[Response changes of inner ear observed after middle ear surgery]. / Zmiana odpowiedzi ucha wewnetrznego obserwowana po operacjach na uchu srodkowym.

BACKGROUND: Relationship beetwen middle ear surgery and function of the inner ear is known. This problem is often discussed in determination of hearing improvement after otosurgery. AIM: Usefulness of the click evoked otoacoustic emissions (CEOAE) in evaluation of the inner ear function and effectiveness of tympanoplasties is discussed. MATERIAL AND METHODS: Prospective analysis of 70 individuals operated on middle ear problems was performed. Patients were divided into four groups of otosurgeries: stapedoplasty, myringoplasty, type II tympanoplasty, type III tympanoplasty. Otoacoustic emissions and pure tones audiometry were performed before middle ear surgery and 3 months after ear operation. RESULTS: In all established groups improvement in ABG (air bone gap) was observed. Improvement of bone conduction thresholds in the ranges of 5dB was observed in individuals with otosclerosis and type I and type III tympanoplasty. Patients with type II tympanoplasty developed no changes of bone conduction threashold after otosurgery. CONCLUSIONS: Behind routine audiometric diagnostics otoacoustic emissions can be useful in postoperative evaluation of effectiveness of middle ear surgery (especially in patients operated on otosclerosis and in individuals with chronic otitis media with intact ossicular chain).

[Skull base defects in the middle and posterior cranial fossa with unchanged mucous lining middle ear spaces]. / Ubytki kosci podstawy srodkowego i tylnego dolu czaszki przy niezmienionej wysciólce ucha srodkowego.

BACKGROUND: Skull bone defects in the region of middle ear are usually observed in the cases of chronic otitis media. Such loses can also be congenital, posttraumatic, iatrogenic or due to hyperplasia. They can potentially lead to development of otogenic intracranial complications. AIM: We present the patients who were not observed during otosurgery to have any pathological changes to the mucous of the middle ear and were diagnosed as having bone defects in the middle and/or posterior cranial fossa. We discuss also methods of reconstruction during otosurgery. MATERIAL AND METHODS: The prospective analysis involves the patients operated on middle ear in the Department of Otolaryngology at the Jagiellonian University of Krakow in the years 2007-2011. 495 first-time otosurgeries were performed in this period of time. RESULTS: Skull bone defects were diagnosed in 46 patients who had undergone surgery and 25% of these patients had no changes to the middle ear mucous. This points to congenital etiology of the defects. In this group the most common cause for otosurgery was chronic otitis media (10 patients). In 1 patient, bone defect occurred along with otosclerosis. In patients with congenital skull bone defects otogenic intracranial complications were described in 4 cases. CONCLUSIONS: Nearly 80% of skull bone defects remain asymptomatic; they are revealed incidentally during the surgery of the middle ear. The above observations emphasize the significant role of preoperative imaging diagnostics. The methods of bone defects reconstruction using the fascia, strengthened with the pedicle muscle flap where larger defects occurred, as well as with either bone lamella or cartilage in particular cases, proved successful.

[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.

[Endoscopic treatment of giant skull base osteomas]. / Endoskopowe leczenie olbrzymich kostniaków podstawy czaszki.

INTRODUCTION: Osteomas are relatively common, benign, slow-growing neoplasms. Mainly occurring in frontal and ethmoid sinuses. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. AIM: We discuss our experiences in endoscopic treatment of giant osteomas. RESULTS: In giant osteomas Draf III or Lothrop approaches are prefered. Periostium of the orbit was intact in all cases. Discharge of cerebrospinal liquid was not observed. CONCLUSIONS: Size of tumor determines type of surgical aprroach. Endoscopic surgery is more and more popular way in surgical treatment of giant osteomas.

[Reoperations in patients with chronic otitis media cholesteatomatosa]. / Reoperacje w przebiegu otitis media chronica cholesteatomatosa.

INTRODUCTION: Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. AIM: This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. MATERIAL AND METHODS: Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004-2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. RESULTS: 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. CONCLUSIONS: The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.

Serum zinc level in depressed patients during zinc supplementation of imipramine treatment.

