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<b>Introduction:</b> Standard treatment for pleomorhic adenoma (PA) of the parotid gland is complete surgical excision. Radiotherapy (RT) as a primary treatment method is controversial and generally is not applied. However, RT might be considered as an adjuvant therapy in some selected cases. </br></br> <b>Aim:</b> The aim of this work was to define recommendations for RT in patients with parotid gland PA after primary surgical treatment.</br></br> <b>Material and methods:</b> Based on the results currently published in the literature and the authors' own experiences from leading Polish laryngological and oncological clinical centers dealing with the treatment of salivary gland tumors, the indications for irradia- tion and its methods in patients with PA of the salivary glands were discussed. </br></br> <b>Results and discussion:</b> Authors recommend personalized treatment based on multidisciplinary panel decisions in each patient. Adjuvant RT should be considered in cases of suboptimal resection of primary PA (close margin, intraoperative tumor spillage, risk of recurrence based on clinical factors and histological features), and in cases of PA recurrence. Doses/ fractions and techniques of irradiation are recommended depending on the clinical extension of the primary or recurrent tumor. </br></br> <b> Conclusions:</b> Adjuvant RT in PA treatment should be a result of a personalized multidisciplinary decision after considering all possible risks of irradiation consequences. Recommendations for this treatment should be taken into consideration.

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.

CRS is a process involving a number of adverse changes in the mucosa of the paranasal sinuses and nasal polyps, e.g. increased fibroblast proliferation, angiogenesis, increased formation of fibrous tissue (subepithelial fibrosis) and tissue destruction. There are biomarkers whose levels can be increased in chronic inflammation of the paranasal sinuses: peripheral blood eosinophilia, IgE immunoglobulin, cytokines - IL-4, IL-5, IL-13, IL-25, IL-33, periostin, P-glycoprotein, CXCL-12, CXCL-13, INF-Υ, TNFα, TGFβ1, albumins, eotaxin. These biomarkers are not pathognomonic for CRS. The concentration of biomarkers is also increased in bronchial asthma and atopic dermatitis. The TGFβ, in particular, the β1 subunit, was identified as the main factor involved in the remodeling of tissue stroma. In conjunction with the continuous improvement of tissue testing methods, it is advisable to search for new factors that will more accurately allow the assessment of tissue remodeling in the chronic processes of paranasal sinuses.

Objective: We reviewed functional outcomes of tympanoplasty., Study Design: The results of tympanoplastic surgery are changing in time. We present late treatment outcomes among different types of tympanoplasty., Methods: Eighty-six patients who underwent tympanoplasty were enrolled in the study. The results of pure tone audiometry performed 7 days before, then at 3 months, 1 year, and 3 years after the surgery were assessed. Type II tympanoplasty involved implantation of a partial ossicular replacement prosthesis and type III tympanoplasty involved reconstruction with a total ossicular replacement prosthesis and the use of autogenous homogenous material. Statistical analysis was performed., Results: With all four types of tympanoplasty, hearing improvement was achieved at 3 months and 1 year after surgery based on the magnitude of the mean ABG reduction (p<0.001). In patients who underwent type I, type III, and type IV tympanoplasty, the ABG reduction at 3 years after surgery was maintained at the level reported at 3 months and 1 year after surgery (p<0.001). In patients who underwent type II tympanoplasty, however, the mean ABG value was increased at all tested frequencies (p<0.05). The mean ABG values reported 3 years after type II and type III tympanoplasty were similar., Conclusions: Based on the results over time, hearing improvement seems to be less durable after reconstruction with the partial ossicular replacement prosthesis procedure compared to the total ossicular replacement prosthesis procedure.

