Hearing Improvement in the Patients Operated on Otosclerosis by Right-Handed Surgeons.

BACKGROUND: Otosclerosis is a disease of the osseous labyrinth. The disease causes 5% to 9% of all cases of hearing loss and 18% to 22% of conductive hearing loss. The treatment of choice is a surgery. The hearing improvement after the operation is determined by various factors. AIMS/OBJECTIVES: The aim of the analysis is to determinate changes in hearing after stapedoplasty in view of surgery side in the patients operated on otosclerosis by right-handed surgeons. MATERIAL AND METHODS: The analysis involved patients hospitalized and operated on otosclerosis between 2012 and 2018. Only patients with their first middle ear surgery due to otosclerosis were included in the study. The patients were operated by 2 right-handed surgeons who used the same surgical technique and had similar experience in otosclerosis surgery. The study included patients who were divided into 2 groups: with self-tightening prosthesis and with manually tightening prosthesis. RESULTS: The procedure performed by right-handed operators on the left side using prostheses requiring manual fixation on the incus was associated with poorer audiometric results compared to the results of surgeries on the right side. In patients with the self-tightening prostheses, the audiometric improvement of hearing was bilaterally comparable independently from operation side. CONCLUSION: (1) The dependence of hearing improvement on the surgery side was demonstrated in cases of surgeries performed on the left ear by right-handed surgeons, particularly with manually tightening prosthesis. (2) Self-tightening prostheses in stapedotomy limit the human factor, reducing the risk of complications after otosclerosis surgery and provide repeatable hearing improvement.

Otosclerosis - analysis of factors influencing the improvement of hearing after surgical treatment.

<b>Introduction:</b> Otosclerosis is a disease that occurs only in humans, in the course of which there are foci of pathological ossification in the temporal bone. The etiology of the dise ase is not fully understood. Treatment of the conductive component of hearing loss is surgical. The results of the treatment are influenced by factors related to the surgery, the local condition of the middle ear and the function of the inner ear. </br></br> <b>Aim:</b> The aim of the study is to identify factors influencing the improvement of hearing in patients treated surgically due to otosclerosis. </br></br> <b>Material and methods:</b> The study included patients who underwent otosclerosis for the first middle ear surgery and under-went stapedotomy. Considering the factors that may affect the outcome of surgical treatment, the patients qualified for the analysis were divided into subgroups. All patients underwent a medical history and physical examination of otorhinolaryn-gology and a complete set of audiological examinations. </br></br> <b> Results:</b> A statistically significant reduction in cochlear reserve was observed in all patients after stapedotomy. The be-neficial effect of the performed treatment on the improvement of threshold values of bone conduction in patients with mild sensorineural hearing loss was also confirmed. Intraoperative removal of adhesions present in the tympanic cavity significantly improved hearing in terms of bone conduction values, especially at 500 Hz. </br></br> <b> Conclusions:</b> (1) The conducted study confirmed the influence of factors related to the local condition of the middle ear lining on the final result of otosclerosis surgery; (2) Audiometric markers of cochlear otosclerosis, observed before surgical treat-ment, are an unfavorable factor in the improvement of hearing after the performed treatment.

Olfactory Dysfunction in Patients With Relapsing-Remitting Multiple Sclerosis Treated With Disease-Modifying Therapies.