BACKGROUND: Recurrent major depression is associated with decreased blood zinc concentrations that may be increased by effective antidepressant therapy. Some clinical investigations point to alterations of the zinc level in blood as a potential marker of depression. METHODS: A placebo-controlled, double blind study of zinc supplementation to imipramine therapy was conducted on sixty patients fulfilling the DSM-IV criteria for major depression (18-55 years old, 40 females, 20 males). Moreover, a group of 25 healthy volunteers was recruited (16 females, 9 males). Blood samples were drawn for the assay of serum zinc once from the control subjects and four times (before, and then 2, 6 and 12 weeks after the beginning of treatment) from the depressed subjects. RESULTS: We report that: 1) the serum zinc level was significantly lower (by 22%) in depressed patients than in healthy volunteers, 2) all groups demonstrated a gradual increase in zinc concentrations over the period of imipramine treatment with or without zinc supplementation, 3) treatment-resistant patients demonstrated lower concentrations of zinc (by 14%) than treatment-non-resistant patients, 4) zinc concentrations were higher in zinc-supplemented patients than in placebo-supplemented patients, 5) zinc supplementation increased zinc concentrations over the period of treatment, and 6) at a 12-week imipramine treatment, a significant negative correlation was demonstrated between the Montgomery-Asberg Depression Rating Scale and the serum zinc level together with a concomitant increase in serum zinc in patients in remission. CONCLUSIONS: Serum zinc is a state marker of depression.

[Amanitin determination in mushroom poisoning diagnostics]. / Oznaczanie amanityny w diagnostyce zatruc grzybami.

There are some serious poisonings with toxic mushroom species in Poland every year. Good prognostics in the cases is correlated to short time from mushroom consumption to hospitalization, correct distinguish not specific gastrointestinal and Amanita phalloides syndrome and immediately specific treatment. The purpose of the paper was to make appraisal of usefulness of amanitin blood and urine determination and transaminases activity determination (ALT, AST) in diagnostics of mushroom poisoned patients up to three days after mushroom consumption. The material was twenty two retrospective histories of mushroom poisoned patients treated in the years 2007-2008. Amanitin blood and urine determinations were made by ELISA method. Urine amanitin results in samples collected within 40 h from mushroom consuming were positive in all Amanita phalloides syndrome cases. Serum amanitin determination was not useful for the diagnostics. Trans-aminases activity determinations let to distinguish Amanita phalloides syndrome on the second and the third day after mushroom consumption. In the first poisoning phase (within 24 h), the ALT and AST activities were in normal ranges and only amanitin urine determination let to confirm or exclude Amanita phalloides poisoning. Amanitin urine determinations were useful to take fast decision about specific treatment and avoid internal organs dysfunctions.

[Defects of facial nerve canal according to a character and localisation of lesions in middle ear]. / Ubytki kostne kanalu nerwu VII a charakter i lokalizacja zmian w uchu srodkowym.

AIM: The aim of this study is the assessment the occurence of facial nerve canal (Fallopian canal) dehiscence in patients operated due to chronic medial otitis (depending on the location and type of inflammatory lesions) and in patients operated due to otosclerosis. Facial nerve paresis in patients with dehiscence found during surgery was also assessed. MATERIAL AND METHODS: The study group consisted of 456 patients operated at the Department of Otolaryngology at the University Hospital in Krakow, 359 due to chronic otitis media and 97 due to otosclerosis. Facial nerve canal dehiscence was found during surgery in 26 patients (6% of operated patients) more frequently in men. RESULTS: In most cases (54%) dehiscence was observed in patients with chronic medial otitis with cholesteatoma (27% with choleseatoma and 27% with cholestatoma and granulation), and equally (23% each) dehiscences were observed in patients with granulation and even in patients with otosclerosis and chronic simple otitis media. In over than half (54%) of patients with dehiscence inflammatory lesions involved all the middle ear spaces, in 15% the tympanic cavity, attic and antrum while in 4% of patients inflammatory lesions were limited to the tympanic cavity, attic or antrum. CONCLUSIONS: The facial canal nerve dehiscence is observed in majority in patients with cholestatoma and granulation, especially in tympanic region. In some cases its coexistence with circuit canals dehiscence.

[Vertigo and labyrinthine fistules at the patients operated on chronic otitis media]. / Zawroty glowy i przetoki perylimfatyczne u chorych operowanych z powodu przewleklego zapalenia ucha srodkowego.

BACKGROUND: Otitis media is a frequent condition. Chronic infections of the middle ear can lead to defects of bony walls and development of complications. MATERIAL AND METHODS: We performed prospective analysis of patients operated on chronic otitis media in ENT Department Jagiellonian University of Krakow between 2004-2008. Nearly 650 operations on ears were performed in that period of time. RESULTS: Labyrinthine fistule was observed in 40 patients: 36 with COM, 3 with otosclerosis and 1 after head trauma. Vertigo was mentioned in ca. 30% of individuals in preoperative history. Labyrinthine fistule was usually noticed in the course of chronic cholesteatoma otitis media and chronic granulomatous otitis media and almost always it was located on lateral semicircular canal. In these patients defects of facial nerve bony canal were more frequent but the frequency of skull base defects was like in patients without labyrinthine fistule. The fistules were sealed routinely with a fragment of fascia. This procedure proved effective.

