Search

Introduction: Pharyngoplasty techniques for the treatment of obstructive sleep apnea syndrome (OSAS) have evolved, which improved the understanding of the anatomy, patient selection, and adoption of functional approaches. Aim: To analyze long-term results of pharyngoplasty in OSAS patients. Material and methods: Between 2007 and 2021, a total of 234 adult patients with OSAS who had previously failed positive airway pressure (PAP) therapy underwent sleep surgery. Of this group, 75 patients met the criteria of a minimum 5-year follow-up. To date, 25 patients completed the follow-up study protocol, including the medical history, visual analog scale (VAS) for snoring loudness, body mass index (BMI), endoscopy of the upper airways, type III sleep study, and standardized questionnaires including Epworth Sleepiness Scale (ESS) and EQ-5D-5L Euro – Quality of Life Questionnaire. Results: The average period of follow-up was 96.80 ± 30.20 months. The mean age of participants was 54.6 ± 14.02 and the mean BMI 30.28 ± 2.74. Patients underwent uvulopalatopharyngoplasty (n = 21) and expansion sphincterpharyngoplasty (n = 4) between 2008–2015. A long-term improvement in sleep parameters was observed for the mean AHI (29.84 ± 20.06before and 19.45 ± 18.53 after surgery, p = 0.0294), and the median VAS (8.13 before and 3.78 after surgery), mean oxygen saturation during sleep 94,5% (IQR 93.0–95.25), and the median ESS score was 6.17 ± 4.57. The majority of patients reported subjective long-term improvement in sleep quality and a reduction of snoring. Conclusions: In OSAS patients who failed PAP therapy, pharyngoplasty may provide a long-term improvement in upper airway obstruction during sleep.

Introduction Sleep is a physiological state essential for proper functioning of the body. One of the reasons for sleep disorders is obstructive sleep apnea syndrome (OSAS). Aim: The aim of this research is histological evaluation of the mucous membrane of the soft palate in patients affected by various forms of OSAS. Material and method: The studied group consisted of patients with sleep-related breathing disorder in the form of primary snoring or OSAS. People with chronic tonsillitis, without a history of sleep-related breathing disorders, were included in the comparative group. Fragments of the mucous membrane of the uvula (study group) and the glossopalatine arch (comparative group) were taken for histological examination during surgery. Using histological, histochemical and immunohistochemical methods, we assessed the presence and severity of inflammation (CD3, CD20, CD68), the structure of nerve fibers (S-100) and the size of blood vessels (CD34) in the examined tissue. Results: Patients with OSAS developed a local inflammatory process in the oropharyngeal tissues (stronger expression of CD3, CD20, CD68 in people with OSAS). The exacerbation of the immunohistochemical reaction with CD3 correlated with the phase of OSAS. We found a higher degree of fibrosis and a higher expression of CD34 and S-100 receptors in subjects with OSAS compared to snoring patients and patients from the comparative group. Discussion: Due to chronic tissue vibration, snoring most likely leads to damage to the nerve fibers in the soft palate, which can intensify episodes of shallow breathing during sleep and increase the occurrences of apnea.

This manuscript intends to review types, pathogenesis, associated risk factors, and potential methods of prevention and treatment of the retraction pockets in adults and children. The importance of retraction pockets (RP) lies in loss of original histological and anatomical structure which is associated with development of ossicular chain erosion, cho¬lesteatoma formation and potentially life threatening complications of cholesteatoma. The trans-mucosal exchange each gas in the middle ear (ME) is towards equalizing its partial pressures with the partial pressure in the environ¬ment. MEs that have abnormalities in the volume and ventilation pathways in the epitympanic may be more suscep¬tible to retraction pockets. Sustained pressure differences and/or inflammation leads to destruction of collagen fibers in the lamina propria. Inflammatory mediators and cytokines lead to release of collagenases result in viscoelastic properties of the lamina propria. The process of changes in the tympanic membrane structure may evolve to the cho¬lesteatoma formation. There are many different staging systems that clinicians prioritize in their decision making in the management of RP. The authors discuss the management possibilities in different clinical situations: RP without and with ongoing or intermittent evidence of Eustachian Tube Dysfunction (ETD), presence of adenoid hypertrophy or re-growth of adenoids, presence or absence of effusion, invisible depth of RP without effusion. invisible depth of RP with effusion, ongoing RP after VT insertion, and finally suspicion of cholesteatoma in a deep RP with ME effusion. A decision algorithm regarding the management of TM retraction and retraction pockets is provided.

Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.

Cholesteatoma represents progressive expansion of the keratinizing squamous epithelium in the middle ear with subsequent chronic inflammation in subepithelial connective tissues. The hypothesis was tested that receptor for advanced glycation endproduct (RAGE) and its ligand, high-mobility box 1 (HMGB1), are overexpressed in cholesteatoma, and the RAGE/HMGB1 axis might contribute to its pathogenesis. Cholesteatoma samples (n = 36) and 27 normal skin specimens were studied by immunohistochemistry (IHC) for HMGB1 and RAGE expression. Effects of HMGB1 signaling on proliferation, migration, cytokine production, and apoptosis of human immortalized keratinocytes (HaCaTs) and normal keratinocytes were studied by quantitative reverse transcription (qRT)-PCR, IHC, Western blots, and flow cytometry after cell co-incubation with HMGB1. While all studied tissues expressed HMGB1, its expression was higher in cholesteatoma than in normal skin (p

