Endoscopic approach to the resection of adenoid cystic carcinoma of paranasal sinuses and nasal cavity: case report and own experience.

Adenoid cystic carcinoma (ACC) is a rare malignant tumor that might occur in nasal cavity and paranasal sinuses. It is characteristic for poor prognosis, especially the solid histopathological subtype of the tumor. ACC might spread along nerves and fascias and it is usually diagnosed at advanced stage. Computed tomography and magnetic resonance imaging together with fine-needle biopsy are the gold standards in the diagnostic procedure of the cancer. Surgery with adjuvant therapy are the most common methods of treatment. Among the surgical approaches, the functional endonasal sinus surgery seems to be the most appropriate and favorable way of treatment. In the study, the authors present a case of a 62-year-old patient with T4aN0M0 ACC tumor treated endoscopically at the Department of Laryngology and ENT Oncology, WSS No. 5 in Sosnowiec. The authors indicate the usefulness of FESS procedure in the treatment of malignancies of nasal cavity and paranasal sinuses. They also review the recent publications on endonasal versus open approach in similar cases. In conclusions, the authors favor endonasal approach as a mini-invasive method of surgical treatment of ACC of paranasal sinuses that results in satisfactory oncological outcome and high quality of patient's life.

Usefulness of intraoperative monitoring of oculomotor and abducens nerves during surgical treatment of the cavernous sinus meningiomas.

PURPOSE: We analyzed the usefulness and prognostic value of intraoperative monitoring for identification of the oculomotor (III) and the abducens (VI) nerve in patients with cavernous sinus meningiomas. MATERIAL/METHODS: 43 patients diagnosed with cavernous sinus meningiomas were divided according to their topography. Function of the nerves was scored on original clinical and neurophysiological scales. RESULTS: The percentage of nerves identified correctly with the monitoring was significantly higher (91% vs. 53% for nerve III and 70% vs. 23% for nerve VI, p<0.001). The fractions of nerves III and VI identified correctly by means of the monitoring were significantly higher in the case of tumors with intra- and extracavernous location (89% vs. 32%, p<0.01) and intracavernous tumors (80% vs. 20%, p<0.05), respectively. The quality of post-resection recording correlated with functional status of both the nerves determined 9 months after the surgery (R=0.51, p<0.001 for nerve III and R=0.57, p<0.01 for nerve VI). Even a trace or pathological response to the post-resection stimulation was associated with improved functional status (90% vs. 50%, p<0.05 for nerve III and 93% vs. 38%, p<0.01 for nerve VI). CONCLUSIONS: Neurophysiological monitoring of ocular motor nerves enables their intraoperative identification during resections of the cavernous sinus meningiomas. Intraoperative monitoring of nerve III is particularly important in the case of tumors with extra- and intracavernous location, and the monitoring of nerve VI in the case of intracavernous tumors. The outcome of the post-resection monitoring has prognostic value with regard to the clinical status of the nerves on long-term follow-up.

Impact of rhinosinusitis symptoms on patients' self-esteem before and after FESS.

INTRODUCTION: Chronic rhinosinusitis (CRS) is one of the most common diseases in Polish society. According to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 the incidence of CRS among European and US citizens varies from 5 to 16%. Its treatment is based on pharmacotherapy or surgical procedure. The aim of the study was to evaluate the correlation between general health condition of the patients with CRS with each symptom of the disease before and after Functional Endonasal Sinus Surgery (FESS) procedure. MATERIALS AND METHODS: The study was conducted on 100 patients, who evaluated symptoms and general health condition twice - before and after FESS, by means of visual analogue scale (VAS). RESULTS: Before FESS the highest severity among all symptoms concerned the nasal blockade and olfactory disorders, while after the procedure this ratio was found to be the opposite. All results were statistically significant (p<0.05). CONCLUSIONS: The authors emphasize a great role of general health assessment in patients with CRS as the element of proper diagnosis and better comprehension of patients' needs. They indicate that the patient's estimation of the disease and its symptoms differs from the clinician's interpretation to much extent.

[Epidemiological and demographic analysis of indications for Baha® surgery in Poland--multicenter study]. / Analiza epidemiologiczna i demograficzna wskazan do implantacji systemu Baha® w Polsce--badanie wieloosrodkowe.

AIM OF THE STUDY: To collect and analyze epidemiological and demographical data of patients qualified for and implanted with the Baha® system in Poland. MATERIAL AND METHOD: 17 out of 28 otolaryngology departments performing Baha® implantation in Poland participated in the study. Up to date there were 286 patients registered in database. Data were obtained from the preoperative questionnaires including information such as age and gender, indications for the implantation, previous hearing aid use as well as data regarding the surgical technique. RESULTS: The most frequent indication for the Baha® system was bilateral mixed hearing loss (51%), followed by SSD (18%), bilateral conductive hearing loss (17%), unilateral mixed (8%) and conductive (6%) hearing loss. In 11% of subjects hearing impairment was congenital versus 89% cases of acquired. The mean age was 44 years with the slight prevalence of women (52%). 63% of patients did not have previous experience with hearing aids. The most frequent surgical technique was classic dermatome single stage procedure performed under general anesthesia (65%). CONCLUSIONS: Data gather in this multicentre research serve as a valuable source of information on qualifications for the Baha®, shows demographic spectrum of adult recipients in Poland. It also presents the preferences of surgical procedures. Outcomes of the study may constitute a reference for each centre participating in this research as well as for new centers starting the Baha® procedure.