[An analysis of indications orthodontic for surgical treatment of Waldeyer ring hyperplasia in pediatric patients of the Otolaryngology and Stomatology department of the University Hospital of Krakow]. / Analiza wskazan ortodontycznych do leczenia operacyjnego przerostu pierscienia Waldeyera u dzieci w materiale Kliniki Otolaryngologii i Instytutu Stomatologii CMUJ w Krakowie.

INTRODUCTION: The lymphatic system of a child's throat has got a special role to play. It is the first line of contact for a developing organism with antigens in the environment. For a particular group of children Waldeyer ring hyperplasia is much bigger than it is for a usual group of patients. And that's what causes different illnesses AIM: The analysis of ortodonthic indications for surgical treatment of adenotomy and tonsillotomy. MATERIAL AND METHOD: The research was conducted on a group of hospitalized children in the Otorhinolaryngologic and in Stomatology Departament of Jagiellonian University Hospital in Krakow. The were treated for pathologic hypertrophy of adenoid and palatine tonsils. The analysis of occlusion disorder was carducted and the assessment of surgical and orthodontic treatment was performed. RESULTS: In the years 2002-2006 in the Otorhinolaryngologic and in Stomatology Departament of Jagiellonian University Hospital in Krakow 24 children were being treated for pathologic hypertrophy of adenoid and/or palatine tonsils accompanied by an occlusion disorder. CONCLUSIONS: Adenotomy with or without tonsillotomy is one of the most frequently performed surgical operations on children. Throughout many years the indications for this procedure were infringed. Nowadays the operation is being performed mainly because of the rhinological and/or otological indications for the pathologic hypertrophy of adenoid and/or palatine tonsils. There is also another indication although it is less frequently used. This indication is an occlusion disorder which needs to be treated orthodontically.

[Laryngeal leiomyosarcoma in clinical cases of the Otolaryngology Departament in the University Hospital of Krakow]. / Leiomyosarcoma krtani w materiale klinicznym ORL w Krakowie.

INTRODUCTION: Leiomyosarcoma is a malign neoplasm coming from the non-epithelial tissue. It rarely developes in the larynx. 0,5-1% of all of the neoplasm of the larynx is leiomyosarcoma. It usually developes in the age of 40-70 and mostly effects men. AIMS: Improvement of the therapy of patients with leiomyosarcoma of the larynx. MATERIAL AND METHODS: The analysis of the medical documentation of the 5 patients with the diagonosis of leiomyosarcoma laryngis treated in Otorhinolaryngologic Clinic UJ in 1996-2006 was performed. The procedures and effects of the therapy were analized. RESULTS: In this particular period of time 11 patients was operated because of the sarcoma of the larynx. In this group there were 5 cases of leiomyosarcoma, 4 cases of chodrosarcoma and 1 case of agniomyxofibrosarcoma and 1 case of sarcomy synoviale. CONCLUSIONS: On the basis of the material of the Clinic the frequency of these tumors was estimated and the therapeutic procedure including widening of the surgical indications for the partial laryngectomy and narrowing the indications for nodular surgery of the neck was proposed.

[Ways of treatment of non-malignant laryngeal tumors in older patients--laryngeal amyloidosis]. / Zasady leczenia niezlosliwych guzów krtani u chorych w wieku podeszlym--amyloidoza krtani.

INTRODUCTION: Amyloidosis' are the heterogeneous group of diseases characterized by extracellular accumulation of secondary protein structures causing progressive disturbances of the organs. Amyloid deposits are localized mainly in the tissues of parenchymal origin (spleen, kidneys, liver) and as far as otorhinolaryngologic organs are concerned the primary pathological process is rare. AIM: The case presentation and the diagnostic and surgical procedure analysis with the assessment of the effects of therapy in patients in elderly age with amyloidosis of larynx. MATERIAL AND METHODS: A 82-year-old patient with a tumor of the larynx hospitalized in Otorhinolaryngology Clinic in Cracow. The first symptom of the pathologic process in this patient was an increasing laryngeal dyspnoe and the preliminary macroscopic assessment based on indirect laryngoscopy and endoscopy suggested the proliferative process from the group of non-epithelial neoplasm. RESULTS: In this case tracheotomy was performed and four days later the pathologic change was endoscopically removed from larynx. The improvement of the local state was achieved which enabled to decannulate the patient. CONCLUSIONS: The amyloid deposits in otorhinolaryngologic organs are rare. Isolated changes in larynx suggesting malign neoplasm are the benign changes but on account of the specificity of the organ they can be a real threat to life.

[Pseudomonas and alcaligenes--pathogens of the chronic ear infection in clinical cases at the Otolaryngology Department of the University Hospital in Krakow]. / Pseudomonas i Alcaligenes--patogeny przewleklego zapalenia ucha srodkowego w materiale klinicznym ORL.