To evaluate the correlation between quality of the surgical field, intraoperative bleeding during endoscopic sinus surgery (ESS) and the density of microvasculature of the nasal mucosa.Nasal mucosa of 30 patients, operated for chronic rhinosinusitis, was biopsied to assess expression of CD34 antigen on vascular endothelium. Quality of surgical field was evaluated with Fromm-Boezaart scale at mean arterial pressure (MAP) of 70-80 mmHg. If at this MAP surgical field quality was not satisfactory further reduction of hemodynamic parameters was performed until 'bloodless surgical field' (grade 2 or lower) was achieved. The rate of intraoperative bleeding was calculated from the ratio of total blood loss and the operative time. The extent of the disease was assessed according to computed tomography findings using Lund-Mackay staging system.Significant positive correlation (Spearman correlation test; p0.05) was found between CD34 antigen expression and quality of surgical field at MAP between 70 and 80 mmHg as well as the rate of intraoperative bleeding. More intense reduction of MAP was necessary to achieve 'bloodless surgical field' in patients with high CD34 expression than in those with moderate and low expression. Lund-Mackay score correlated with quality of surgical field but not with the rate of intraoperative bleeding.During ESS, it is microvascular density of the nasal mucosa rather than the extent of the disease that contributes to the intensity of intraoperative bleeding, although both factors negatively influence the quality of surgical field.

Nasal polyps and hypertrophic lower nasal conchae are common disorders of nasal cavity. The majority of etiopathogenetic theories indicate inflammatory background of polyps and hypertrophic concha. N-acetyl-β-D-hexosaminidase and β-glucuronidase are lysosomal exoglycosidases revealing accelerated activity in inflammatory processes.The aim of the study was to evaluate the catabolism of glycoconjugates in nasal polyps and hypertrophic nasal concha basing on the activity of N-acetyl-β-D-hexosaminidase (HEX) and β-glucuronidase (GLU).Material consisted of nasal polyps taken from 40 patients during polypectomy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and hypertrophic lower nasal conchae taken from 20 patients during mucotomy. The activity of HEX, HEX A, HEX B and GLU in supernatant of homogenates of nasal polyps and hypertrophic lower nasal concha tissues has been estimated using colorimetric method.Statistically significant decrease has been observed in concentration of the activity (per 1mg of tissue) of HEX (p0.05), HEX B (p0.001) and specific activity (per 1mg of protein) of HEX B (p0.001) in nasal polyps tissue in comparison to hypertrophic lower nasal conchae tissue.Decrease in the activity and specific activity concentration of the majority of examined lysosomal exoglycosidases (increasing in inflammations) in comparison to hypertrophic lower nasal conchae suggests electrolytes disorders and questions the inflammatory background of nasal polyps.

Background. The effect of multiple infusions of infliximab (INF), a chimeric anti-tumor necrosis factor alpha antibody, on the concentration of hexosaminidase (HEX) activity in a synovial cell culture derived from human synovial inflamed fluid obtained from patients suffering from rheumatoid arthritis (RA) has been evaluated. Objectives. The aim of this study was to prove INF efficacy in RA. Material and Methods. Inflamed synovial fluid was taken from RA patients (a study group) and patients who had undergone knee trauma within 7 days (a control group). The following solutions of infliximab were used: 40, 60 and 140 µg/mL. Determination of the concentration of HEX activity in cell cultures was performed after 24, 48, 72 and 96 h of infliximab administration. To identify synoviocytes in cell culture immunohistochemical staining with vimentin and pancytokeratin was performed. Results. A predominance of fibroblast-like synovial cells has been observed in the study group. In the control group the concentration of HEX activity without adding infliximab to the cell culture was 283.00 nkat/mL. After 96 h of incubation with infliximab, the concentrations of HEX activity in cultured synoviocytes according to infliximab doses of 40, 60 and 140 µg/mL were respectively: 280.00, 271.50 and 293.50 nkat/mL. In the study group, the concentration of HEX activity without adding infliximab to the cell culture was 542.27 nkat/mL. The final concentrations of HEX activity of cultured fibroblast-like synovial cells measured after 96 h of incubation with infliximab were: 471.72, 498.27 and 556.72 nkat/mL, according to infliximab doses of 40, 60 and 140 µg/mL. In all groups (besides the infliximab concentration of 140 µg/mL after 96 h of incubation), the level of concentration of HEX activity was significantly higher in the study group compared to the control group, irrespective of infliximab concentration and time of infliximab incubation. Conclusions. Infliximab changes the concentration of HEX activity depending on the drug dose and time of administration (Adv Clin Exp Med 2015, 24, 5, 807–813).

The aim of this study was to describe the similarities and differences as well as the convenience in using of cephalometric radiographs and craniofacial computed tomography in obstructive sleep apnea syndrome (OSAS) patients and to demonstrate the relationship between the severity of sleep-disordered breathing and severity of cephalometric abnormalities. A total of 28 randomly selected patients with snoring, and varying degrees of sleep-disordered breathing were included in this study. A control group included 22 patients. These patients had no snoring or clinical evidence of sleep-disordered breathing as evaluated by polysomnographic test. No patients had prior pharyngeal or maxillomandibular surgery. All patients were evaluated by otolaryngological examination and had polysomnography, cephalometric radiographs and craniofacial CT scans. In study group the evaluation between cephalometric analysis on radiographs and CT scans was made. The comparison between the control and the study group was also assessed as far as cephalometric data are concerned. The cephalometric parameters revealed major differences between controls and patients with OSAS regarding the size and position of soft palate and uvula, volume and position of tongue, hyoid position, mandibulo-maxillary protrusion and size of the pharyngeal airway space. OSAS is associated with statistically significant changes in cephalometric measurements. Lateral cephalometric analysis and craniofacial CT scans add further information to the anatomical assessment of patients with OSAS. We found craniofacial CT scan measurements to be easier and more accurate especially when applying to soft tissues. We believe that this method may also be useful for patient classification to surgical procedures.