Blood flow velocity in the arteries of the anterior cerebral artery complex in patients with an azygos anterior cerebral artery aneurysm: a transcranial color-coded sonography study.

OBJECTIVE: It is presumed that increased blood flow through the single azygos anterior cerebral artery (Az) may contribute to the formation of an Az aneurysm. The aim of this study was to assess the blood flow velocities in the arteries of the anterior cerebral artery (ACA) complex in patients with the Az aneurysm. PATIENTS AND METHODS: A series of three patients (2 men, aged: 65, 52 and 41) with an aneurysm (unruptured in two cases) of the distal Az was examined. Blood flow velocities in the Az and the A1 segment of the ACA were measured by means of a transcranial color-coded duplex sonography (TCCS) and the Az to A1 segment (Az/A1) velocity ratio was calculated. The control group consisted of 22 healthy subjects (mean age: 44 years). RESULTS: There was a trend toward decreased (p=0.06) mean blood flow velocity in the Az compared to the A2 segment of the ACA of the control group. Blood velocity in the A1 segment did not differ between the study and control groups. Pulsatility and resistance indices in the Az were similar to those in the A2 segment of the control group. There were no differences between the Az/A1 ratio in the study group and the A2/A1 velocity ratio in the control group. CONCLUSION: Our results suggest that Az aneurysms are not associated with increased blood flow velocity in the Az. Possibly, a hemodynamic stress related to the Az bifurcation geometry, together with a bent course of this artery around the genu of the corpus callosum, predispose to aneurysm formation.

[The results of hearing screening in selected population of primary schoolchildren in Silesia]. / Wyniki badan przesiewowych sluchu u wybranej populacji dzieci szkól podstawowych na Slasku.

The aim of this study was analysis of results of audiologic evaluation in the group of 191 children with hearing loss. Children were selected from the group of 8885 pupils of primary schools in Silesia by screening test "Slysze" in 2002. Universal Screening Program of Hearing in Children and Teenage "Slysze" was created and introduced in to the clinic practice by Institute of Physiology and Pathology of Hearing in Warsaw in 1999. The screening program consists of: pure tone examination and speech audiometry in noise. Children with hearing loss detected by this test in 2002 were followed laryngological and audiological examination. Special attention was paid on articulation disturbances, communicational and educational problems in children with hearing loss. The authors focused also attention on "discreet signs of hearing deficiency" (not reacting to commands, turning up a TV-set, loud speech). The validation of screening test "Slysze" was also conducted. In the selected population of primary schoolchildren in Silesia hypoacusis occurred in 6% of examined children, in "city" schools the percentage proved to be higher than in "village" schools. In the group aged 6 to 10 the conductive hearing loss occurred considerable more frequently. Eustachian tube dysfunctions in children with conductive hearing loss occurred more frequently in the group of the younger ones. Older than 10 years old in most cases proved to have perceptive-type of hearing loss. The hearing loss hinders a child's psycho-intellectual development, it is important to detect it as early as possible. The evaluations showed that despite frequent occurrence of "discreet symptoms of hypoacusis", only 17.8% of parents suspected hearing loss in their own child. According to the frequency of parents' signals of "discreet symptoms of hypoacusis" it was found that the fact of turning up TV sound was the most powerful sign indicating the probability of hearing loss (45.5%). The most common risk factors of hearing loss in schoolchildren were also estimated. A characteristic, homogenous group of 34 children (17.8%) was the group with MSHL minimal sensorineral hearing loss of high frequencies (6-8 kHz). Results obtained give evidence of low level of awareness in the society concerning the problem of hypoacusis, which confirms the necessity to screening of hearing in schoolchildren and improving of health care in this respect. Diagnosing hypoacusis in case of children is an interdisciplinary problem, requiring cooperation of medical circles but also teachers, speech therapists and parents.

[The stapedius muscle--the present opinions about anatomy and physiology]. / Miesien strzemiaczkowy - aktualne poglady na temat anatomii i fizjologii.

The authors present current opinions about anatomy and physiology of the stapedius muscle and its role of the hearing process. The stapedius muscle is the smallest striped muscle of the human body and contracts reflexive in response to acoustic stimulation. The stapedius muscle puls the neck of the stapes in the direction of the stapedius tendon. This movement causes stiffening of the incus and the malleus and also changes the pressure of the perilymph in the inner ear. This is the protective inner ear action of the stapedius reflex against hearing damage by noise. The stapedius reflex shows bilateral interactions and its center is located in the brainstem. The binaural interaction of the stapedius reflex plays an important role in the maintaining of the sound direction. The stapedius tendon also plays role in the vascularization of the long process of the incus.

[The evaluation of efficaciency of the "Slysze" screening test on the base of the results of hearing examinations in schoolchildren in Silesia in 2002 year]. / Ocena skutecznosci testu przesiewowego "Slysze" na podstawie wyników badan skryningowych sluchu u dzieci na Slasku w 2002 roku.

