showed that DPOAE activity well reflects the increasing and notch-like hearing loss functions up to about 40 dB HL. The effect of age on the DPOAE level was clearly noted only for the tinnitus patients with clinically normal-hearing thresholds and was ambiguous for the tinnitus patients with hearing loss.

Poznan's program of cochlear and brainstem implantation: a general review.

The cochlear implantation program in Poznan started in January 1994. Within 8 years, 151 patients were implanted (149 cochlear and 2 auditory brain-stem implants). The implanted group comprised 111 children and 40 adults. We have extended the lower age limit for cochlear implant candidates, and the youngest implanted patient was 18-months-old at the time of surgery. We have also implanted six multi-handicapped subjects. All patients were implanted with different nucleus devices (22, 24 M, 24 K, 24 Contour, 24 Double Array and 24 ABI). Insertion of the Nucleus 24 Contour electrode carrier requires a little larger cochleostomy in comparison with conventional straight array. After insertion, the intraoperative measurements are taken (impedance telemetry, electrically evoked stapedius reflex and NRT). The day after surgery, each patient undergoes an X-ray examination (the cochleogram or cochlear view). The calculated length of the electrode array insertion was 12.75-24.0 mm (mean: 22.05 mm) and the degree of electrode rotation was 180-540 degrees (mean: 292.82 degrees). After speech processor switch-on, we performed NRT measurements. Our results indicated that the NRT threshold was in 51.4% of the dynamic range within the group of examined patients. The adults' progress of rehabilitation was checked during individual sessions. The rehabilitation of children included two rehabilitation schedules: continuous ones and weekly rehabilitation camps. The progress of the recovery process of implanted children enabled them to change their school profile from hearing impaired to mainstream. Voice rehabilitation is often monitored by acoustic analysis using the Multi Dimensional Voice Program (MDVP).

[Anatomy of the temporal bone assessed by high resolution computed tomography, endoscopy and microscopy]. / Badania anatomiczne kosci skroniowej z uzyciem tomografii komputerowej o wysokiej rozdzielczosci, endoskopii i mikroskopii.

Visualization of all anatomical structures inside the middle ear is indispensable to perform surgical treatment. The aim of this study was the attempt to show landmarks of the middle ear employing different imaging techniques. The value of high resolution CT with 1 milimeter layers, Hopkins endoscopy and operating microscope with 16 time magnification were assessed. The primary evaluation by the CT scans were made and directed the further efforts. Endoscopy and microscopy were performed as a next diagnostic steps and allowed for tool-eye visualization of all important anatomical structures in the middle ear. The anatomy and pathology of tympanic cavity assessed by three different technics used together occurred to be much more detailed. The results were complementary and useful.

[A rare case of adenoid cystic carcinoma of the larynx]. / Rzadki przypadek oblaka krtani.

One case of rare laryngeal tumor--adenoid cystic carcinoma in 58 year old woman was reported in this paper. Authors wanted to drew attention to few complaints and only slight dysphagia in comparison to local extensiveness of the neoplasm. Diagnostic difficulties were underline. Epidemiology, clinical course and therapy were demonstrated in laryngeal adenoid cystic carcinoma.

[An attempt to identify the most frequent genomic mutations responsible for isolated deafness in patients after cochlear implantation]. / Próba identyfikacji najczestszych mutacji genowych odpowiedzialnych za gluchote izolowana u pacjentów nieslyszacych zaopatrzonych w implant slimakowy.

The aim of this study was to identify subjects with 35delG mutation of GJB2 gene as the most frequent genetic cause of deafness. Deaf patients receiving cochlear implantation at the ENT Clinic at University of Medical Sciences in Poznan and their family members were recruited to the study. Peripheral blood lymphocytes DNA was amplified in allele-specific PCR and analysed for single strand conformation polymorphism (SSCP) to detect mutation at DFNB1 locus. 35delG mutation at both alleles was found at 42.9% of deaf patients and 29.4% of health relatives were found to be carrier of the mutation at one allele. The study is thought to be a first step in analysis of typical mutations in Polish deaf population.

[A case of objective tinnitus caused by palatal myoclonus]. / W sprawie obiektywnych szumów usznych o charakterze mioklonii podniebiennych.

The very rare case of palatal myoclonus manifesting in objective tinnitus was discussed. Options of surgical and pharmacological treatment were analysed with particular emphasis of therapeutic success with application of muscle-relaxant--Baclofen.

[Epidemiology of acoustic neuromas in Poland]. / Epidemiologia nerwiaków nerwu VIII w Polsce.