Matrix metalloproteinase 9 (MMP-9), able to degrade type IV collagen, plays a key role in inflammatory cell migration as well as in the destructive behaviour of cholesteatoma. The aim of our study was to compare the expression of MMP-9 and TIMP-1 in cholesteatoma tissue and in the concentrations in serum and plasma concentrations.Twenty five adult patients suffering from cholesteatoma (a study group) were included in the study. A comparison group consisted of 25 adult patients admitted to hospital due to nasal septum deviation. MM-9 and TIMP-1 serum and plasma concentrations as well as proteins' expressions in cholesteatoma tissues (study group) and normal retroauricular skin specimens (control group) were evaluated. MMP-9 and TIMP-1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Cholesteatoma tissues and normal retroauricular skin specimens were evaluated immunohistochemically.In the study and a comparison groups, MMP-9 and TIMP-1 concentrations were similar with no significant difference within the groups. In cholesteatoma tissues, the expression of the investigated enzyme and its inhibitor was higher than in normal skin specimens, limited mostly to cholesteatoma perimatrix.Cholesteatoma may be limited to the middle ear or parts of the temporal bones. Our findings suggest better clinical usefulness of MMP-9 and TIMP-1 expression in cholesteatoma tissues than either serum or plasma levels of these proteins. It might suggest that the higher the expression of MMP-9 the stronger the inflammation -accompanied cholesteatoma.

Objectives: The aim of the study was to investigate whether orally administered steroids might improve surgical field conditions during functional endoscopic sinus surgery. Methods: Total blood loss and visualization of the surgical field during the surgical procedure were compared in 2 groups of 18 patients each with severe nasal polyposis. The groups were similar in respect to age, body mass index, general health status, incidence of allergy, bronchial asthma, aspirin triad, and stage of disease. One group received 30 mg of prednisone daily for 5 consecutive days before the operation. The second group served as a control. Results: Although the total blood loss was only slightly less in the steroid group, the visual conditions of the surgical field improved significantly. Conclusions: Better surgical field conditions were the results of the powerful anti-inflammatory and antiedematous activity of the drug, which facilitated blood and secretion evacuation from the operated area and prevented the optic system from staining.

The aim of this study was to determine the distribution and apoptotic capacity in the various layers of cholesteatoma epithelium compared to the normal skin. Cholesteatomas were collected during surgical procedures of the ear. Normal skin specimens taken from the retroauricular area served as controls. Apoptosis was detected by using highly specific antibodies against APO2.7 antigen. The Membstain Apoptosis kit Direct based on in situ labeling of nuclear DNA fragmentation (Tolt-mediated dUTP nick and labeling TUNEL staining) was used. The distribution of apoptotic cells in the layer of the cholesteatoma epithelium and the epidermis was determined. The percentage of apoptotic cells was then counted per 100 cells of cholesteatoma epithelium and the normal epidermis in three different areas of each section and expressed in terms of mean +/- SD. An automatic analyzing system was used for counting. In normal epidermis, the apoptotic cells were observed in the granular layer of the epidermis. The percentage of these cells was 28.5 +/- 8.1%. A significantly greater number of apoptotic cells was observed in the suprabasal layers of the cholesteatoma epithelium (47.39 +/- 6.2%). A statistically significant difference was obtained for APO2.7-positive cells in the cholesteatoma epithelium as compared to the skin (P0.05) as determined by Student's t-test and the Mann-Whitney U test. Apoptotic activity is mainly observed in the suprabasal layer of cholesteatoma epithelium. It is not seen in the basal layer. Apoptosis plays an important role in the pathogenesis of cholesteatoma. It seems to be part of the differentiation and accumulation of keratin debris within the middle ear and expansion of cholesteatoma.

Objectives: The study aim was to investigate the activities of hexosaminidase (HEX) in cholesteatoma tissue compared with that in normal skin. Design and methods: The enzyme activities were determined using the Chatterjee et al. method in the modification of Zwierz et al. in cholesteatoma and skin. Results: Significantly higher activity of hexosaminidase was observed in cholesteatoma tissue compared with the skin. Conclusions: Hex may be considered as a new pathogenetic factor in that destructive lesion.

Minimally invasive transnasal medial maxillectomy with preservation of the nasolacrimal duct may provide an alternative method for surgical treatment of selected maxillary sinus and inferior orbit pathology if more extensive endonasal or external approach procedures are to be avoided.To present a modification of the transnasal endoscopic approach to the maxillary sinus leading through its medial wall, anteriorly to the nasolacrimal duct that considerably improves access to the antero-inferior part of the maxillary sinus and entire orbital floor. To discuss indications for the procedure along with surgical outcome after at least 12 months of follow-up.A total of 22 selected patients with extensive/refractory inflammatory maxillary sinus disease that could not be cleared completely through middle meatal antrostomy or pathologies of the inferior orbit that required uncompromised access to the orbital floor were operated with this method. The effectiveness of the treatment was evaluated through clinical symptomatology and endoscopic examination to confirm eradication of the disease.The presented method allowed for good overall symptom control and eradication of disease confirmed endoscopically in about 90% of cases with an inflammatory type of disease. The visualized reach within the maxillary sinus with commercially available endoscopic instruments was conspicuously improved as compared with middle meatal antrostomy.