INTRODUCTION: The measure of efficaciency of screening test is specificality and sensitivity. The validation of the screening test by using Program "Slysze" in Silesia in year 2002 was done. MATERIAL AND METHODS: The Program consisted of two parts: 1. The screening test in schools: a) pure-tone test, b) speech audiometry in noice, and 2. Audiometric verifying of "positive results" of the test. 8885 children were tested in Silesia in 2002. 919 schoolchildren (10.3%) had "positive results". 465 pupils reported to a verifying examination. The hearing loss was confirmed in 191 children. 6 months after the end of Program the control audiometric examinations to validate the Program "Slysze" were done in 100 children, who gained "negative results" in screening test. RESULTS: Program "Slysze" had a high specificality--0.93, sensitivity--0.70, ability to identify--0.92. A positive predictive value was--0.40, and negative predictive value was--0.98.

[The results of surgical treatment of the facial nerve paralysis]. / Wyniki operacji naprawczych porazien nerwu twarzowego.

UNLABELLED: Paralysis of the facial nerve reveales some symptoms which are very unfavourable for esthetic point of view (deformity of the face with incompetence of the palpebal function). It is recognized as the one of the most invalidity for humane life. There are many surgical techniques to reconstructive facial nerve such as: decompression, end to end or side to end anastomosis with hypoglosal, glosopharyngeal, axesorius or mandibular nerves. Reconstruction technique depends upon the extent of injury, the availability of the proximal stump and time since injury and duration of muscle denervation. In the presence of facial paralysis electrodiagnostic tests should be performed before surgery and every 3 mounts after, during rehabilitation, which play also the most important role in recovery. MATERIAL AND METHODS: The authors present the outcome of the surgical treatment of the facial nerve paresis in 31 patients cured in the Silesian Department of Laryngology in Katowice from 1991 to 2002. The reasons of the paresis were otitis media with cholesteatoma and granuloma in 18 cases, head trauma in 2 patients and iatrogenic impairment after ear operations in 11 cases. The decompression of the facial nerve was done in 20 patients, anastomosis end to end in 3, crossover anastomoses between the facial nerve and the hypoglossal nerve was done in 1 case, and transplantation of auricular major nerve in 7 cases. RESULTS: The outcome was good in 20 patients (64.5%), satisfactory in 10 patients (32.3%) and non satisfactory in one case (3.2%). CONCLUSION: In our material the most of cases was caused by otitis media with cholesteatoma. The best outcome was obtained after decompression of the facial nerve. The rehabilitation before and after surgery play the very important role in the recovery.

[A 20-year retrospective histoclinical analysis of parotid gland tumors in the ENT Department AM in Katowice]. / Analiza histokliniczna guzów slinianek przyusznych u chorych operowanych w okresie 20 lat w Klinice Laryngologii SlAM w Katowicach.

INTRODUCTION: Salivary gland neoplasms represent the diverse group of tumours encountered by the head and neck surgeons. MATERIAL AND METHODS: The study is analysis of 531 patients with parotid gland tumours in patients treated in ENT Department during 1986-2006. We analysed surgical treatment and intraoperative tumour stage. The results of histological diagnosis were presented. RESULTS: The frequency of incidence of benign neoplasm was 80%. The most frequent tumour was pleomorphic adenoma--75% and adenolymphoma--16%. Malignant tumours constituted 20% of all gland tumours. Mucoepidermoid (27%) and adenoid cyst (22%) carcinomas were the most common malignant tumour. Tumour stages T3-T4 was in 90%.

[Results of myringoplasty and type I tympanoplasty with the use of fascia, cartilage and perichondrium grafts]. / Wyniki myringoplastyk i tympanoplastyk typu I z uzyciem ochrzestnej, chrzastki i powiezi miesnia skroniowego.

Since the publication of Miodonski, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplasty. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplasty in comparison with the material used. The studies included a selected group of 142 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. The comparison group consisted of 30 patients when fascia of the musculus temporalis was used to close a defect of the eardrum. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery. The comparison of operation results showed that there was no significant difference between the two groups.

[The evaluation of cartilage and perichondrium grafts for the reconstruction of the tympanic membrane]. / Ocena przydatnosci chrzastki i ochrzestnej w operacjach odtwórczych blony bebenkowej.

Since the publication of Miodonski, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplastic surgery. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplastic surgery with the use of cartilage and perichondrium grafts. The studies included a selected group of 112 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery.

[An extremely rare case of primary lipoma of the middle ear in an 8-year old girl]. / Wyjatkowo rzadki przypadek pierwotnego tluszczaka ucha srodkowego u 8-letniej dziewczynki.

Authors described an extremely rare case of primary lipoma of the middle ear in 8-years old girl. A histological structure, localisation and occurrence of this tumor in the temporal bone was discussed on the basis of the literature. Authors have presented symptomatology, diagnosis difficulties and treatment of primary lipoma of the middle ear. They have paid attention to the course of disease and non-characteristic symptoms, which imitated the symptoms of the chronic otitis media.