INTRODUCTION: Otitis media chronica is the most common disorders encountered in otolaryngology. The great multitude of different bacteria which may couse otitis media constitutes the need for bacteriological diagnostics, especially in cases where classical conservative treatement of the inflammatory process fails. MATERIAL AND METHODS: Bacterial culture results procured from hospitalized and ambulatory patients which chronic otitis media, admitted from 2003 to 2006 at the otolaryngological department were analyzed. RESULTS: In total 47 patients were found to have their middle ear infected with Pseudomonas species and 1 patient with Alcaligenes xylosoxidans rods. CONCLUSIONS: In cases of ear infection which fails conservative treatment, especially in immunocomprimised can be caused by pathogens which are resistant to most commonly administered antibiotics.

[The influence of tobacco smoking on the lead and cadmium concentration in the urine of pregnant women and the health state of newborn]. / Wplyw palenia tytoniu przez kobiety ciezarne na stezenie olowiu i kadmu w moczu oraz na stan zdrowotny noworodka.

The purpose of the study was to measure the concentration of lead and cadmium in urine of women who smoked, were exposed to environmental tobacco smoke (ETS) and were unexposed during pregnancy. The correlations between exposition to tobacco smoke and socioeconomic factors, course of pregnancy and health status of newborns were estimated. The subjects of the study were 231 pregnant women. Information about exposition to tobacco smoke, socioeconomic state, course of pregnancy and health status of newborns was collected from self-created questionnaire. The estimation of tobacco smoke exposition of the women was based on the questionnaire data and their urine cotinine concentration. The urine concentration of lead and cadmium was measured by atomic absorption spectrometry with graphite furnace. The mean urine lead concentration of women who smoked, were exposed to ETS and unexposed to tobacco smoke during pregnancy were respectively: 38.2 +/- 59.1; 36.2 +/- 50.1; 32.7 +/- 53.5 ng/ mg of creatinine, and mean cadmium concentration were respectively: 1.9 +/- 1.6; 1.1 +/- 1.2; 1.3 +/- 1.5 ng/mg of creatinine. The correlation between the urine concentration of cadmium and cotinine was statistically significant. Increased frequency of tobacco smoking was in the group of the women aged less than 25 years, that finished primary or vocational school, had monthly income less tan 500 zl/family member, and have smoking partners. In the group of women who smoked during pregnancy the childbirth was statistically more often by caesarian and supported delivery. The newborns of mothers who smoked and were exposed to ETS had birth weight respectively 348.5 g and 281.1 g smaller than newborns of unexposed mothers. The length of newborns of smoking and ETS exposed mothers were respectively 2.8 cm and 0.7 cm shorter then newborns of unexposed mothers.

[Alcaligenes xylosoxidans--a pathogen of chronic ear infection]. / Alcaligenes xylosoxidans--patogen przewleklego zapalenia ucha.

INTRODUCTION: We discuss a case of a 48-year old man admitted to our Department with symptoms of chronic ear infection, that didn't answer to typical conservative treatment. The culture of the discharge was positive for Alcaligenes xylosoxidans. MATERIAL AND METHODS: We report characteristic features of that bacteria and we compare them with features of other pathogens typical for otitis media. We present performed treatment too. RESULTS: Alcaligenes xylosoxidans is a nonfermenting gram-negative rod. It can be confused with other nonfermentive, gram-negative rods, especially Pseudomonas species, in clinical specimens so that its role as a significant pathogen may be underestimated. Alcaligenes xylosoxidans is a part of normal human flora, especially skin and gastrointestinal tract, and can cause serious infections in human (especially in patients with immunodeficiency and premature children). CONCLUSIONS: Reports about Alcaligenes xylosoxidans as a cause of chronic otitis media are very rare and it can be supposed to stay a new kind of ear infection.

[Effect of tobacco smoke exposure on urine lead concentration of pregnant women]. / Wplyw narazenia na dym tytoniowy na zawartosc olowiu w moczu kobiet ciezarnych.

Among other toxic compounds, tobacco smoke contains also heavy metals, for example lead. Lead can cross the placenta barrier and have negative influences on fetus development. In the study compared urine lead concentration of pregnancy women exposed to tobacco smoke (active smokers and exposed to environmental tobacco smoke--ETS) with unexposed. There was find that mean urine lead concentrations in groups of pregnant women exposed and unexposed to tobacco smoke was no different (F2,189=0.2 p>0.8). However it was found that in urine of women exposed to tobacco smoke the concentration of lead increase with increase the concentration of cotinine (r2=0.14, t106=4.2, p<<0.0001).