BACKGROUND: Olfactory dysfunction evaluated with time-consuming tests was more common in patients with multiple sclerosis (MS) than in controls and correlated with neurological deficit. The aim of the present study was to compare olfactory function between patients with relapsing-remitting MS (RRMS) and controls with short and simple screening tool-the Sniffin' Sticks Identification Test (SSIT)-and search for its association with clinical and radiological features of the disease. METHODS: The study included 30 controls and 30 patients with RRMS treated with disease-modifying therapies-injectables (interferon ß or glatiramer acetate, N = 18) and oral drugs (dimethyl fumarate or fingolimod, N = 12). Hyposmia was defined as a score of 6 points or fewer in the SSIT olfactory test. The data concerning number of previous relapses, disability in Expanded Disability Status Scale (EDSS), and recent brain magnetic resonance imaging (MRI) scan were collected. Moreover, thalamic volume and third ventricle width were recorded in every patient. Additionally, cognition and fatigue in patients were evaluated 24 months after olfactory assessment with the Symbol Digit Modalities Test (SDMT) and Fatigue Scale for Motor and Cognitive Functions (FSMC), respectively. RESULTS: Patients with RRMS had a higher risk of hyposmia than controls (66.7% vs 36.7%, OR = 1.82, 95% CI, 1.10-3.67, P = .02). Neither inflammatory (number of previous relapses or new brain MRI lesions) nor neurodegenerative (EDSS, SDMT, and FSMC scores; thalamic volume; third ventricle width) MS features did not correlate with SSIT score (P > .05). In patients treated with oral drugs, olfactory dysfunction correlated with FSMC cognitive subscale (r = -0.90, P = .006). CONCLUSIONS: Olfactory dysfunction is nearly twice as common in RRMS as in controls and correlates with fatigue level in patients treated with dimethyl fumarate or fingolimod.

The Audiometric Assessment of the Effectiveness of Surgical Treatment of Otosclerosis Depending on the Preoperative Incidence of Carhart's Notch.

Objective: The presence of Carhart's notch at 2000 Hz in otosclerosis links the changed bone conduction for this frequency with the otosclerotic process occurring in the oval window. The aim of this study is to perform an audiometric assessment of the effectiveness of surgical treatment of otosclerosis depending on the incidence of Carhart's notch. Methods: The analysis included 116 patients treated surgically for the first time due to otosclerosis. Patients were divided into 4 groups depending on the occurrence of Carhart's notch, determined by pure-tone audiometry (PTA) before the surgery and 36 months afterward. The mean value of bone conduction thresholds was calculated for 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz in the groups in which the Cahart's notch was observed. This value of bone conduction (BC) was a reference point for further analysis in patients who had no preoperative or postoperative Carhart's notch. Results: The analysis indicated that Cahart's notch in preoperative PTA is a statistically significant improvement factor for average BC. It was found that over a longer observation period, the presence of Carhart's notch has adverse effects on the size of the postoperative air-bone gap, and consequently on hearing improvement after surgical treatment. A comparison between patients from the two groups without preoperative Carhart's notch found that no beneficial effects of the surgery on speech comprehension were observed regarding high-level sensorineural hearing loss (SNHL). Conclusions: (1) In a long-term observation post-stapedotomy, average BC values were found to improve. Nevertheless, the improvement is less evident in patients with preoperative Carhart's notch. (2) Disappearance of Cahart's notch after surgical treatment of otosclerosis is a good prognosis of improvement in speech audiometry. (3) Deep SNHL in the absence of Carhart's notch in PTA constitutes a bad prognostic factor for improvement in speech audiometry in patients qualified for surgical treatment of otosclerosis.

Chronic suppurative otitis media with cholesteatoma and chronic otitis media with granulation by scanning electron microscopy based on analysis of 140 patients.

Objectives Chronic purulent cholesteatoma of the middle ear, as well as to a lesser extent chronic granulomatous otitis media, lead to destruction of bone structures within the middle ear space. Above process is controlled by the OPG/RANKL/RANK system. Material and methods An analysis of 140 patients operated on due to chronic otitis media was performed. For the detailed analysis in the scanning electron microscope, 40 patients were selected who had been diagnosed with chronic cholesteatoma of the middle ear and chronic granulomatous otitis media. Finally the study in SEM included 20 patients. Results The regular structure of cholesteatoma depicted in the Scanning Electron Microscope concerned 5 patients with diagnosed. In the remaining 7 patients, the system was irregular and even chaotic. Lack of regularity can also be observed in the case of granulation tissue, which in the SEM image presented itself as an irregular tissue mass without detectable regularities. Conclusions 1. Regular pattern of the cholesteatoma matrix cells observed in some patients with chronic cholesteatoma of the middle ear reduces the molecular permeability of inflammatory cytokines, concurrently limiting the destructive activity on bone structures. 2. The presence of inflammatory granulation tissue in the middle ear is accompanied by an influx of leukocytes: neutrophils and lymphocytes, which are the source of pro-inflammatory cytokines, the growth of which activates the processes leading to the damage of bone tissue and the development of inflammation. 3. No specimen of acquired cholesteatoma revealed presence of commensalism like organism on the surface of exfoliated human epithelium of Demodex species.