In 1996 the Polish Skull Base Surgery Society was founded and assembled mainly otolaryngologists and neurosurgeons from several dozen clinics and hospital wards. Its main aim was to encourage co-operation between those two specialties. For this reason among others a common project entitled: "Epidemiology of acoustic neuromas in Poland" was launched in 1997. Information was collected from questionnaires in seven neurosurgery and in three laryngology centres in the years from 1997-1998. So far, no epidemiology of acoustic neuromas was established for the population of Poland. In this span of time 72 patients were operated. The agreement upon similar criteria, terminology and ways of evaluating the treatment results was quite a problem. Most cases were found in patients in their fifties (19 cases) and sixties (15 cases), mostly women. The average duration of the symptoms was 43 months. Large tumours predominated in the study group--T4 in the Samii (67%), and > 26 mm in the Tos (74%) classification. Most commonly, the patients were subjected to computer tomography in the preoperative period. All patients were treated surgically, with the retrosinusoid approach predominating. Only in one case, the translabyrinthal approach was used. Authors of this work are all participants of the project. Despite the fact that the number of performed operations is not too high, the fact of co-operative studies on the results by representatives of those two specialties can be considered a success. Hopefully, in the next years it will gradually be possible to widen the scope of the project and obtain more precise information.

[Does the electrodes insertion depth influence speech rehabilitation progress in CI patients?]. / Czy glebokosc wprowadzenia elektrod ma wplyw na postepy w rehabilitacji mowy u osób z wielokanalowym wszczepem slimakowym?

Many interdisciplinary teams from difference CI centers are studying speech rehabilitation process of implanted patients. Speech rehabilitation progress depend on many conditions like: duration of deafness, age at implantation, cause of deafness. Rehabilitation of postlingually deafened patients is very short. These subjects return very fast to the world of sounds. By the other side speech rehabilitation of prelingually deafened patients needs much more time (years). There are although well seen differences in language skills acquisition inside these groups. It confirmed, that speech rehabilitation after cochlear implantation could depends on others conditions as well. The aim of this study was electrodes insertion depth evaluation (cochleograms) and its influence on speech rehabilitation progress.

[Comparison of DNA adducts between oral, pharyngeal and larynx cancer]. / Porównanie zachowania sie poziomu adduktów kancerogen: DNA w rakach jamy ustnej, gardla i krtani.

The results concerning examination of DNA adducts in oral (23 patients), pharyngeal (23 patients) and larynx cancer (10 patients) subjects are presented. DNA adduct levels were compared in respect to anatomical structure (primary tumour location), number of cigarettes smoked, TNM stage, and age of patients. DNA was isolated from removed tissue (tumour and non-tumour surrounding tissue) using detergent/phenol extraction. 32P-postlabelling assay including nuclease P1-enhancement modification was applied. Aromatic DNA adducts were found in all studied tissues. Total DNA adduct levels (tumour and non-tumour tissues) was lowest in larynx cancer, higher in oral cancer and highest in pharyngeal cancer. There were no influence of age into formation of DNA adducts. The higher level of DNA adducts was found in tumour tissue of oral cancer in the group of smokers with metastasis into lymph nodes.

[The quality of life in head and neck cancer patients: description of randomized examination formula based on standardized questionnaires EORTC QLQ C-30, EORTC QTQ-H-N35 and Kiel Questionnaire]. / Jakosc zycia u chorych z nowotworami glowy i szyi--wstep do randomizowanych badan opartych na standaryzowanych kwestionariuszach EORTC QLQ C-30, EORTC QLQ-H&N35 i Kwestionariuszu Kilonskim.

The notion of quality of life (QL) was first introduced in the US in the 50-ies. This notion is much broader then health, it is a personal, subjective feeling of well-being that comes from actual, widely-meant life experiences. The QL is not a measurable value, however, it may be assessed by means of appropriate indices. In the contemporary holistic attitude to a patient, in modern oncology, QL has become a parameter of equal importance to other values characterizing the treatment success, as important as numbers describing e.g. mean survival, disease free survival, or neoplasm controlled survival. Head and neck neoplasms bring about deterioration of the basic functions of the organism such as: breathing, swallowing, speaking and senses: hearing, taste and smell. Application of treatment may intensify pain, dyspnea, hoarseness or cause any kind of discomfort. It influences directly the patients' family and social life. Comparison of QL of patients treated for larynx, tongue, tonsill, glands, and paranasal sinuses neoplasms depending on localisation of primary foci, advancement of the disease, the applied treatment and its radicality, age, sex, place of living (town/country), and educational level. Correlation between the subjectively assessed QL and the objectively evaluated condition of the patient is measured. In ENT Dept. K. Marcinkowski University of Medical Sciences 46 patients were examined from May to September 2000. EORTC QLQ C-30, EORTC QLQ-Head and Neck and HAD scale were used. Kiel Questionnaire was introduced in September. The main reason for introducing it was the fact, that surgery is the method of choice in the treatment of head and neck malignancies in our Dept. The team composed of a psychologist and an ENT doctor has been working together on objective assessment of each patient. The QL assessment may be of practical importance when trying to improve the model of health care in cases of oncological patients. This knowledge enables us to learn how the accompanying side effects of therapy influence the QL of our patients, and how these problems may be overcome by proper education, advice, and support provided by the qualified staff. The authors are evaluating the QL in the period of 2, 6 months and 1 year after surgery in patients not supported psychologically. Our goal, in the future, is to introduce the psychological treatment, i.e. repetitive meetings in small groups, conducted by a psychologist. We have contacted 4 major ENT centers in Poland in order to coordinate the research on detailed assessment of QL in Head and Neck Cancer Patients in Poland. The results will be presented in the further publications.