The aim of the study: To assess the effectiveness of sodium tetradecyl sulfate injection in the region of the soft palate to treat primary snoring and mild obstructive sleep apnea/hypopnea syndrome. Sodium tetradecyl sulfate, a preparation belonging to detergents, widely applied in Poland to treat varices by the method of compressive sclerotherapy was used in the study. Material and methods The procedure of injected snoreplasty was performed in 21 patients, who were diagnosed with primary snoring or mild obstructive sleep apnea/hypopnea syndrome, based on subjective examination and polysomnography. Injected snoreplasty involves administration of sodium tetradecyl sulfate in the form of Fibrovein 1% or 3% preparation in the volume of 2 ml, in the region of the soft palate. Injection of the preparation in the area of the soft palate induces the development of aseptic inflammation, which creates a scar which stiffens the soft palate and makes the tissues of this region less susceptible to vibrations. Results The patients after injected snoreplasty reported a significant decrease in the intensity of snoring. The markedly shortened total time of snoring was found in check-up polysomnography performed six months after the procedure. Conclusions Injected snoreplasty is an effective procedure, especially, in patients manifesting persistent snoring. It is not indicated in the treatment of obstructive apneas during sleep. The advantages of this method are: minimal invasiveness, the low number of complications and slight pain.

The enzymatic profile of lysosomal exoglycosidases in middle ear cholesteatoma has not been well known. The assessment of glycoconjugate catabolism may contribute to a better understanding of cholesteatoma pathogenesis.The study aim was to evaluate catabolic processes of glycoproteins, glycolipids, and proteoglycans in cholesteatoma through outlining the concentration of N-acetyl-β-hexosaminidase (HEX), β-glucuronidase (GLUC), and β-galactosidase (GAL) activity as well as in serum of cholesteatoma patients and healthy volunteers.Acquired cholesteatomas (n = 25) and normal retroauricular skin specimens (n = 25) were taken during surgery as well as serum from cholesteatoma patients and healthy volunteers. HEX, GAL, and GLUC activity was assessed on basis of p-nitrophenol release from derivatives of the substrate (HEX: N-acetylglucosamine i N-acetylgalactosamine, GAL from galactose, and GLUC from glucuronide).The mean concentration of activity of HEX 1142.39 pKat/ml, GAL 8.90 pKat/ml, and GLUC 14.06 pKat/ml was significantly higher compared with the concentration of enzyme activity in normal tissue: HEX 267.65 pKat/ml, GAL 3.44 pKat/ml, and GLUC 3.90 pKat/ml. In the serum of cholesteatoma patients, the mean concentration of enzyme activities were as follows: HEX 641.62 pKat/ml, GAL 4.55 pKat/ml, and GLUC 12.80 pKat/ml and were significantly higher compared with the concentration of HEX activity (215.75 pKat/ml), GAL (1.89 pKat/ml), and GLUC (5.51 pKat/ml) in the serum of the healthy control group. In cholesteatoma compared with the normal tissue, there is an increase of the glycoconjugate catabolism due to significantly higher concentration of HEX, GAL, and GLUC activity in cholesteatoma. Cholesteatoma causes systemic reaction due to the increase of HEX, GAL, and GLUC activity in patient serum.

To collect and analyze epidemiological and demographical data of patients qualified for and implanted with the Baha® system in Poland.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.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%).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.

Nasal polyposis affects about 1 to 4% of the population. Polyps develop in oedematous and inflammated mucous membrane. In spite of the intensive research the pathomechanism of their development is not fully understood. The majority of the theories concerning the development of nasal polyps emphasize the role of the inflammatory process causing the rupture of the epithelium and the basal membrane. Cathepsin D is one of important mediators of inflammatory processes, that may be involved in the pathogenesis of nasal polyposis.was to establish the role of the cathepsin D in the pathogenesis of nasal polyps. MATHERIAL AND METHOD: Tissues were taken from 39 patients treated with endoscopic sinus surgery due to chronic rhinosinusitis with polyps. The activity of the cathepsin D was assesed with spectrofotometric method using the specific inhibitor (pepstatin) in tissue of nasal polyps, in oedematous and the inflammated mucous membrane of the nasal conchae and the samples of mucous membrane taken from the nasal septum.Statistically significant difference in cathepsin D activity between polypoid tissue, inflammated mucosa and the mucous membrane of the nasal septum was detected (t-student test, p0.05). No difference in the activity of this enzyme was observed between the polypoid tissue and the inflammated mucosa.Increased activity of the cathepsin D in nasal polyps and inflammatory changed mucosa confirm the important role of the cathepsin D in inflammatory processes leading to damage and subsequent remodeling of mucous membrane. We believe that further research on the activity of other proteolytic enzymes is necessary to demonstrate the differences between the inflammable changed mucous membrane and nasal polyps.