Carhart Notch-A Prognostic Factor in Surgery for Otosclerosis.

OBJECTIVE: Otosclerosis is an underlying disease of the bony labyrinth. This disorder, occurring only within the area of a person's temporal bone, is characterized by a progressive hearing loss and tinnitus. MATERIAL AND METHODS: The study looked for the answer to the question of whether the presence or absence of Carhart notch in the presurgical tonal audiogram affects the final outcome of the otosclerosis surgery. RESULTS: The analysis included 140 patients operated on for the first time due to otosclerosis between 2010 and 2016. The study group consisted of 107 women aged from 19 to 62 (average age: 40.33) and 33 men aged 27 to 59 (average age: 38.23). Analysis showed a statistically better result of stapedotomy in patients without the notch than in the same procedure in patients with the notch present. The opposite situation occurred in the case of stapedectomy. CONCLUSION: (1) The presence of a refraction of the bone conduction curve with a depth of 10 to 20 dB at a frequency of 2000 Hz (the so-called Carhart notch) in the presurgical tonal audiogram is an unfavorable prognostic factor in relation to closing the cochlear reserve and improving bone conduction after the stapedotomy. (2) Regardless of the presence or absence of Carhart notch in the presurgical tonal audiogram, stapedotomy is the procedure with the highest efficiency in the treatment of otosclerosis.

Scanning Electron Microscopy in the Evaluation of Defects to the Ossicular Chain in the Course of Chronic Otitis Media.

OBJECTIVE: Chronic otitis media is a heterogeneous disorder. Chronic suppurative otitis media with cholesteatoma and, to a lesser extent, chronic otitis media with granulation lead to the destruction of bone structures within the middle ear. Bone loss may appear in the prominence of the horizontal semicircular canals and the bony canal of the facial nerve. The inflammatory process may spread to the bony labyrinth of the sigmoidal sinuses and the cranial cavities. MATERIALS AND METHODS: The analysis comprised the examination of fragments of auditory ossicles removed during surgery in 21 patients with various types of chronic inflammation of the middle ear. The purpose of this study was to evaluate the usefulness of scanning electron microscopy in evaluating the erosion of middle ear ossicles in different types of chronic otitis media. Images captured at various magnifications were used for the best possible illustration of the observed lesions in bone tissue. RESULTS: The observed lesions and the degree of bone surface damage were dependent on the type of chronic inflammation of the middle ear. The largest destructive changes in the ossicular chain were observed in chronic otitis media with cholesteatoma; smaller changes were observed in chronic otitis media with granulation. CONCLUSION: In the case of damage to the ossicles inflicted by inflammation, the use of a modeled bone block made of a temporal bone taken from outside the tympanic cavity or a biomaterial prosthesis is a good choice in ossiculoplasty.

Biomaterials in the Reconstruction of Nasal Septum Perforation.

INTRODUCTION: Septal perforations are among the most common craniofacial defects. The causes of septal perforations are varied. OBJECTIVES: The purpose of the study was to develop a septal cartilage implant biomaterial for use in the reconstruction of nasal septal perforations and prepare personalized implants for each patient individually using 3D printing technology. METHODS: Fragments of septal nasal cartilage from 16 patients undergoing surgery for a deviated nasal septum were analyzed to establish microfeatures in individual samples. A scanning electron microscope was used to estimate the microstructure of the removed septal cartilage. 3D models of porous scaffolds were prepared, and a biomaterial was fabricated in the shape of the collected tissue using a 3D printer. RESULTS: Of the various materials used in the Fused Deposition Modeling (FDM) technology of 3D printing, PLLA was indicated as the most useful to achieve the expected implant features. The implant was designed using the indicated pre-designed shape of the scaffold, and appropriate topography, geometry and pore size were included in the design. CONCLUSIONS: The implant's structure allows the use of this device as a framework to carry nanoparticles (antibiotics or bacteriophages). It is possible to create a porous scaffold with an appropriately matched shape and a pre-designed geometry and pore size to close nasal septal perforations even in cases of large septal cartilage defects.