Nasal and sinus mucositis is a significant health problem associated with significant organizational and financial burden for the health care system. In recent years, several important guidelines and positions of expert groups and scientific associations have been published with regard to the diagnostics and treatment of rhinosinusitis, including European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2012) [1] and Polish Standards for the Treatment of Rhinitis (PoSLeNN 2013) [2]. The management of viral and postviral rhinosinusitis involves systemic treatment including administration of plant origin products. The goal of this article is to present the current knowledge on the use of intranasal preparations containing natural saponin fractions from the rhizomes of Alpine cyclamen (Cyclamen europaeum). Saponins contained in the extract of Alpine cyclamen (Cyclamen europaeum) rhizomes are surface-active compounds that reduce the surface tension on the nasal mucosal cells while simultaneously stimulating the trigeminal nerve receptors leading to increased production of seromucous secretion and extensive drainage of the nasal and sinus cavities. The analysis of published studies on the efficacy and safety of intranasal products containing lyophilized extracts from Cyclamen europaeum tuber warrants the conclusion that these products are useful in the management of nasal and sinus mucositis due to their beneficial impact on the course of the treatment of acute rhinosinusitis. When used in patients with acute rhinosinusitis, an intranasal preparation containing lyophilized extracts from Cyclamen europaeum tuber efficiently reduces the symptoms, particularly the feeling of pressure and pain in the face. According to the authors of PROSINUS study, single-agent treatment using Cyclamen europaeum extracts is more efficient (in terms of the percentage of success) than other monotherapy or combination regimens.

Introduction: Isolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications., Aim: Describe four patients with acute sphenoid sinusitis who presented with acute onset of severe headache and consider the role of medical or surgical management. Two patients do not required surgical intervention and medical treatment was sufficient. One patient had sphenoidotomy due to meningitis. One patient was performed surgical intervention after fail of medical therapy. Acute isolated sphenoid sinusitis appears to be difficult to diagnose. It is important to be aware of acute sphenoid sinusitis in the setting of new onset severe headache, when imaging studies are unrevealing for intracranial pathology. Medical therapy focused on infection, inflammation, and obstruction may be adequate for resolution, but surgical intervention may be required in certain situations., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Introduction: Intracranial or orbital complications after chronic and acute rhinosinusitis are rare, but could be dangerous. The complications of acute rhinosinusitis more often are observed in young patients. The combination of both intracranial and orbital complications together is found after acute inflammation., Material and Methods: We present a case of a patient with primary developed orbital complication during acute rhinosinusitis followed by intracranial abscess during the same treatment period., Results: One week after intravenous antibiotic therapy with good outcome we observed an aggravated inflammation process with osteitis of frontal bone and brain abscess formation. We performed an external approach for frontal sinus surgery combined with neurosurgical brain abscess evacuation. Swabs taken during surgery were positive for: Streptococcus constellatus and Parvimonas micra sensitive for penicillin and metronidazol. We observed a good recovery after two weeks of treatment., Conclusions: We recommend performing a complementary CT of the sinus and CT of the brain with contrast when complications of acute rhinosinusitis are suspected. The coexistence of intracranial and orbital complications could be observed in younger patients mostly after acute sinusitis.

Objective: To relate the authors' experience to the diagnosis and follow-up of patients with benign paroxysmal vertigo of childhood (BPV) who were followed-up at the Children's Hospital of Bydgoszcz between 1999 and 2004, and to review and discuss controversial issues regarding the disease., Methods: Among 124 children suffering from vertigo 14 were classified as having BPV. All the children were submitted to differential diagnosis protocol which consisted of meticulous history, otolaryngological, ophthalmological, psychological, neurological examination, biochemical tests and standard neurootological examination including caloric tests. The children were followed-up and the tests were repeated if no improvement was observed., Results: All the children suffered from episodic vertigo of variable intensity and frequency. All of them were neurologically intact. In 8 patients pathologic ENG results were found, only 1 patient with canal paresis could be considered as having peripheral lesion, 7 patients had central/mixed pathology. The follow-up was favorable in majority of patients. Six of them recovered completely, in 6 an improvement was noted and in 2 no improvement was observed. Three patients after remission of BPV attacks developed migraine. One child before development of BPV attacks suffered from paroxysmal torticollis of infancy., Conclusions: Childhood BPV is a disorder of vestibular system with the onset occurring mainly in preschoolers aged 1-7. Older children with the onset of BPV - like symptoms should be suspected for functional background of the disease. There are no typical ENG features for BPV. The only objective evidence of vestibular dysfunction is the presence of nystagmus during the attack. The disease is probably of vascular origin and there is strong evidence for close relationship between spasmodic torticollis, BPV and migraine.

