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Introduction: The aim of this work was to analyse the bacterial and fungal flora in maxillary sinuses in patients operated due to the FESS method., Material and Methods: Studies were conducted on 110 patients, including 47 women aged 17-78 and 63 men aged 17-66, who underwent endoscopic surgical procedures due to chronic polypoid maxillary sinusitis between 2006 and 2007. 214 cultures were prepared altogether. During the endoscopic operation on paranasal sinuses, a cannula was introduced along the natural entrance and material for the culture and antibiogram was removed by suction., Results: In the studied material of 214 cultures, 72 (33.6%) cultures obtained positive results, including 2 cases with bacterial and fungal floras present simultaneously (Aspergillus fumigatus and Aspergillus niger) in 38 operated patients. In 25 (34.5%) cultures we noted the presence of Staphylococcus epidermidis, which was sensitive to the following antibiotics: Cotrimoxazole, Rifampicin, Vankomycin, Teicoplanin and Levofloxacin. Staphylococcus epidermidis was isolated in 22 (31.0%) cultures, showing 100% sensitivity to similar antibiotics like the previous one. Another bacteria (Escherichia coli) was cultured in 10 cultures (13.8%), in 70% of the cases every second bacteria was Staphylococcus epidermidis with 100% sensitivity mainly to cephalosporins and aminoglycosides. In 3 cultures (4.17%) we found Klebsiella pneumoniae, with 100% sensitivity to cephalosporins and aminoglycosides and 100% resistance to penicillins. In three cases Pseudomonas fluorescens and Proteus mirabilis (4.17% each) were cultured with their sensitivity and resistance similar to those of Klebsiella pneumoniae. Two cases (2.8% each) in the cultures were noted: Citrobacter freundii, Streptococcus oralis and Hafnia alvei, which were 100% sensitive to some cephalosporins and aminoglycosides whereas their resistance to penicillins and Cefuroxime was as high as 100%., Conclusion: In the operated patients suffering from chronic polypoid maxillary sinuses we found 33.6% of positive results in the bacterial flora. This indicates that the changes were accompanied by an acute inflammatory condition, thus surgical procedures had to be followed by a guided antibiotic. The cultured bacteria demonstrated sensitivity to some cephalosporins and aminoglycosides and resistance to penicillins, which proves the abuse of penicillins in the treatment of acute inflammatory states of upper airways.

Introduction: The aim of the study was the comparison of hearing before and after ear surgery in patients with chronic otitis media according to Fowler and Sabine criteria., Material: The study comprised 42 patients (42 ears), aged 19-72 (26 females and 16 males). The patients were divided into three groups, considering the type of surgery; Group I--20 ears after myringoplasty, group II--14 ears after mastoidectomy with canal up and myringoplasty and group III--8 ears after the mastoidectomy with canal down., Methods: Audiologic examination was performed together with the evaluation of hearing loss according to the criteria of Fowler and Sabine (CPT), before and 3 months after the ear surgery. The difference of 20% (CPT) was considered improvement or deterioration of the hearing., Results: On the basis of the intraoperative examination, chronic otitis media with perforation was found in 18 patients, granulating otitis media in 16 patients and the chronic otitis with cholesteatoma in 8 patients. The myringoplasty was performed in 20 patients, the mastoidectomy with canal up and myringoplasty in 14 patients and the mastoidectomy with canal down in 8 patients. In 14 ears of group I (70%) hearing improvement was noticed, and in 6 (30%) remained unchanged. The mean hearing loss according to CPT in this group was 40.39% before ear surgery and 24.26% after. In group II in 6 ears (43%) hearing improvement was observed, whereas in 8 (57%) remained unchanged. The mean hearing loss according to CPT in this group was 71.40% before and 61.85% after surgical treatment. In group III, hearing improvement was noticed in 37% of ears and in 5 (63%) did not change after the ear operation. The mean hearing loss (CPT) in this group was 81.57% before treatment and 71.37% after., Conclusions: Considering early evaluation of hearing the best results were obtained in patients subjected to myringoplasty and conservative operations of the middle ear with canal up procedure.

Introduction: This work aimed at the analysis of results of the treatment of nasal and paranasal sinus polyps by the endoscopic method., Material and Methods: The tests were conducted on 142 patients, including 75 women and 67 men at the age of 17-68, who underwent the endoscopic surgical treatment due to nasal polyps and paranasal sinus polyps between 2006-2007. In all the patients we conducted functional surgical procedures of the nose and paranasal sinuses by the endoscopic method. In the post-operative treatment we applied the nasal steroid therapy and guided antibiotic therapy. The efficiency of the treatment was assessed 6 months after the procedure., Results: All in all, we conducted 278 polipectomies (163 repolipectomies) of the nose, 278 ethmoidectomies (56 reethmoidectomies), 188 ostium-ductal complex operations, 43 maxillary sinus operations, 21 sphenoid sinus operations and 64 surgical dilatations of the sphenoid sinus ostinum, 49 surgical dilations of the frontal sinuses. In 7 cases the nasal septum operation was conducted simultaneously. Six months following the operation, the endoscopic test showed a correct patency in the ostinum of the paranasal sinuses, sphenoid and frontal sinuses, and no inflammatory traits like reddening, swelling of the nasal mucosa or any pathological secretion. Four times we noticed reddening and swelling of the nasal mucosa, and the mucopurpulent secretion accompanying correct patency of the ostinum in the paranasal sinuses. The control examination carried out 6 months after the surgical treatment showed, according to the patients, the appropriate nasal patency in 93.7%, sensation of the blood flowing down the throat in 20.4%, mucorrhoea in 2.8%, smell impairment in 17.6% and headache in 2.8%., Conclusions: In the majority of the cases we conducted nasal and paranasal sinus re-operations after the prior traditional procedures, which are still used in many institutions not equipped with endoscopic surgery appliances.