[Intracranial complications of sinusitis in the material of the Otolaryngology Department, K. Marcinkowski University of Medical Sciences in Poznan in the years 1964-1999]. / Zatokopochodne powiklania wewnatrzczaszkowe w materiale Kliniki Otolaryngologii AM w Poznaniu w latach 1964-1999.

In the period of 35 years 25 patients with intracranial complications of paranasal sinusitis were treated in the Department of Otolaryngology of the Karol Marcinkowski University School of Medical Sciences in Poznan. In the past 15 years the number of complications decreased annually by half. Intracranial sinusal complications were more frequently present in young men. In 25 patients abscesses of the frontal lobe and epidural abscesses were most often diagnosed. Surgical treatment was carried out in each case when the inflammation process spread into the bony parts or into intracranial space. The method of choice in treatment of frontal lobe abscess and subdural abscesses is elimination of sinuses inflammatory foci with a simultaneous evacuation of the abscess by puncturing of the abscess and gradual exchange of its content into antibiotic solution. Intensive antibiotic therapy was carried out for the period of 4 weeks. Mortality rate in our material concerned patients with the brain frontal lobe abscesses and amounted to 12%. In the last 15 years we succeeded to treat all 17 patients.

[Cochleography and cochlear view as the way of assessment of successful surgical inner ear implantation]. / Kochleogram i projekcja slimakowa jako sposoby oceny skutecznosci chirurgicznej implantacji ucha wewnetrznego.

115 cochlear implantation were performed in ENT Department Karol Marcinkowski University of Medical Sciences in Poznan in 1994-2001. Nucleus Mini System 22 and Nucleus 24 of Cochlear Ltd were used in these operations. Two approaches were performed: middle fossa approach in one case and traditional one. The aim of this study was evaluation of cochleogram and cochlear view as the ways of assessment of successful inner ear implantation. One of X-ray projection were performed in implanted patients 24 hours after implantation. In cochleograms the degree of electrodes rotation in cochlea was calculated. The number of inserted electrodes in cochlea was calculated in cochler view projection. Described X-ray projection were performed in 70 patients. On X-ray projection (cochleograms) rotation degree of electrodes in majority were equal or higher than 250 grades (according to literature it is sufficient for successful speech rehabilitation). X-ray projection--cochlear view confirmed full insertion of electrode.

[Cochlear implantation through the middle fossa approach]. / Implantacja wszczepu slimakowego z dojscia przez srodkowy dól czaszki.

The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding.

[Contribution to etiology of otitis media with effusion]. / Przyczynek do etiologii wysiekowego zapalenia ucha srodkowego.

BACKGROUND: Otitis media with effusion is characterized by gathering and retaining of effusion within the tympanic cavity and the structures of the mastoid bone. The aim of this study was to explain the role of immunological reaction in pathogenesis and development of this disease. MATERIAL AND METHOD: The studied group comprised 6 patients aged between 7 and 14 years. The effusion present within the tympanic cavity was aspired and then the agarare gel immunoelectrophoresis was performed. After 24 hours the precipitation stripes of the IgA and IgG were analysed. Blood serum specimens were also collected in the studied group. After centifrugation, blood serum concentrations of IgA and IgG were evaluated. RESULTS: IgA and IgG were present in the effusion taken from the tympanic cavity in all examined cases. The level of IgA was higher in older individuals.

[Otoacoustic emission evaluation in patients with tinnitus]. / Badanie otoemisji akustycznych u chorych z szumami usznymi.

Analysis of otoacoustic emission is highly objective, noninvasive and sensitive method representing cochlear function. In The Centre of ENT Rehabilitation in Poznan more than 900 patients were evaluated because of tinnitus. Standard tests were broaden by otoacoustic emission (SOAE, TEOAE, DPOAE) and results are discussed. Our results suggest that otoacoustic emission is possible to record in normally or with moderate hearing loss patients. 18 patients had SOAE. Only 2 patients had the same frequency of SOAE and tinnitus.