Introduction: Diagnosis and management of perilymphatic fistula (PLF) is a controversial topic in the international neurotologic literature. An illustrative case of post traumatic PLF with clear surgical indications is presented. This manuscript also reviews the various clinical presentations, pathogenesis, diagnostic examinations, and management options of PLF., Materials and Methods: Case report and literature review., Results: A 40 y/o female presented with paroxysmal vertigo, imbalance and severe sensorineural hearing loss (SNHL) following minor occipital head trauma from a fall six months prior to presentation. Laboratory examination included intermittently positive fistula sign on video-nystagmography. Patient failed to respond to trials of pharmacologic treatment and bedrest and ultimately underwent surgical exploration and repair. Patient had earlobe fat placed in the round and oval windows. Postoperatively, she had prompt resolution of vestibulopathy and ultimate full return of sensorineural function., Conclusions: Patients with appropriate antecedent history demonstrating fluctuating SNHL and vestibulopathy, failing to respond to conservative medical treatments, should be considered for exploratory tympanotomy. In the absence of any other violations of labyrinthine integrity, connective tissue grafting of the round and oval windows should be performed even if no obvious flow of fluid is observed. This management protocol is safe and effective in properly selected patients.

Introduction: Malignant fibrohistiocytoma is one of the rare neoplasms of the larynx. It has nonepithelial origin. The most common sites of the neoplasm are: limbs, trunk and retroperitoneal space. Other localizations within head and neck are very rare. There are 5 histologic types. The most common is pleomorphic type. It is built of histiocytes, fibroblasts and multinuclear giant cells. An examination of the neoplasms consists of microscopic and immunohistologic examination with identification specific tissue markers and intermediate filaments of proteins. Treatment methods of the neoplasms are radical surgery, radiotherapy, chemiotherapy and associate methods of therapy. Prognosis is very bad., Material and Methods: [corrected] We present 71 years old man with croak for four mounths. The tumor of the larynx was examined in laryngoscopy. Biopsy of the tumor confirmed malignant fibrohistiocytoma. Laser surgery (chordectomy) was used to treatment this tumor without radiotherapy., Results: One year observation of the patient didn't show recurrence of neoplasm, but he had only croak., Conclusions: Malignant fibrohistiocytoma of the larynx doesn't differ from other malignant neoplasms of the larynx. Malignant fibrohistiocytoma of the larynx is very rare malignant neoplasms of the larynx.

Hunter's Syndrome (MPS II) is a class of hereditary disorder characterized by a deficiency of specific enzyme--iduronate sulphatase required to break down mucopolisacharides and occurs in Poland in one of 100-150 thousand male live births. MPS II may be lethal in the second decade of life as a result of infiltrativ cardiomiopathy leading to irreversible heart failure or upper airway obstruction caused by infiltration, granulation and deformation in trachea or larynx. We report a case of 14-year-old male with Hunter Syndrome who developed tracheal obstruction and was treated with Nd-Yag laser. We discuss the possibility of treatment and our results--improvement in patient's symptomatic and functional status.

Introduction: The most troublesome problem during endoscopic surgery is fouling of the endoscope lens (tip) with blood. Irrigating systems are available on the market but they are relatively very expensive. We present our own simple irrigating system, very effective and inexpensive., Material and Methods: The system consists of: polyethylene catheter No 6, sterile intravenous line with interposed stopcock, 500 ml saline solution, endoscope. The catheter is fixed to the endoscope with sterile sticks and connected to the bottle of saline solution with intravenous line. During the operation the irrigant solution flow is controlled with interposed stopcock., Conclusions: A simple irrigating system allows cleaning of blood from the endoscope obviating the need for frequent removal of the endoscope from the nose. This allows more rapid and safer endoscopic surgery. It is very simple and cheap.