The aim of this work was a clinical analysis of patients suffering from vertigoes of neck origin, conducted within the own study. The study covered a group of 120 patients, including 76 females and 44 males, aged 20-85, who were diagnosed and treated due to vertigoes of neck origin in the Clinic of Otolaryngology and Laryngological Oncology the Medical University of Łódź between 2005-2006. Criteria for all the patients treated for vertigoes of neck origin include: an interview, subject otolaryngological treatment, complete audiological tests, laboratory tests, computerized tomography of the head or classical and functional x-ray of the cervical spine, blood flow in vertebral arteries and the basilar artery due to the Doppler method (using Transport-TCD apparatus, 2 Mhz head through the great foramen and using the torsion of the neck test). The electronystagmographic examination (ENG) covered registration of: position nystagmus detected in five classical positions according to Nylen, neck nystagmus in the torsion of the neck test. All the patients suffering form vertigoes of neck origin were treated with physical therapy and kinesitherapeutic exercises. The major part of the studied material of the patients with vertigoes of neck origin constituted: office workers (56.76%), aged 41-60 (59.16%), smoking (50.83%), suffering from hypercholesterolemia (35.29%), with abnormal x-ray of the cervical spine (93.37%) and injuries in this segment (13.33%), using non-steroid anti-inflammatory (69.17%) and vascular (52.59%) drugs, thus not young people with some additional pathological history. On the grounds of the obtained results it is claimed that the registration of the neck nystagmus in the torsion of the neck test as well as the position nystagmus examination according to Rose were most useful in this study, which facilitated reliable diagnostics of the vertigoes of the neck origin and monitoring of their intensity after applied treatment.

Introduction: Many pathologies of the posterior fossa can induce vertigo or dizziness. Usually they are due to benign or malignant tumors. The aim of our study was to present the cases of the patients with central vertigo attended to the Otorhinolaryngology emergency department of the University Hospital., Material and Methods: The authors present three cases of the posterior cranial fossa tumors. All of the patients underwent a battery of audiovestibular tests. Each patient presented with positional vertigo, and electronystagmography revealed positional nystagmus indicative of a central lesion. In these cases positional vertigo was the first and only presenting symptom of central nervous system disease., Conclusions: The findings in these cases emphasize the need of looking for positional nystagmus in patients with suspected posterior fossa lesions as well as radiological diagnosis by using CT or MRI.

Introduction: The aim of the study was to analise tinnitus diagnosis and treatment on the basis of our experiences., Material and Methods: 137 patients hospitalizated in Otolaryngology and Laryngological Oncology Clinic because of tinnitus (88 women - 64% and 49 men - 35,8%) were included to the study. The diagnostic procedures were unified that enabled put forward correct diagnosis. After history and otoscopy, detailed audiologic diagnostic procedures (pure tone audiometry, suprathreshold audiometry, speech audiometry, acoustic immittance measures, auditory brainstem responses) were taken. Electronystagmography and videonystagmography, tinnitus loudness match, head and neck radiologic examinations supplemented diagnostic procedures. Alternative tinnitus treatment options were applied., Results: Study confirmed that tinnitus is the most frequent in patients above 50 years old (67,8% of participants). Tinnitus frequently coexist with bilateral sensorineural hearing impairment (69,1% of participants). 40,1% from asalysed group of patients complained of tinnitus of medium frequencies and 30,6% of patients complained of high frequency tinnitus. 42,3% of participants suffered from vertigo., Conclusions: The risk of tinnitus increases in patients above 55 years old that suffer from metabolic conditions and cervical spondylosis. Tinnitus frequently coexist with bilateral sensorineural hearing impairment and are bilateral or they are noticeable in better hearing ear. The most beneficial to tinnitus is causal and symptomatic treatment with several methods application.

Introduction: The aim of the study was to evaluate the influence of the selective electrical stimulation of the hearing organ on tinnitus in people with sensorineural hearing loss., Material and Methods: The study comprised 248 tinnitus patients treated by using electrical stimulation. The material was divided into two groups, regarding the method of stimulation. In group I--168 people, transtympanal electrical stimulation of the promontory was applied, whereas in group II--80 people, hydrotransmissive technique was used. ENT examination, audiological and radiological diagnostics, as well as the evaluation of the audiometric parameters of tinnitus was performed. The patients were asked to fill in the questionnaire concerning tinnitus. In 80 patients hydrotransmissive electrical stimulation was conducted using the own prototype device, in 168 patients--transtympanal stimulation, after local anaesthesia with Xylocain gel., Results: On the whole, in group of 248 patients, subjective improvement (decrease in the severity of tinnitus) was noticed in 130 people (52.4%), comprising 32 cases (13%) of total relief. In 93 patients (37.5%) tinnitus remained unchanged, and in 25 (10.1%) the deterioration was observed. The comparison of the results of two electrical stimulation methods, showed the superiority of hydrotransmissive one (improvement in 58.75% of patients), however, the number of cases of total relief was greater in the case of transtympanal method (15.5%). Considering subjective evaluation, as well as audiometric (the intensity and the frequency parameters, MML) the hydrotransmissive method appeared to be more effective (improvement in 53.75%) comparing to transtympanal stimulation (improvement in 44.6%)., Conclusions: On the basis of studies conducted in the Clinic and the long history of the electrical stimulation administration in tinnitus treatment, it can be stated that this method may by applied in cases, in which other therapeutical methods failed.