One of the most frequent complaint in patients with isolated sphenoiditis is headache. In large proportion of these patients no pathologic findings are revealed in sphenoethmoidal recess endoscopicaly thus discrimination between sinus originated and primary headache in such cases may be especially difficult.Was the assessment of the influence of endoscopic treatment of isolated, small inflammatory sphenoid sinus lesions on headache sensation.13 patients suffering from headache, with CT-diagnosed isolated, small inflammatory lesions of sphenoid sinus such as mucosal thickening, polypoid tissue and cysts were treated endoscopicaly. Headache was assessed on the basis of five-grade scale before surgery, 1 month after surgery and after the observation period that varied between 5 to 40 months.In the first postoperative month the improvement in their headache was declared by 84.6% of patients, but after longer observation the success rate lowered to 61.5%. The improvement was observed both in patient whose the only complaint was headache and in patients with negative endoscopic findings.Small isolated sphenoid sinus lesions constitute a group of specific pathologies of paranasal sinuses, which is still difficult to diagnose despite of technological advancement. The treatment of these lesions remains controversial. Decision as to operative treatment should be taken cautiously since headache in great proportion of these patient is not sinus originated. Further multicenter studies on the basis of larger group of patients are necessary to delineate the indications for surgical intervention in patients with small isolated inflammatory sphenoid sinus lesions.

To evaluate the cytology of nasal mucosa and sense of smell and nasal patency in patients underwent carbon dioxide laser turbinoplasty (CO2 laser mucotomy) due to chronic nasal hypertrophy. 46 patients with inferior turbinate hypertrophy underwent complete laryngological examination, anterior rhinomanometry, olfactory measurements and cytology of nasal mucous which were performed before and 3 months after CO2 laser mucotomy. Laser mucotomy was performed under local anesthesia. Cytograms revealed significant changes in cell proportion before and after the surgery. Goblet cells predominated in nasal smears before the laser mucotomy. An average percentage of eosinophils in evaluated cytograms before the surgery was 2.1%. Three months after laser mucotomy we observed decrease in goblet cells proportion (the mean range of goblet cells was 16.4%) in nasal cytology. We have also observed improvement in olfactory function, however only in 7 patients (20.6%). The mean value of total nasal airway resistance (NAR) before treatment was 0.98+/-0.24 Pa/cm3/s at 75 Pa. Rhinomanometry after 3 months showed a reduction in mean total resistance from the pretreatment level to 0.77 Pa/cm3/s. We believe that CO2 laser mucotomy is an efficacious, minimally invasive and easy to use treatment of inferior turbinate hypertrophy which is performed under local anesthesia with little discomfort for the patient and does not require hospitalization.

Middle ear cholesteatoma is a cyst like structure composed of keratinizing squamous epithelium that contains keratin debris and subepithelial connective tissue. Bone resorption may lead to destruction of ossicular chain and temporal bone. The higher activity of N-acetyl-beta3-glucosaminidase (HEX) was noted in cholesteatoma tissue, compared to the controls. It is supposed, that HEX takes part in bone resorption in middle ear cholesteatoma. Using of HEX inhibitors in cultured fibroblasts and evaluation HEX mRNA expression may contribute to showing new ways of understanding cholesteatoma pathogenesis.was to elaborate cholesteatoma fibroblast cell culture (CF) technique and evaluate in vitro inhibition potential of pyrimethamine.Cholesteatoma and normal retroauricular skin sample obtained during surgical treatment were used in the study. CF served as a study group and fibroblast derived from skin specimens--as controls. Pyrimethamine was used at the concentrations of 1.5, 3, 10 and 20 microg/ml. The reverse transcriptase-polymerase chain reaction (RT-PCR) was carried out for the determination of HEX gene expression.RT-PCR established the elevated expression of HEXA and HEXB mRNA in cholesteatoma. HEXA mRNA in CF was six times higher than in the controls. HEX mRNA expression found to be regulated by pyrimethamine. Inhibition of HEXA and HEXB mRNA expression was achieved when the highest concentration of PYR was used. Low concentrations of pyrimethamine upregulated HEX gene in CF.Pyrimethamine, depending on its concentration, contributes to regulating the HEX gene expression in CF and controls. Pyrimethamine may be regarded as a new future research direction on factors, that may limit development of cholesteatoma.

Vocal fold polyp is usually a result of the injury of the vocal cords. It often appears after vocal overuse or misuse causing trauma in vocal fold mid-membranous and wound formation. THE AIM OF THE STUDY was to assess the activity of hexosaminidase in vocal fold polyps in the comparison to the control tissue.Vocal polyps (n=8) were collected from 8 patients during direct laryngoscopy. Specimens of normal vocal folds were obtained from 8 cadavers (n=8) served as controls. Specimens were immediately frozen in -80 degrees C. To assess hexosaminidase activity, release of p-nitrophenol from p-nitrophenol derivatives was used.We observed statistical differences between the activity of investigated enzyme in all vocal folds specimens compared with that in normal tissue homogenates. However the activity of HEX achieved a low level. Mean release of HEX from the activated cells in vocal fold specimens was 1.073 nkat/g wet tissue compared with 0.766 nkat/g wet tissue in normal cadaveric vocal fold homogenates.Low activity of HEX in vocal fold polyps suggests that inflammation may not be a primary factor in the development of the disease and other mechanism should likely be considered in the pathogenesis of vocal fold polyps.