Long-term results of a hearing test in patients operated for chronic otitis media.

<b> Introduction: </b>Chronic otitis media is characterized by tympanic membrane perforation and conductive hearing loss. In the active form of this disease, there will also be periodic or permanent otorrhea. With a number of surgical techniques available depending on intraoperative findings, otosurgery is the treatment of choice in such cases, the extent of which depends on the type and extent of the pathological changes. <br><b>Material and Method:</b> We carried out an analysis of 79 patients with chronic otitis media undergoing surgery at the Department of Otolaryngology, Jagiellonian University Medical College in Kraków between 2005 and 2014. Total audiometry was used as a part of hearing assessment, before the surgery, 6 months after the surgery and in the distant 10-year observation period. In addition, each patient completed the questionnaire and was examined by an otolaryngologist. <br><b> Results:</b> The analysis included 79 patients operated on due to chronic otitis media. The mean bone conduction (for frequencies 500,1000 and 2000 Hz) before surgery was 31.8 dB, it did not differ significantly (p = 0.355) after 6 months after surgery (32.8 dB), while it significantly increased (p < 0.001) in a distant 10-year control of 43.4 dB. The mean air conduction (for frequencies 500, 1000 and 2000 Hz) before the procedure was 57.6 dB, it significantly improved in the early control by 50.5 dB, at p < 0.001. In long-term follow-up it increased again to 61.3 dB and was significantly different from the early postoperative period (p < 0.001). The mean air-bone gap for frequencies 500, 1000 and 2000 Hz before surgery was on average 26.4 dB, it was significantly (p < 0.001) reduced in the postoperative period by 17.6 dB. The level of air-bone gap remained at a similar level in distant control. <br><b>Conclusions:</b> (1) A completely preserved ossicular chain in the absence of active chronic otitis media is the best prognosis for stable hearing improvement over the years with normal inner ear function; (2) Reoperation worsens the long-term results of a hearing test compared to the first operation.

Does the short-term exposure to radiofrequency electromagnetic field originating from mobile phone affect auditory functions as measured by Acoustic Admittance and Evoked Otoacoustic Emission tests?

BACKGROUND: Mobile phones constitute an important source of radiofrequency electromagnetic field (RF-EMF) for humans. Taking into account high sensitivity of sensory hair cells of the inner ear to endogenous and exogenous agents, the potential impact of mobile phone usage on auditory organs is of particular interest. AIM: The aim of the study was to evaluate the impact of short-term exposure to RF-EMF generated by a mobile phone during 15-minute simulated phone call on human hearing as measured by Transient Evoked Otoacoustic Emission (TEOAE) and Acoustic Admittance Testing (AAT). MATERIAL AND METHODS: Within-subject study was performed on 23 healthy volunteers. All of the participants underwent TEOAE and AAT before and immediately after 15-minute simulated phone call with the use of a standard, modern smartphone. Analyzed parameters included: static compliance of tympanic membrane, middle ear pressure, ipsi- and contralateral acoustic reflex thresholds and percentage of signal reproducibility in TEOAE for exposed and non-exposed ear. Additionally, the results were compared in subgroups distinguished basing on self-reported sensitivity to RF-EMF originating from mobile phones. RESULTS: No statistically significant differences were identified between results of TEOAE and AAT before and after exposure, both in exposed and non-exposed ear. The results of EMF sensitive and non-sensitive subjects were comparable in all performed tests. CONCLUSIONS: Short-term exposure to mobile phone electromagnetic field did not influence auditory functions as measured by Evoked Otoacoustic Emission test and Acoustic Admittance Testing.

Pre- and Post-operative Speech Audiometry Evaluation in Patients with Chronic Otitis Media.