Introduction: The aim of this work was to assess the value of impedance audiometry in the differential diagnostics of hearing disorders, especially in patients suffering from tinnitus., Material and Methods: The analysis dealt with results of the audiological tests in 198 patients (116 female and 82 male), hospitalised in 2007 due to their hearing deterioration, tinnitus or sudden deafness. The conducted audiological tests covered threshold and suprathreshold pure tone audiometry, speech audiometry, BERA and impedance audiometry. RESULTS OF THE STUDIES: Women (58.5%) and people over 50 years old (58.6%) constituted the majority of the patients. In 166 (83.8%) patients the conducted tests via impedance audiometry did not prove any deviations from the normal condition, the lesions referred to both ears in 32 (16.9%) patients and one ear in 17 (8.5%) patients. An incorrect tympanogram was found in 23 people, including type As in 11, type Ad in 2, type B in 4 and type C in 6 subjects. Low values of acoustic receptivity of the middle ear were noted in 20 ears, whereas high values in 11 ears. In 3 ears we found low values of the gradient (below 0.3), high values--in 11 ears. The middle ear pressure between -170 and -350 daPa was noticed in 20 ears, and positive values, above +50 daPa up to +75 daPa, in 3 ears. Disorders in the stapedial reflex registration were observed in 38 (19.1%) patients. The assessment of the conducted subjective and objective audiological examinations allowed to recognise bilateral perceptive hearing injuries in 139 patients, including 49 (25.9%) of cochlear origin with OWG, in further 70 patients the hearing loss referred to higher frequencies and was rather slight., Conclusions: The own experiences indicated that the impedance audiometry constitutes the integral part of contemporary audiological diagnostics and still remains an objective method facilitating quick, non-invasive evaluation of the functions of particular elements in the middle ear.

Introduction: Jet engine noise may be very harmful to the auditory organ. Transient evoked otoacoustic emission (TEOAE) seem to be non-invasive, objective and frequency specific audiometric test for evaluating hair cell damage caused by noise and other etiological factors. Sounds of high intensity often cause damage to the organ of Corti. It is well known that the outer hair cells often get damaged first. There are data that OAEs in humans and in animals become weaker after short exposures to noise and OAE measurements appear to be a sensitive method of monitoring the early cochlear changes after noise-induced trauma. The aim was to assess the effects of exposure to jet engine noise on TEOAE and in comparison to PTA in jet engine servicing personnel before and after one year., Material and Methods: The study comprised of 40 men exposed to jet engine noise and 20 professional soldiers additionally exposed to impulse nose. Comparative group consisted of 40 men not exposed to noise with normal hearing. TEOAE and PTA were recorded in both group., Results: Reductions of TEOAE amplitude were noticed for the both group exposed to noise mainly for the frequencies of 1414 Hz (p < 0.05). The control group did not show any significant audiometric changes neither TEOAE during the time of experiment., Conclusion: The reduction of TEOAE in individuals exposed to jet engine noise was incommensurably greater than the changes in PTA. The technical personnel participating in jet engine tests (even in the case of a single exposure) are exposed to noise which greatly exceeds permissible and safe levels.

Introduction: The aim of the study was to evaluate the influence of electrical stimulation on severe tinnitus., Material and Methods: The study comprised 46 patients (66 ears) suffering from severe tinnitus, persistently or temporarily, 27 women and 19 men, ranging in age from 22 to 84 years, on average 55. The material was divided into two groups. Group I was treated using electrical stimulation, whereas group II was being applied additionally the kinesitherapy of the cervical part of the vertebral column. The average duration of tinnitus was similar in both groups and equals 4.5 years. All the patients were administered medicines, without expected result. Otolaryngological, audiological diagnostics was conducted as well as head and cervical computer tomography. The patients were asked to fill in the questionnaire concerning tinnitus. The electrical stimulation was performed using silver electrode which was dipped in saline solution in external auditory canal. Direct current was used, the intensity ranged from 0.15 mA to 1.15 mA. Fifteen electrical stimulations were entire treatment administered twice or three times a week. Before and after treatment the subjective evaluation of tinnitus was made., Results: The subjective improvement was noticed in 36 people (n 46 ears--71%). Persistent tinnitus was registered in 30 ears and temporary in 30 ears, in 6 tinnitus disappeared completely. On the basis of audiometric tests improvement was noticed in 33 ears (55%). In group I in 17 ears (44%)--in 4 ears tinnitus disappeared, in 13 partial relief was noticed, 10 ears were without any change and in 12 ears the intensification of tinnitus was recognized. In group II in 16 ears improvement was observed, in 2 of them tinnitus disappeared, in 14 decreased. In 9 ears no change was obtained and in 2 intensification was noticed., Conclusions: Electrical stimulation can be an alternative therapy in severe tinnitus treatment. The administration of kinesitherapy of cervical column may have an additive effect on tinnitus treatment.

Introduction: The aim of the study was evaluation of effectiveness of whole-body cryotherapy in patients with tinnitus., Materials and Methods: The research was carried out in 120 patients (aged 20-68) with tinnitus, divided into two groups: I--80 patients treated by cryotherapy and II--40 patients non treated. There were: 73 women and 47 men. Among patients of I group: 39 reported bilateral tinnitus, 20 reported right tinnitus, 15 reported left tinnitus and 6 reported tinnitus in head. Duration of the ailment took from 1 month to 23 years. The methods included: taking a history, otolaryngological physical examination, audiometry establishing level of tinnitus, medical consultation, X-ray examination of chest and cervical spine and CT of head. After examinations and additional consultations the patients were qualified for cryotherapy unless there were some contraindications. The patients underwent 10 procedures in two cycles with the weekend break. They were in cryochamber in temperature of -110 degrees C for 3 minutes. After cryotherapy they used kinesitherapy for 45 minutes. Intensity and troublesomeness of tinnitus was evaluated using self-assessment chart (point scale 0-100) and audiometry establishing level of tinnitus before and after treatment., Results: The results indicates complete elimination of tinnitus in 4 patients, decrease in their intensity in 47 patients, maintenance of the ailment on the same level in 13 people and slightly increase of tinnitus in 16 patients. In audiometry we could observe in I group changes in frequency of tinnitus in 138 ears and changes in intensity of tinnitus in 91 ears. After treatment decrease of average hearing loss and average hearing damage were observed., Conclusions: Treatment of tinnitus may be effective by using whole-body cryotherapy.