Introduction: Rotation suction knife (shaver or microdebridor) was developed in beginning 1985 in orthopedic surgery. In the field of otolaryngology it was used in 1992-1994. Shaver is a combination of suction and cutting round knife working together. Knives of different shapes are put into handpiece. They have outer sheath with window, which protect the inner rotating blade. The blade is connected to suction and cutting tissue is removed from the operation field. In otolaryngology surgery we mostly used the oscillation cutting mode which is the most sufficient. Shaver surgery is precise in soft tissue resection, so the most advantages to powered the system is in rhinosurgery, polypectomy with extension to pansinus surgery. Microdebridor can be also used for nasopharynx-adenoidectomy, chonanal atresia surgery, turbinoplasty, dacryocystorhinostomy, sella turcica tumor resection or laryngeal surgery., Material and Methods: We used the Storz's shaver system with a handpiece with a motor in the vertical part of the T-shaped handle. Suction and transport of rejected material does not pass through the motor system. The suction channel is straight and clogging is minimized. We performed shaver surgery during functional endonasal endoscopic surgery (FESS) for polypectomy in 15 cases, medial antrostomy (uncinectomy for "swinging door" procedure) in 10 cases, nasopharyngeal-adenoidectomy in 3 cases and turbinoplasty (inferior turbinectomy) in 10 cases., Results: In our material we did not observe any complications during and after surgery. The healing process is very good without obstruction and crusting. The shaver system has an excellent protection for surrounding tissue and minimalized the tissue destruction., Conclusions: Shaver is an excellent powered instruments for rhinosurgery especially massive polyps of nose and sinuses. It is very sufficient to prevent normal tissue and remove pathological one, this can be achieved in no bleeding area.

On the base of retrospective analysis of 12,888 cases of carcinoma of larynx and hypopharynx, diagnosed in 19 ENT Departments in Poland from 1991 to 2001, the assessment of basic epidemiological data, including the localization of tumor and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 11 years the trends to change of the mentioned above parameters has been examined. The significant increase of female patients in this period was observed, with average proportion M:F = 8:1. The glottis localization of carcinoma dominated (47.6%), followed by supraglottis (40.8%) and pyriform fossa (7.8%), with significant increase of pyriform fossa tumors in the analyzed period of 11 years. In the majority of cases the carcinoma of larynx and hypopharynx was diagnosed in the advanced stage (T3 + T4) of local disease, with the highest percentage in localization within the pyriform fossa (81.0%), and the lowest percentage in glottis tumors (45.6%). The regional lymph nodes metastases has been diagnosed in 46.7% of the analyzed group, with the highest percentage in tumors localized in pyriform fossa (82.9%), and the lowest percentage in tumors of glottis localization (33.1%). In the 11 years time the significant drop down of N0 cases and tendency to increase of N2 and N3 in the supraglottis localization of tumor. The distant metastases in the analyzed group at the time of diagnosis has been registered in 2.0%, with the highest percentage in posterior pharyngeal wall (7.6%) and pyriform fossa (7.4%). The authors postulate the renewal of prospective study on epidemiology, clinical characteristics and treatment results of larynx and hypopharynx carcinoma in Poland.

Benign cartilaginous tumours of the larynx and trachea are rare. The most common is chondroma, and only 6 cases of osteochondroma of the larynx have been reported in the world literature. We present a case of 74 year's old woman with osteochondroma of the right arytenoid cartilage. This is followed by a review of the literature, diagnostic evaluation and surgical management.

The authors present the surgical technique of stellate ganglion excision as a therapeutic method in patients with the long QT syndrome. The operations were performed through an anterior supraclavicular approach. Discussing the anatomic considerations, the possibilities of complications and side effects, both temporary and permanent, including Horner's syndrome are reviewed. On the base of the review of present literature and the postoperative results in patients treated in the Otolaryngological Department of the Medical Academy in Bydgoszcz, the authors confirm that the results of stellate ganglion excision in patients with the long QT syndrome are encouraging, but the possibilities of complications, including sudden death after stellectomy, must be taken into consideration.