Although the frequency of smell disorders after the operations of the anterior communicating artery aneurysm depends to a large degree on the used surgical approach, several independent of surgery factors may contribute to the postoperative smell tests outcome. THE AIM OF OUR STUDIES: The evaluation of the sense of smell in patients who underwent the operation of ruptured anterior communicating artery aneurysm using pterional approach.In the retrospective studies the results of smell test of the group of 21 patients operated for ruptured anterior communicating artery aneurysm and 21 healthy volunteers of control group were compared. The patients suffering from neurodegenerative, metabolic and endocrynological disorders, as well as those with rhinoscopic symptoms of rhinosinusitis and with decreased nasal potency confirmed by anterior rhinomanometry were excluded from the study.During the operations it was possible to anatomically retain olfactory nerves in all operated patients. Severe smell disorders (severe hyposmia and anosmia) were detected in 1 (4.7%) patient of the control group and in 6 (28.5%) patients of postoperative group. The mean composite olfactory score in Cain test of the postoperative group was 4.53, and in the control group 5.47 points. The difference did not reach statistic significance (Mann-Whitney test, p = 0.068).Although pterional approach to anterior communicating artery is relatively low traumatic to olfactory tract, the subarachnoid hemorrhage may have an unfavorable effect on postoperative olfactory nerve functioning. Considering the fact, that in spite of thorough examination of the patients, we were not able to exclude from the studied groups all the patients with preoperatively impaired smell, it seems reasonable to perform similar smell test studies in the prospective way.

The evaluation of voice quality of 22 patients with obstructive sleep apnea syndrome (OSAS), who underwent uvulopalatopharyngoplasty (UPPP), was performed. The voice quality was assessed before the operation, and 1 month and 6-months after the procedure. The grade of dysphonia was determined on a six-grade dysphonia scale according to the Union of European Phoniatricians. Maximum phonation time (MPT) was analyzed. The acoustic examination of voice was performed determining fundamental frequency (F0) value and shimmer, jitter and NHR acoustic parameters. Formants analysis of voice was made estimating the level of F1, F2, F3 and F4 formants.Registered hearing dysphonia directly after the surgery was transient. The surgery did not significantly change F0 and jitter parameters that decrease the grade intensification of dysphonia. The reduction of maximum phonation time, changes in jitter and NHR acoustic parameters as well as the reduction of F3 and F4 formants confirmed the occurrence of open nasality directly after UPPP.Registered voice quality and timbre disturbance after UPPP were periodic.

The role of neuroendocrine cells (NC) in physiology and pathology of the human's respiratory tract is not fully understood. The aim of the study was the quantitative and morphometric assessment of NC in nasal mucosa in some pathological states.40 patients, aged 28-63 years, with clinical signs of chronic, hypertrophic rhinosinusitis were qualified for the study. Rhinitis chronica hypertrophica coexisted with aspirin triad or asthma in 10 patients (group I), with advanced obstructive sleep apnea syndrome (OSAS) in 10 patients (respiratory disturbance index, RDI40, group II). Group III consisted of 10 patients with simple rhinitis chronica hypertrophica who habitually smoked cigarettes (at least 20 cigarettes a day) while 10 non-smoking patients with simple rhinitis chronica hypertrophica were qualified to the control group. Fragments of nasal mucosa of approximately 0.5 cm(2) were collected from medial or inferior turbinate during mucoplasty procedures. NC were detected immunohistochemically using antibodies against chromogranin A (DAKO). The microscopic sections were evaluated in the light microscopy.The study did not reveal the increased number of NC in examined fragments of nasal mucosa. Scattered NC were detected in single preparations of nasal mucous membrane in some patients in all groups. The number of detected neuroendocrine cells did not differ statistically between groups.

Cholesteatoma is a destructive disease characterized by the progressive expansion of keratinizing squamous epithelium in the middle ear and mastoid, and chronic inflammatory reaction of the subepithelial connective tissue. N-Acetyl-beta-d-hexosaminidase (HEX) catalyzes the release of terminal non-reducing N-acetyl-d-hexosamine residues acting on glucosides and galactosides in glycoproteins, G(M2)-gangliosides and glycosaminoglycans (GAGs). In this study the activities of HEX were measured in cholesteatoma tissue and in normal skin to demonstrate a possible role of HEX in bone resorption in the area adjacent to cholesteatoma. Cholesteatomas (n = 21) and normal adult retroauricular skin (controls, n = 21), were collected from patients during surgery due to chronic otitis media. In 20 of 21 specimens a significantly higher activity of HEX was observed in cholesteatoma tissue compared with that in normal skin. Mean release of HEX from the activated cells was 68.55 +/- 30.77 nkat/g wet tissue in cholesteatoma and 31.79 +/- 10.02 nkat/g wet tissue in skin specimens. It may explain the process of bone resorption in the area adjacent to cholesteatoma, i.e. ossicles or temporal bone. This study suggests that drugs inhibiting HEX activity, such as iminocyclitols, may be useful in cholesteatoma treatment.

There is abundant conflicting information in the literature about prognostic value of sophisticated, diagnostic tests as well as data from simple clinical examination in its surgical treatment due to the complex nature of OSA. The aim of our study was to assess the efficacy of uvulopalatopharyngoplasty in the treatment of mild and moderate OSA patients who were preliminary selected by simple clinical examination.20 patients with obstructive sleep apnea syndrome were included in this study. There were patients who met the following criteria: RDI less than 30, BMI less than 30, collar size less than 43 cm, normal nasal potency, modified Mallampati grade I or II, were enrolled in the study. The mean age of the patients was 45,5. Modified Mallampati score was used for evaluation the structures of oropharynx.55% of patients were classified for grade I in Mallampati score and 45% of patients- grade II in this scale. At least 50% reduction of RDI after UPPP was observed in 75% of patients. The mean RDI was decreased from 21,35 in preoperative period to 9,85 in the control study. In 60% of our patients the RDI dropped to the value of less then 10. In 5% of the patients, the surgical treatment did not decrease at least 50% of RDI. However in this patient group, we observed a slight improvement of mean minimal saturation (from 84,1 +/- 3,8 to 86,2% +/- 3,6).Using simple clinical parameters for preliminary selection of patients with mild and moderate OSA enabled us to achieve considerably better success rate after UPPP.