Authors introduce case of the lymphocytoma of the laryngeal pocket at the patient hospitalized in the Clinic of the Otolaryngology and the Laryngological Oncology for the location of the incommunicado button and large diagnostic difficulties under examination histopathologic.

Introduction: The aim of this research was to describe nomograms of brainstem auditory evoked potentials, oscillating stimulation of the vestibular organs and ultrastructural research methodology of a spiral organ of guinea-pigs., Materials and Methods: For the experimental purposes 60 guinea-pigs of both sexes, weight 250-300 grams, were used as research materials. After general anesthesia with Ketalar dosed 100 milligrams per kilogram and with Fentanyl dosed 0.1 milliliter per kilogram of the body mass, brainstem auditory evoked potentials were registered and the oscillating chair test (no prior anesthesia). Was placed on an assistant's knees, who was sitting on a chair. Then the guinea-pigs were anesthetized with 35 per cent solution of chloral hydrate intraperitoneally (dosed 1 milliliter per kilogram of the body mass). For electron microscopic research membranous helix was collected bilaterally by the method of micropreparation. Qualitative observation was conducted in the Philips' electron microscope (EM 300)., Results: On the basis of the obtained results it was concluded that the time of transmission between elements P1-P2 is constant and figures between 3.1 and 3.6 ms independently from a force of stimulation. Vestibular organs of a guinea-pig are more sensitive to high accelerations (17-12 degree/s2) than human vestibularl organs. However, their reaction is much weaker to lower accelerations (12-0 degree/s2)., Conclusions: The processed nomograms of the brainstem auditory evoked potentials, oscillating stimulation of vestibular organs and methodology of ultrastructural research in guinea-pigs' spiral organs are expected to facilitate using them in experimental research.

Objective: The aim of the study was to assess the influence of short-term impulse noise to temporary threshold shift in soldiers using hearing protectors., Study Design and Setting: The study included 80 subjects with correct tympanic membrane and thresholds measured by pure-tone audiometry less than 20 dB. There were two groups: 40 soldiers protected during shooting and 40 young males who didn't shoot. TEOAE were performed by ILO 292 Echoport Otodynamics device 3 to 5 minutes before shooting and 2 minutes and 1, 2, and 3 hours after shooting., Results: Short-term exposure to impulse noise generated by five gunshots from the rifle kbk AKMS hasn't induced temporary threshold shift of hearing for chosen frequencies in soldiers using hearing protectors. Spectral analysis for chosen frequencies revealed that measurement reproducibility, stimuli level, and probe stability appeared to be comparable and repeatable., Conclusion: Our results show that the use of hearing protectors safeguarded against impulse noise., Significance: The use of earmuffs is strongly recommended because they seem to sufficiently attenuate shooting noise.

Introduction: The aim of the study was to assess the effectiveness of pharmacotherapy and physiotherapy in cervical vertigo treatment., Material and Methods: 80 patients with cervical vertigo (41 women and 39 men), aged 20 to 85, were treated by pharmacotherapy or physiotherapy. There were two groups: group I was treated by pharmacotherapy and group II was treated by physiotherapy and kinesitherapy. The effects of vertigo treatment were assessed by positional nystagmus testing according to Cawthorne and Rosen; cervical nystagmus testing in neck rotation test; by everyday task self-control cards and vertigo staging system according to Silvoniemi (0-4 points). The effects of treatment were assessed before therapy, 6 and 12 weeks after therapy. Patients from group I were treated by Nootropil and Betaserc; group II received magnetic Fidel, laserotherapy, massage and kinesitherapy exercises., Results: The obtained results showed that the most useful methods of cervical vertigo diagnosis were neck rotation test and Rose method. The average number of points (according to Silvoniemi scale) on the basis of ten everyday activities, was lower after 6 weeks of treatment than before the treatment and the lowest after 12 weeks of treatment. The difference was higher in group II than in group I., Conclusions: Patients treated by physiotherapy (group II) performed better in everyday activities than the patients treated by pharmacotherapy (group I). Cervical vertigo treatment by physiotherapy is cheap and underestimated method.

Introduction: It is generally agreed that impulse noise that occurs mainly in industrial processes, military forces and recreational target practice und hunting is especially hazardous to the ear. From the physical point of view the phenomenon is defined as an acoustic pressure disturbance of short duration less than 1 sec and high intensity with the peak sound pressure levels greater than 100 dB SPL., Materials and Methods: The study included 80 subjects (160 ears) aged 19-23 with correct tympanic membrane and thresholds measured by pure tone audiometry less than 20 dB. There were divided into two groups: I comprised 40 recruit soldiers put to the shooting training and group II consisted of 40 recruit soldiers using hearing protectors during shooting. Transient evoked otoacoustic emission (TEOAE) measurements were performed by ILO 292 Echoport Otodynamics device 3-5 min before shooting and then 2 min, 1, 2 and 3 hours respectively after shooting in both groups., Results: It was found that the gunshot impulse noise from kbk AKMS rifle caused in group I temporary hearing threshold shift (TTS) for 1, 2, 3, 4 and 5 kHz frequencies of 1.07; 0.96; 1.41; 0.88 and 1.25 dB SPL respectively. TTS turned out to be maximum at 4 and 5 kHz and minimum at 1 and 2 kHz. In group II the soldiers used ear-muffs post-exposure changes were not significant., Conclusions: Short-term impulse noise generated by the rifle gunshots induced threshold shift of hearing. The usage of hearing protectors should be highly recommended because most of them seem to sufficiently attenuate impulse noise from firearms should be highly recommended because most of them seem to sufficiently attenuate impulse noise from firearms.