OBJECTIVES: The primary function of the human auditory system is to ensure proper speech comprehension. Speech audiometry enables the assessment of the conductive and the sensory aspects of the ears, providing some insight into the central auditory processing function. MATERIALS AND METHODS: We conducted an analysis of 79 patients with chronic otitis media (COM) undergoing surgery at the Department of Otolaryngology, Jagiellonian University Medical College, in Kraków between 2005 and 2014. Tonal audiometry and speech audiometry were used as part of the hearing assessment. The pre-operative and long-term post-operative findings were compared, focusing mainly on speech audiometry. RESULTS: At the end of the mean 10-year follow-up, a significant percentage worsening in speech comprehension from the baseline was demonstrated in group III (hearing loss > 70 dB(decibels)), as compared with the remaining groups. There was a significant (p = 0.017) difference in speech comprehension between the treated and contralateral ears, with the mean maximum speech comprehension rates of 80% in the treated ear versus 92% in the contralateral ear. CONCLUSION: We demonstrated a correlation between the findings of tonal audiometry and speech audiometry. The severe damage caused by chronic middle ear diseases not only leads to conductive hearing loss but also acts as a significant contributor to poor speech comprehension in a long-term follow-up. The speech comprehension in a healthy ear is significantly better than in a diseased ear. Middle ear reconstructive surgery offers the maximum improvement in speech comprehension at the hearing loss of 41 to 70 dB in speech audiometry.

Auditory ossicles in ScanningElectron Microscopy.

<b>Introduction: </b>Knowledge about the physiology of a healthy middle ear is essential for understanding the activity and mechanics of the ear as well as the basics of ossiculoplasty. Trauma of the epithelial lining of the tympanic cavity as well as the ossicular chain may be the result of chronic inflammation and surgery. Depending on the observed changes of the middle ear lining, there are several types of distinguished chronic inflammatory changes: simple, with cholesteatoma, with the formation of inflammatory granulation tissue, in course of specific diseases. <br><b>Purpose: </b>The aim of the article is presentation of the microstructure and vasculature of the ossicular chain in the Scanning Electron Microscope. Particular attention is drawn to the anatomical aspects of the structure and connections of auditory ossicles as vital elements for reconstruction of the conduction system of the middle ear. <br><b>Material and method: </b>The analysis covered auditory ossicles standardly removed in accordance with the methodology of the investigated surgical procedures. The preparations were evaluated in a scanning electron microscope. <br><b>Results: </b>The exposure of bone surface promotes deep erosion. The advanced process of destruction of bone surface in the case of chronic otitis media correlates with a significant degree of damage to both the lining covering the auditory ossicles and that surrounding articular surfaces. <br><b>Conclusions: </b>(1) The ossicles in the image of the Scanning Electron Microscope are covered with lining. It passes from the surface of the ossicles to the vascular bundles, forming vascular sheaths; (2) Damage to lining continuity on the surface of the auditory ossicles promotes the rapid destruction of bone tissue in the inflammatory process; (3) The dimensions of the individual ossicles are respectively: malleus - 8.36 +/- 0.01, incus - 8.14 +/- 0.0, stapes - 3.23 +/- 0.01 mm. Behavior of the anatomical length of ossicular chain during tympanoplasty appears to be essential to maintaining adequate vibration amplitude of the conductive system of the middle ear.

Recommendations of the Main Board of the Polish Society of Otorhinolaryngologists, Head and Neck Surgeons for providing services during the COVID-19 pandemic for outpatient and hospital practices.

Recommendations of the Main Board of the Polish Society of Otorhinolaryngologists, Head and Neck Surgeons for providing services during the COVID-19 pandemic constitute the guidance to outpatient and hospital practices in all cases where contact with a patient whose status of COVID-19 is unknown. They have been created based on world publications and recommendations due to the current state of the COVID-19 pandemic. Justification for suspension of planned provision of services in the first phase of a pandemic was presented. The indication of the best medical practices for the time of stabilization, but with the persistence of the risk of COVID-19 infection in the population are discussed. The possibility of providing services in the following months of the pandemic is important. We provide the rationale for launching medical activities and indicate optimal practices until the consolidation of SARS COV-2 prevention and treatment methods.

The suitability of scanning electron microscopy in the evaluation of bone structure surfaces and selection of alloplastic materials for facial skeletal reconstruction.