The aim of the study was to compare the vessels among cholesteatoma perimatrix, cholesterol granuloma and skin sections and to investigate the localization and expression of CD34 antigen. 14 cholesteatoma specimens were used in this study. Comparative material consisted of skin specimens taken from the retroauricular area during the ear surgical procedure and 4 specimens of cholesterol granuloma collected from children. Monoclonal mouse antibodies against human CD34 were used for immunohistochemistry which was performed using a standard labelled avidin-biotin technique. Automatic imaging analyzing system was used for counting. The skin specimens showed presence of small blood vessels in the subepithelial area and around the glands. The mean number of the vessels in these specimens was 5.44/mm2 and the mean relative proportion of total vessel area/total area of connective tissue: 4.9+/-2.0%. In the specimens of cholesterol granuloma the mean number of vessels was 34.06+/-21.2/mm2 and the mean relative proportion of total vessel area/total area of connective tissue: 22.1+/-3.1%. In cholesteatoma perimatrix, the mean number of microvessels calculated within 1 mm2 of the subepithelial connective tissue was significantly higher (22.79+/-11.2/mm2) and the mean relative proportion of total vessel area/total area of the perimatrix was 12.1+/-2.8%. Angiogenesis appear in the subepithelial connective tissue of cholesteatoma (perimatrix). The process of angiogenesis makes possible and sustains the migration of keratinocytes into the cavity of the middle ear, their increased proliferation and the expansion of cholesteatoma. Therefore, angiogenesis is considered to be one of the destructive features of this disease.

The aim of this study was to determine the proliferative capacity in certain layers of the cholesteatoma epithelium and normal skin.Cholesteatoma and skin were obtained during ear surgical procedures. The number of PCNA- and Ki-67-positive cells were counted within each of three microscopic fields at a magnification of x400. Fourteen normal skin specimens collected from the retroauricular area were used as controls.The skin specimens were found to have a lower proliferative capacity than the cholesteatoma epithelium. This activity was mainly observed in the cell nuclei of the basal layer of the epidermis. The percentage of PCNA-positive cells was 23% in the epidermis and 45.7% in the cholesteatoma epithelium. Immunohistochemical investigation of the epidermis revealed 7% Ki-67-positive cells, mainly located in the basal layer of the epidermis. The presence of Ki-67 antigen in the cell nuclei was determined in the parabasal layer of the cholesteatoma epithelium and stroma. Ki-67-positive cells made up 22% of the cholesteatoma epithelium, compared with 7% in the skin.Proliferative activity is mainly observed in the basal and suprabasal layers of the cholesteatoma epithelium. The proliferative capacity of the cholesteatoma epithelium is different in the various areas of the epithelium and does not depend on its thickness.

The aim of the study was to determine the correlation between proliferation and apoptosis in cholesteatoma epithelium with that in normal skin. Cholesteatomas were collected from 20 patients during surgical procedures. 13 normal skin preparations collected from outside of the external ear were used as controls. Dako detective kit with Ki-67 antigen and PCNA was used to assess cell proliferation. Immunohistochemical reaction intensities in the cells were determined. Mebstain Apoptosis kit Direct with antigen APO 2.7 were used to estimate apoptosis. Positive PCNA cells in the suprabasal layer were observed in 9 preparations, 9--in parabasal layer, and in 2--in both basal and stromal layers. Skin preparations showed decreased proliferative ability in comparison to cholesteatoma epithelium. The presence of Ki-67 antigen was presented in cell nuclei of parabasal and stromal layers mainly. Apoptotic cells were detected in suprabasal, prickle and granular cell layers of cholesteatoma epithelium.1. Proliferation and apoptosis are significantly higher in cholesteatoma epithelium as compared with the epidermis of the skin. 2. Proliferative activity and apoptosis were observed mainly in the suprabasal layers in the cholesteatoma epithelium. 3. Hyperproliferation and apoptosis in cholesteatoma do not depend on the thickness of the epithelium.

The aim of the study is to assess the results of surgical treatment in otosclerosis patients. The study included 68 patients (51 women and 17 men) aged 19-61 (mean age: 42) operated on for otosclerosis.77 surgical procedures were performed (67 stapedotomies and 10 stapedectomies). The operation on the second ear was performed in 9 cases. Tonal audiometry and stapedius reflex were performed in all the patients. Mean hearing loss was determined by applying five frequency: 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Audiometric examinations were done before and 8 to 20 days after the operation.Mean hearing loss of the patients was 63.6 dB. Mean hearing improvement in the stapedotomy patients group was 26.6 dB and in the stapedectomy patients group: 29.5 dB. The lack of hearing gain was observed in 4 patients. A decrease of air-bone gap below 10 dB or its closure was shown in 74% of the cases. In 16% of the patients the air-bone gap after the surgical procedure ranged from 11 to 20 dB, in 10% of the cases overdrew 21 dB. Early complications, up to one month after the operation, appeared in 4 patients in the form of vertigo, balance disorders, tinnitus and the feeling pressure in the ear. In one patient, tinnitus in the operated ear appeared 12 months after the surgery.The surgical procedure in otosclerosis patients has improved their hearing. In the first few days after the operation, balance disorders were observed.