The present notion - tracheotomy, originates from the Latin words trachea - windpipe, which comes from the combination of Latin "tracheia" and Greek "arteria" indicating an uneven road, and "tome" - cut. Procedures of pharyngotomy have a long-lasting history. First similar operations were found on the ancient Egyptian clay tablets dating back to 3600 BC. Mentions of pharyngotomy operations were found in the papyrus called Ebers's Papyrus dating back to about 1550 BC, which can obviously be treated as an encyclopaedia of the medical knowledge that the ancient Egyptians possessed. Guidelines for the person performing pharyngotomy were described in Rig Veda - the holy scriptures of Hindi medicine, about 2000 BC. Asclepiads of Prussia in Bithynia (124-156 BC), a Greek physician practising in Rome, is commonly considered the father of pharyngotomy. In the 1st century BC he documented an operation similar to pharyngotomy. Procedures similar to pharyngotomy were conducted by Claudius Galenus of Pergamon (about 130-200 AD) who was treating gladiators at the beginning of his medical career. A precise description of the technique in pharyngotomy performed by the method adopted from Antilla (3rd century AD) was presented by Paulos Aeginata (625-690 AD), whereas in modern times the first surgical pharyngotomy was performed by Antonio Brasavola (1490-1554) in 1546. In those times pharyngotomy operations were applied as life saving procedures and were associated with a desperate fight for life. The best example is given by Sanctorio Santorius (1561-1636) who pierced the trachea lumen with a trocar. All the experiences connected with the pharyngotomy technique were collected by Lorenz Heister (1683-1758) and published in his work "Surgery" in 1716. Until the end of 18th century the work finally established views about performing pharyngotomy operations. In 1856 Eugeniusz Bonchut conducted the first pharyngotomy in a child with passing an intubation tube into the trachea lumen. The operation was performed according to theoretical assumptions by Armando Trausseau (1801-1867), whose contributions to emergency pharyngotomy methods are enormous. Finally, at the beginning of the 20th century Chevalier Jackson (1865-1958) set principles for surgical techniques in pharyngotomy that still remain in force. The return to Sanctorius's method and also adaptation of Selinger's method (1953) of cannulation of blood vessels turned out to be fundamental for the further development of transdermal pharyngotomy. The first set for multistage, dilatation pharyngotomy was provided by P. Ciaglia et al. in 1985. A one-stage pharyngotomy by special forceps was described by W. M. Griggs et al. in 1990. A technique of transdermal pharyngotomy from inside the trachea was presented in 1995 by A. Fantoni with his group. Modern methods of transdermal pharyngotomy are good complementary techniques for classical methods of pharyngotomy in both emergency and chronic cases.

A squamous cell carcinoma of the nasal vestibulum is rare variant of skin cancer and constitutes only 7% of malignant tumors of the nasal cavity. Authors presents a case of neck lymph node metastases from primary site (nose vestibulum) which was completly surgical excision 3 months before. When another primary site of cancer were non confirmed selective neck dissection and adjuvant radiotherapy was performed.

Objective: The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes, prevalence of vertigo, and decreased blood flow velocity through vertebral arteries (VA) after head rotation., Study Design and Setting: A prospective, controlled study in academic neurotology was conducted. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained of positional vertigo lasting more than 6 months. Patients were examined by transcranial Doppler ultrasound with head rotations., Results: We showed significant association between velocity flow in basilar artery after neck rotation and age, prevalence of vertigo, grade of radiological changes, and positional vertebral artery flow lesion., Conclusion: Spondylotic-induced VA compression may be the reason for decreased blood flow velocity in the basilar artery during head rotation, which may be of particular importance for older patients, especially complaining of vertigo., Significance: Every patient with high-grade cervical spondylosis, especially complaining of vertigo, should be examined by using TCD (transcranial Doppler) with head rotations. In case of positional blood flow reduction during head rotation, further angiographic examination should be undertaken so as to plan suitable treatment., Ebm Rating: C-4.

The Aim: Evaluation of military flight personnel is of paramount importance in categories both flight safety and combat effectiveness. Assessment of equilibrium system in military pilots is very important part of fitness to fly evaluation. One of the assessment methods is statokinesiometry which can be used complementary to standard ENT evaluation methods., Material and Methods: 18 instructor pilots volunteered to take part in experiment. Age of participants was in range 22 to 47 years (mean 31 +/- 7.78), flight experience (240-4300 flying hours, mean 1408.13 +/-1054 h). All participants had current fitness to fly certificate. Each of participants underwent three expositions on GYRO Instrumental Physiological Trainer and consecutive statokinesiometric assessment in three conditions: "eye open" and "eye closed"., Results: Analysis of recorded parameters revealed individual variations in vestibular organ sensitivity. Capacity of vestibular system to cope an adapt to accelerations evoked in conditions similar to real flight is considered as important factor determining spatial disorientation susceptibility., Conclusions: Therefore it can be used as determinant whether certain individual is capable to perform military flight duties. Proposed method allows for objective and precise assessment of these qualities. Results obtained can be used as an objective complementation to flight personnel training efficiency assessment with use of aviation simulators.