INTRODUCTION: Functional and aesthetic problems can arise even from small losses created in the facial skeleton. Injuries and oncological surgeries are the most frequent causes of these losses within the facial skeleton. Advances in surgical interventions have allowed for ever-increasing degrees of resections, increasing oncological radicality as well as treatment effectiveness, providing the patient with the chance for a longer life. However, this subsequently requires the use of even more advanced reconstruction techniques in order to restore quality of life and comfort to the patient, as well as enable their return to professional and social activities. The necessity of reconstructive surgery applies not only to patients with cancer, but also to patients with impaired or failing sensory and organ function as a result of inflammatory conditions, injuries, or non-oncological surgeries. There are many available reconstruction procedures, which depend on the location of the loss, the type of tissue lost, the degree of loss and patient-dependent factors. Materials used in reconstruction surgeries may include the patients' tissues when available, and artificial reconstruction materials otherwise. MATERIAL AND METHODS: The analysis involved fragments of bone tissue removed during surgery. Due to the nature of the medical procedure and the inability to replant the tissue, it was regarded as medical waste. The preparations used were observed under an optical microscope and an electron scanning microscope, and a chemical analysis was performed. The chemical composition of samples was analysed using a low vacuum detector (LVD) at an accelerating voltage of 15 kV and 10 kV and at a spot size of 4 and 3.5. The observations were performed in a secondary electron (SE) detection system. RESULTS: Observation of parameters under an optical microscope and of images obtained using an electron scanning microscope showed the presence of typical, compact bone tissue with varied surface shapes in each case (various degrees of unevenness and porosity). Chemical composition analysis confirmed the presence of compounds from the CaO-P2O5-H20 system. The Ca/P (calcium/phosphorus) ratio obtained from the chemical analysis varied from 1.33 to 2.1, and indicated a varied morphology of calcium phosphates forming the bone structures of the facial skeleton. CONCLUSIONS: 1. Calcium phosphates are characterised by excellent biocompatibility because of their chemical affinity to bone, and are ideal for the reconstruction of bone losses within the facial skeleton. 2. Biodegradable polymers have the highest functional potential among several groups of biomaterials used in tissue engineering because of their ability to be tailored individually, in addition to their high biocompatibility.

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

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

Impact of surgery in otosclerosis on the non-operated ear.

Backgrounds Otosclerosis is an underlying disease of the bony labyrinth. The hearing loss is most often of conductive nature, in some cases the involvement of the bony part of the cochlea results in mixed hearing loss. Aims: The aim of the analysis was to answer the question whether a surgery on one of the ears affects the state of the other ear in the course of otosclerosis. Methods The analysis included 140 patients hospitalized and operated on between 2010 - 2016. Only patients who had not had a surgical operation within the middle ear due to otosclerosis prior to the study were included in it. An audiological assessment was performed with the use of pure tone threshold audiometry taking into account. Results In the group of patients with no Carhart's notch, the mean threshold of bone conduction was statistically lower than before the procedure for the frequencies of 500, 1000 Hz and statistically equal for the frequency of 2000 Hz. The same analysis in the group of patients with Carhart's notch present in the pre-surgical tonal audiogram of the non-operated ear showed a statistically significant lower value of the post-surgical threshold bone conduction value. Conclusion It was confirmed the possibility of improving the hearing of the non-operated ear after the stapedotomy of the opposite ear, in the author's own studies by an average of 5 dB in the low-frequency range.

The prognostic influence of pre-surgery bone conduction values on the improvement of hearing in patients treated surgically as a result of middle-ear conditions.

Background The influence of the mechanics of the middle ear on the function of the inner ear has been studied for many years. Among surgeries performed in the middle-ear area, those restoring full functionality of the system transmitting sound inside the middle ear may be pointed out as those fully restoring the mechanical influence of the middle ear on the function of the inner ear. Aim: The aim of the performed analysis is to find the prognostic importance of measured pre-surgery values of bone conduction on the improvement of hearing in patients operated as a result of middle-ear disorders. Methods The analysis included 271 patients hospitalised and operated on due to otosclerosis or perforation of the tympanic membrane between 2016 and 2019. Only patients who had not had a surgical operation within the middle ear prior to the study were included. An audiological assessment was performed with the use of pure tone thresholds audiometry. Results A beneficial influence of the performed surgery on the improvement of bone conduction was observed in patients, in which the average threshold value of bone conduction measured before the surgery did not exceed 40 dB. In cases of the perceptive component of hearing impairment being higher than 40 dB, no statistically significant, beneficial influence of a performed stapedotomy or myringoplasty on the change of bone conduction thresholds was observed. Conclusion The perception component of hearing impairment up to 40 dB indicates bone conduction improvement after surgical restoration of the influence of middle-ear mechanics on the inner ear in patients treated as a result of otosclerosis, as well as of eardrum perforation.