The study included 30 patients who underwent irradiation for head and neck cancer in the Regional Oncology Center. Cobalt 60 was used to irradiate facial--cervical area bilaterally and parotid glands partially. Before and after the irradiation, audiometric test, examination for osmaesthesia and sense of taste were performed.All patients underwent laryngologic examination. The sense of smell was estimated by using quantitative method (smell threshold test) and qualitative method (identificational test). Butyl alcohol with serial watery dilution from 0, 002 to 4 were used in the threshold tests. The identificational test relies on recognition of seven commonly known smells. The examination of taste was performed using the quantitative and qualitative methods. The assessment of taste threshold was made with electrogustometer. The organ of hearing was examined with tone audiometry.Audiometric examination of the patients before irradiation revealed sensorineural hearing loss in 14 patients while 6 patients proved mixed hearing loss. After the irradiation, 50% of the patients showed further hearing loss in the range of 5-30 dB. After the irradiation, the percentage of patients with anosmia was elevated to 20%. Normosmic patients were not observed. The quantitative method of the sense of taste before and after irradiation did not show a significant difference. Only 10% of patients who underwent irradiation recognized 4 basic tastes, 30% of them did not show the sense of taste in the qualitative method.1. After the irradiation, 50% of the patients developed further hearing loss. 2. Olfactometric examination of the patients after laryngectomy showed different degree of hyposmia. 3. The quantitative method of smell performed in patients before and after irradiation showed no significant differences. 4. Distinct deterioration of taste recognition was observed in the qualitative method compared to the examination before irradiation.

Epidemiological analysis of patients with the larynx cancer, who were treated in the Department of Otolaryngology in Białystok from 1996 to 1999 was performed. The following aspects were assessed: a) number of patients, b) gender, c) age, d) place of living, e) primary site of the tumour. The results in years 1996-1999 were compared with the earlier published results in years 1986-1994. Altogether 1431 patients (1340-93.6% males and 91-6.4% females) in that period and there were similar numbers of hospitalizations every year. Among patients there were 28-33% farmers, 41-46% labourers, 5-9% white collar workers, the others were old age pensioners. 55-59% patients came from the rural areas and 41-45% patients from urban areas. The most common site of the primary tumour was the supraglottic region (831-58.1%), then glottis (421-29.4%) and rarely in the subglottic region (5-0.3%). Hypopharynx was the tumor primary site in 174 (12.2%) patients. The analysis showed that the numbers of patients with cancer of the larynx or hypopharynx are similar in each year. A constant increase in number of female patients; coming from the rural area, farmers or labourers was found. Increasing incidence rate of supraglottic tumours and little decrease in the number of glottic tumours were also found.

Cathepsin D decomposes cytoplasmic proteins, cell organelles, collagen, elastase and proteoglycans. It takes part in angiogenesis and activates osteoclasts, and is thought to play a major role in the destruction of bone tissue by cholesteatoma. The aim of the present study was to evaluate the activity of cathepsin D in the structures of cholesteatoma.Cholesteatomas were collected from 16 patients operated on for chronic inflammation of the middle ear. Specimens were fixed in formalin at pH 7.2, after which parrafin slices were made. Cathepsin D was assayed with a Dako set. Keratin was measured by the Kreyberg method. Normal skin from behind the ear was taken from the patients during the same operation. The samples included a stratified, desquamative epithelium (matrix), a streak containing connective tissue (perimatrix), and a mass of keratin debris.Cathepsin D demonstrates high activity in perimatrix cells adjacent to bone tissue, while it occurs in trace amounts in the matrix. A highly positive reaction was observed within keratin, which was present in the superficial layer of the epithelium. Pseudocathepsin located in desquamative epithelial cells demonstrated a high positive reaction. There were trace amounts of cathepsin D within the dermis. In the control group (the skin samples), there were trace amounts of cathepsin D within the corneous layer of the epithelium.Cathepsin D places a major role in bone tissue destruction due to cholesteatoma.

Summary Background Isolated sphenoid sinus pathologies are relatively rare. In the majority of cases, symptoms do not arise in the early stages of the disease or are non-specific, therefore making diagnosis difficult. The aim of this study was to investigate the diagnostic process and the reasons for development of complications in patients with isolated sphenoid sinus pathology. Material/Methods The clinical data and observation charts of 32 patients were investigated to determine how long the main symptoms of sphenoid pathology had been present before the patients were referred for medical treatment, and the time that elapsed from the first ambulatory medical assessment to the initial diagnosis. Results Complaints and symptoms of sphenoid sinus pathology had been present for 10.2 months before the diagnosis was established. Although the duration of complaints in “ORL” (diagnosed by otorhinolaryngologist) and “non-ORL” (diagnosed by other specialists) group of patients was similar (10.8 and 9.5 months on average, respectively), unexpectedly, in the “non-ORL” group of patients, the time necessary for making the initial diagnosis was actually shorter than in the “ORL” group (1.8 vs 4.1 months). At the time of hospital admission, endoscopic examination revealed no abnormalities in 31.2% of patients. In 28.1% of patients the pathological process in the sphenoid sinus was diagnosed only after the onset of complications. Conclusions The occult character of the disease and the lack of severe and specific symptoms, rather than the delay in getting extensive diagnostic tests, are responsible for the delayed diagnosis and treatment.