The intricate mechanism of swallowing can be divided into three phases: oral, pharyngeal, and esophageal. Dysphagia is a disruption in the swallowing process, which include difficulty in transporting (or a lack of transporting) a food or liquid bolus from the mouth through the pharynx and esophagus into the stomach. Causes of disruptions in the swallowing process can be divided into superior (oropharyngeal) and inferior (esophageal) according to Paradowski et al. Neurlologic dysphagia may be caused by a disruption in different parts of the central nervous system (supranuclear level, level of motor and sensory nuclei taking part in swallowing process, peripherial nerves level and a pathology of muscle cells and spindles) or neuromuscular and muscular disorders. Neuromuscular disorders causes according to Waśko-Czopnik et al. are: stroke, brain tumors, brain injury, bulbar and pseudobulbar paralysis, neurodegenerative diseases (amyotrophic lateral sclerosis, multiple sclerosis), tabes dorsalis, multisystem degenerations, Parkinson's disease, delayed dyskineses, Huntington's disease, myasthenia and myasthenic syndromes, myopathies and peripherial neuropathies. The correct diagnosis evaluation include history taking, physical examination with palpation and consultations (laryngological, gastrological and neurological). According to Halama radiological esophagogram, videofluoroscopy, flexible endoscopic examination, ultrasound examination, manometry, electromyography, scintigraphy and 24 hour pH monitoring are main diagnostic procedures of dysphagia. Some of the reasons for the neurologic dysphagia may be treated by surgical and pharmacological methods. Neurologic dysphagia rehabilitation is difficult, long-lasting and often falling far short of expected results. Primary it should include neurologic cause treatment if it is possible. According to WHO International Classification of Functioning and Health in 2001 non-invasive methods of dysphagia treatment may be divided into reconstitution, compensatory and adaptive techniques. The most popular reconstitution methods are thermal stimulation (Lazzar's) or tactilethermal application (Rosenbeck's) techniques which may be applied for abnormal duration of stage transition (DST). Abnormal duration of stage transition considerably increase probability of aspiration. Dysphagia treatment by compensatory methods consist in various techniques of swallowing and posture changes application. Adaptive techniques include dietary changes--avoiding of sustenances strengthening dysphagia and adequate dietary intake. The basic principle of dysphagia rehabilitation is that the most effective way to regain efficiency is the regeneration on remains of lost function. Carrying out imperfect swallowing acts is probably the best way of increasing effectiveness and efficiency of swallowing. On the other hand imperfect swallowing acts may be hazardous because of the danger of aspiration and inhalation pneumonia.

Establishing the Chair of Laryngology with the Clinic of the Military Medical Academy was connected with inauguration of the Military Medical Academy in Lódź on the 1st July, 1958 (the Resolution of the Cabinet Council No. 477 / 57 dated 7th November, 1957 and the Order of the Minister of National Defence No. 03 / Org. dated 19th May, 1958) on the basis of the Military Centre of Medical Training, the Central Clinical Hospital in Lódź and the Central Hospital of the Ministry of National Defence in Warsaw. In fact the Chair of Laryngology with the Clinic of the Military Medical Academy was established in September 1958 with Major Antoni Kwilman, M.D. - senior lecturer - appointed to be a temporarily performing duties head of the institution until April 1959. Considering its successive Heads the forty-five years history of the Otolaryngology Clinic at the Military Medical Academy can be divided into four periods. Period I. In April 1959 Assistant Professor Józef Borsuk, MD, PhD (Professor later) was appointed to be the first Head of the Chair of Laryngology and the Clinic. Within scientific scope the Chair cooperated with the Nofer Institute of Occupational Medicine in Lódź, the Military Sanatorium Unit in Ciechocinek and foreign Centres from the then German Democratic Republic and Czechoslovakia. Period II. Since the 1st October 1974 the Chair of Laryngology with the Clinic and since the 1st November that year the Otolaryngological Clinic at the Institute of Sense Organs the Military Medical Academy was run by Assistant Professor Bo2ydar Latkowski, MD, PhD - another Head appointed by the Minister of National Defence - who managed it until the 30th November 1987 and was the only civil Head of the Clinic. Period III. On the 1st December 1987 the third Head got in charge of the Otolaryngological Clinic at the Military Medical Academy - the then senior lecturer at the Clinic - Piotr Zalewski MD, PhD (the Military Medical Academy graduate). Period IV. By open competition on the 1st day of October 2003 Prof. Jurek Olszewski, MD,PhD was appointed to the Head of the Otolaryngology and Phonoaudiological Rehabilitation Clinic and simultaneously has been occupying the position of the Dean at the Faculty of Physiotherapy the Medical University of Lódź.

Introduction: Firearms are a common source of impulse noise that may be very harmful to the auditory organ. Impulse noise from weapons and explosions continually produces hearing damage among military personnel. The discovery of otoacoustic emission (OAE) has given a new possibility of early diagnosis of noise induced hearing loss. The transiently evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) are non-invasive, objective and frequency specific audiometric tests for evaluating outer hair cell function. The aim of the study was to asses the effects of exposure to impulse noise on DPOAE after one year of the obligatory military service., Material and Methods: The study comprised 92 (184 ears) soldiers, subjected to impulse noise during military service. The examine group was divided according total noise exposure. The control group consisted of secondary school students not exposed to noise. DPOAE was recorded before and after one year of military service., Results: After military service significant deterioration of DPOAE level was observed at frequencies of 1, 3, and 4 kHz on the right ear and 2, 5 and 6 kHz left one., Conclusions: 1. Reduction of DPOAE amplitude connected all frequencies. 2. We did not notice significant differences between groups connected total noise exposure.