Rehabilitation after surgical treatment of retrobulbar tumors.

The authors propose a set of rehabilitation exercises concerning the muscles which are responsible for movement of the eyeball. After surgical treatments of retrobulbar tumors, the function of the eyeball muscles is often inadequate. Some compensation should be created at the level of the central nervous system, which means trigging adaptation, substitution and habituation. The exercises should be started just after the patient is awakened: first in the horizontal position, then sitting position and finally standing position. The highest number of exercises should be done in the direction of extreme diplopia.

Exacerbations of Chronic Rhinosinusitis-Microbiology and Perspectives of Phage Therapy.

The chronically inflamed mucosa in patients with chronic rhinosinusitis (CRS) can additionally be infected by bacteria, which results in an acute exacerbation of the disease (AECRS). Currently, AECRS is universally treated with antibiotics following the guidelines for acute bacterial rhinosinusitis (ABRS), as our understanding of its microbiology is insufficient to establish specific treatment recommendations. Unfortunately, antibiotics frequently fail to control the symptoms of AECRS due to biofilm formation, disruption of the natural microbiota, and arising antibiotic resistance. These issues can potentially be addressed by phage therapy. In this study, the endoscopically-guided cultures were postoperatively obtained from 50 patients in order to explore the microbiology of AECRS, evaluate options for antibiotic treatment, and, most importantly, assess a possibility of efficient phage therapy. Staphylococcus aureus and coagulase-negative staphylococci were the most frequently isolated bacteria, followed by Haemophilus influenzae, Pseudomonas aeruginosa, and Enterobacteriaceae. Alarmingly, mechanisms of antibiotic resistance were detected in the isolates from 46% of the patients. Bacteria not sensitive to amoxicillin were carried by 28% of the patients. The lowest rates of resistance were noted for fluoroquinolones and aminoglycosides. Fortunately, 60% of the patients carried bacterial strains that were sensitive to bacteriophages from the Biophage Pharma collection and 81% of the antibiotic-resistant strains turned out to be sensitive to bacteriophages. The results showed that microbiology of AECRS is distinct from ABRS and amoxicillin should not be the antibiotic of first choice. Currently available bacteriophages could be used instead of antibiotics or as an adjunct to antibiotics in the majority of patients with AECRS.

A Biochemical Analysis of the Stapes.

BACKGROUND Otosclerosis is a primary disease of the bony labyrinth. In the course of otosclerosis, abnormal resorption and recalcification of the endochondral layer of the temporal bone is observed. The otosclerotic process most commonly develops in the anterior part of the oval window. MATERIAL AND METHODS We analyzed stapes superstructures from 4 patients undergoing surgery for otosclerosis. The first step involved tissue assessment under a scanning electron microscope. The resulting images were analyzed in terms of morphological changes. The stapes superstructure was then divided into small "ossicles", including fragments from the closest vicinity of the stapes footplate and a fragment of the head of the stapes. This material was examined using a scanning electron microscope with a unit for chemical analysis in microareas. RESULTS Chemical analysis confirms the appearance of considerable quantities of the following elements: carbon, oxygen, potassium, and calcium, and the appearance of small quantities of sodium and magnesium. Based on a detailed analysis of the chemical composition, these fragments could represent a calcium phosphate compound from the following system: CaO-P2O5-H2O. Fragments of the superstructure from the region closest to the base of the stapes demonstrated a considerably larger presence of carbon, oxygen, and nitrogen, which most likely suggests an increased metabolic process in this region. CONCLUSIONS Our analysis revealed an increased metabolic activity in the closest vicinity of the otosclerotic focus, the fissula ante fenestram. The increased metabolism correlated with the bone tissue changes seen on scanning electron microscopy.