Introduction: Noise produced by weapons may be harmful to soldiers during military service. Exposure to impulse noise during compulsory military service depends on the number of shots, explosion impulses, distance of injured ear from causal firearm as well as on the use of hearing protectors. Weapons produce impulse noises, which are characterized by peak pressure level and frequency. The purpose of this work was to calculate and estimate risk on hearing at soldiers during one year of the military service., Material and Methods: The study comparised three groups of soldiers with different kind of exposure to noise divided according total noise exposure. In order to evaluate the amount of the exposure to impulse noise the total level of noise and the spectrum analysis were performed for all types of weapons, which were used during military service. The equivalent continuous A-weighted sound pressure level, L A eq, Te [dB], maximum A-weighted sound pressure level, L A max [dB] and C weighted peak sound pressure level, L C peak [dB] were measured., Results: The highest total exposure to noise concerned group I (2222,9 kPa(2)/s for right ear and 22212,8 kPa(2)/s for left one) with total exposure time 248,3 minutes. In the II group estimated total exposure to noise was 611,8 kPa(2)/s for right ear and 743,6 kPa(2)/s for left one. In the III group least exposed to noise, estimated total exposure to noise was 103 kPa(2)/s for right ear and 109 kPa(2)/s for left one with total time exposure 17,8 minutes., Conclusions: Difference between groups is dependent on kind of military service. Estimated exposure to weapons noise may prevent soldiers before hearing loss. We did not notice differences between sites of ears.

Introduction: Vertigo is one of the most frequent and disturbing sensations that the practicing otolaryngologist is called upon to treat. Vertigo is the illusory sensation of motion. True vertigo is caused by pathology in the peripheral end organ, the vestibular nerve, and the pathways that connect them in the brainstem and rarely, in the cortex., Aim: The aim of this study was to evaluate hearing in people with vertigo according to the etiology of balance disorders. The study comprised 127 patients treated in our clinic between 1999 and 2004, 88 women and 39 men (254 ears) aged 24-90 years. The average age was 56., Methods: Hearing tests (pure tone audiometry, speech audiometry, impedance audiometry, auditory brainstem responses, OAE) as well as vestibular function tests (electronystagmography, rotational chair tests, caloric tests) were performed. In order to evaluate the nature of vertigo radiological diagnostics (head and cervical computer tomography, vascular diagnostics using Doppler sonography) was performed., Results: Audiometric testing showed impaired hearing in 71 of 127 subjects. Among 73 patients with vertigo of vascular origin caused by vertebrae-basilar insufficiency, bilateral cochlear lesion was noticed in 33 cases and unilateral in 9. In 8 patients with cervical ankylosing spondylitis 3 had cochlear hearing loss (1--unilateral, 2--bilateral)., Conclusions: In our group of patients with vertigo in the most of cases the hearing loss was on cochlear origin.

Unlabelled: Impulse noise from weapons and explosions produces hearing damage among military service. The discovery of otoacoustic emissions (OAE) has given a new possibility of early diagnosis of noise induced hearing loss. The aim of the study was to assess the effects of exposure to impulse noise on TEOAE, SNR and PTA., Material and Methods: the study comprised 92 (184 ears, aged 18.5-20 years) soldiers, subjected to impulse noise during one year of military service. The soldiers were divided in to three groups according exposure to noise. Group I the highest exposure 2222, 9 kPa2/s, group II--611, 8 kPa2/s and group III--103-109 kPa2/s. The control group consisted of 60 (120 ears) secondary school students. Hearing evaluation was performed before and after one year of military service, using extended pure tone audiometry, tympanometry, TEOAE and SNR., Results: after military service significant deterioration of hearing was observed on average 1-2 dB for 0.125-3 kHz and 4-6 dB for 4-12 kHz for all examined soldiers without differences between groups. TEOAE reductions were registered predominantly at frequencies of 3 and 4 kHz, for both ears and SNR mean values reduction for the frequencies of 2, 3 and 4 kHz., Conclusions: TEOAE especially in cases where clinical audiometry is less sensitive can monitor small changes in the cochlea. There were no differences between groups and ears.

Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not established. The aim of present study was to asses diagnostic value of classical radiologic, electronystagmographic (ENG) and transcranial doppler ultrasonographic (TCD) examinations in cervical vertigo diagnostic process. Forty patients with vertigo lasting more than 6 months with radiological evidence of cervical spondylosis participated in the study. All patients had ENG and TCD with neck rotation test. Cervical vertigo was diagnosed in patients with positive neck rotation test in: TCD examination (15% decrease of vertebral artery flow) and/or ENG examination (cervical nystagmus). We diagnosed cervical vertigo in 65% of patients. Multivariate model of logistic regression analysis showed that the best statistical predictors of cervical vertigo were: asymmetry of vertebral artery flow in TCD (OR: 92.2; 95% CI: 6,2-1381) and presence of osteophytes and discopathy in radiological examination (OR: 64.1; 95% CI: 1,3-1107). The transcranial doppler ultrasonographic examinations seems to be useful for diagnosing cervical vertigo.

The aim of present study was to characterize the association between prevalence of vertigo and age, grade of radiological changes and positional vertebral (VA) and basilar artery (BA) flow lesion in patients with cervical spondylosis. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained positional vertigo. Patients with neurological symptoms were excluded from the study. ENG was used to exclude patients with another causes of vertigo. TCD evaluations of the distal part of VA and the proximal part of BA were performed with a 2-MHz probe via the suboccipital window. We showed significant and independent association between prevalence of vertigo and age, grade of radiological changes, and positional vertebral and basilar artery flow lesion velocity in multivariate logistic regression model. Spondylotic-induced VA compression may be the reason of decreased blood flow velocity in the basilar artery during head rotation, causing positional vertigo.

A case of isolated neck sarcoidosis is presented. Isolated sarcoidosis confined to the neck lymph node is rare. Sarcoidosis is a systematic disease usually involving pulmonary findings. Extrapulmonary involvement including the liver, eyes, lymph nodes, central nervous system, muscles and bones is common. This report documents a very rare case of isolated sarcoidosis of the neck, which is very rare diagnosed by otolaryngologists.

The authors describe a 46-year-old male patient. Inflammatory state of tonsils and peritonsillar abscess caused a serious complication which came to parapharyngeal phlegmon and superficial soft tissue phlegmon face and neck. A wide application of antibiotic gives a rare complication, but mortality reaches a few percent. A basic method is a surgical treatment--a wide cut of tissues in many places, to drainage interfascia space and compound aim intravenous antibiotic therapy.

The aim of the study was to assess the effectiveness of kinesitherapy in cervical vertigo treatment. Thirty two patients with cervical vertigo, aged 20 to 75, were examined. The patients performed kinesitherapy exercises three times a day for four weeks. The effects of therapy were assessed by everyday task self-control cards and ENG examinations. In the present study, objective improvement was noticed in 18,7% patients. Subjective improvement assessed by the patients everyday task self-control cards reached 62.5%. Kinesitherapy seems to be the good method of treating neck-related vertigo, but it should be confirmed in further study on the large group of patients.

Introduction: Typical high frequency hearing loss is accompanied by an exaggerated response to loudness as the sound level exceeds your elevated thresholds. This exaggerated response to sound levels is termed "recruitment". Recruitment is a paradoxical phenomenon present in hearing losses due to cochlear damage. Loudness recruitment is usually present to some degree as measured on the SISI. There have been many explanation connected this phenomena so far. It has been suggested that otoacoustic emissions might be more sensitive in assessment of changes to the cochlea caused by noise than pure tone audiometry., Material and Methods: In the present study results of the short increment sensitivity index test (SISI), DPOAE as well as slope of DPOAE input/output (I/O) function were compared before and after noise exposure. The I/O function plots DPOAE amplitude as a function of the level of the primary tones, for the progressively increasing stimulus levels (from 45 to 70 dB SPL) for the frequencies 1, 2, 3, 4, 6, 8 kHz. From 40 patients between 18-21 years, 30 ears were extracted with cochlear lesions and good hearing., Results: Both, PTA and DPOAEs amplitude showed in this group significant reduction due to noise exposure. Slopes of the DPOAE I/O function were depended on stimulus levels. For the low intensity stimuli levels (45-55 dB SPL) we obtained DP I/O amplitude value worse than before noise exposure. When stimulus level was above 55 dB SPL for the frequencies (1, 2, 3, 4, 6, 8 kHz) the amplitude and DP I/O slope was higher than before noise exposure. We did not notice that phenomena in persons without cochlear lesions., Conclusions: Our results showed that in examination group with cochlear lesion I/O DP amplitude was higher using stimulus level above 55 dB SPL. This notice can be otoacoustic recruitment phenomena.

The neck midline cyst is the most common congenital malformation in the neck area. In described case of 33 years women the diagnosis was established on clinical examination, the results of USG and the aspiration biopsy. The tumor was surgically excited and the microscopy examination revealed papillary cystic carcinoma of ectopic thyroid gland in glossothyroid ductus. In the every case of neck tumor we have to consider neoplastic process.

Schwannoma is one of the common benign middle ear space tumors. The tumors may present with facial nerve paresis or palsy, otologic symptoms and/or parotid mass middle ear schwannomas may originate from the nerves of the tympanic caviti or by extensions from outside the middle ear space. Schwannomas of the facial nerve can occur along any segment, but they frequently involve the geniculate ganglion and extend proximally or distally from there. MRI and CT imaging characteristics are similar to those of vestibular schwannomas. We present the clinical and radiologic features of a middle-space schwannoma originating from facial nerve. The patient underwent middle ear exploration and mastoidectomy. The tumor was of facial nerve origin and was separated from middle ear. The pathologic diagnosis was schwannoma.

The aim of examination was value of exploratory anterior tympanotomy in differentiation causes of conductives hearing loss and assessment of results treatment. Materials of examinations determined 34 patients aged 15-66 years, treated in 1995-2000 years, who qualified to exploratory anterior tympanotomy in aim decision of cause of conductives hearing loss. Among of examined were 14 patients with suspicion of otosclerosis (41.2%), 12 patients with unclear etiology of hypoacusis (35.3) and 8 patients with deterioration of hearing after stapedectomy (23.5%). Preoperative diagnostic embraced: a history, otolaryngologic examination, full audiologic examination and chosen cases of radiologic assessment of temporal bone by computer tomography. After perioperative decision cause of conductive hypoacousis were performed of operations of improved hearing and comprised of average hearing loss by CPT and PTA pre- and postoperative treatment. After performed of exploratory tympanotomy there vere stated following causes of conductive hypoacusis: otosclerosis (61.8%), separated of prosthesis after stapedectomy (14.7%) synechia of prosthesis with tympanic membrane (8.8%) and in singles causes of ossicular synechia in tympanic cavum (5.9%), tympanosclerosis (5.9%) and vitium of middle ear (2.9%). The best of hearing improvement after repairment operations of conductive system were obtained in cases of stapedectomy, exchange of prosthesis after stapedectomy, reconstruction of system by TORP prosthesis, however smaller improvement after operations of synechias of stapes prosthesis with surroundings and postoperation of tympanosclerosis.