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<b>Background:</b> The aim was to present the methodology and interpretation of intraoperative hearing monitoring with simultaneous Transtympanic Electrocochleography (TT-ECochG) and direct Cochlear Nerve Action Potential (CNAP) measurements during vestibular schwannoma removal. <br><b>Materials and Methods:</b> Detailed methodology of measurements and interpretation of results are presented in three exemplary patients who underwent tumor removal via middle fossa approach (MFA) with the use of intraoperative monitoring of hearing with TT-ECochG and direct CNAP performed in real time. In addition, all responses were automatically recorded and stored along with surgical information and subjected to detailed analyses and calculation after surgery. <br><b>Results:</b> The following changes in TT-ECochG and direct CNAP responses were observed: Patient #1 - TT-ECochG and CNAP responses with minor, but transient, morphology changes (hearing was preserved); Patient #2 - CNAP responses changed significantly but, temporarily, from triphasic into biphasic responses later, with marked but partially reversible desynchronization of CNAP; changes in TT-ECochG responses were also observed but, at the end, returned to baseline (surgery-related deterioration of hearing); Patient #3 - irreversible changes of TT-ECochG and direct CNAP (complete loss of hearing). <br><b>Conclusions:</b> A combination of TT-ECochG and direct CNAP allows for real-time monitoring of auditory function during vestibular schwannoma resection and surgical manipulation which contribute to the risk of hearing loss. Therefore, the surgeon can be instantly informed about changes which could increase the possibility of preserving the patient's hearing.

Background: The study evaluates clinical features of vocal fold (VF) leukoplakia in predicting its benign or malignant nature., Materials: 57 patients with 84 lesions were evaluated before undergoing laryngeal microsurgery. The texture, color, thickness and size of the leukoplakia, along with an assessment of the surrounding mucosa vascularization using narrow-band imaging (NBI), and VF vibratory function were analyzed. Receiver-operating characteristic curves were constructed to determine the predictive value of each feature and area under the curve (AUC) was calculated., Results: Histopathological examination revealed high-grade dysplasia or invasive cancer in 13 of VF leukoplakia. Seventy-one lesions were nondysplastic or low-grade dysplasia. Nonhomogenous color, irregular texture, and prominent thickness predicted malignancy with statistical significance (P < 0.05). AUC was 0.793, 0.793, and 0.679, respectively. Absence of a mucosal wave on laryngovideostroboscopy was significant for the detection of malignancy (P < 0.001) with an AUC of 0.927. The NBI diagnosis of horizontal vessel loops was significant with the highest AUC of 0.993., Conclusions: The comprehensive clinical evaluation of VF leukoplakia with laryngovideostroboscopy and NBI creates the opportunity to differentiate between low- and high-risk malignancy lesions. The perpendicular vascular pattern and the limited or absent mucosal wave appear to be the most powerful indicators of malignancy., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: The olfactory groove (OG) is a common site of iatrogenic cerebrospinal fluid (CSF) leak during endoscopic sinus surgery. We aimed to evaluate the prevalence of CSF leak during endoscopic removal of osteomas involving the OG and identify CT findings indicating increased risk of this complication., Methods: A retrospective review was conducted of patients operated on for frontoethmoidal osteoma from 11 years in a single institution. A retrospective review of the literature, 1999 to 2019, of perioperative complications in patients operated on for frontoethmoidal osteoma using endoscopic or combined approaches., Results: Case series: 73 patients were identified including 17 with the OG involvement. The only case of CSF leak occurred in a patient with spongious part of osteoma at the OG. Among six osteomas with spongious component at the OG, one was detached and five had to be drilled down, leaving a small remnant in four. In contrast, all the 11 osteomas with ivory part at the OG were safely detached and completely removed from the OG after debulking. The prevalence of CSF leak was not statistically different between the patients without and with involvement of the OG. Systematic review of the literature: Among the 273 identified patients there were 8 cases of intraoperative CSF leaks (3%) including 2 from the OG (0.7%)., Conclusion: Involvement of the OG does not significantly increase the risk of intraoperative CSF leak. However, this risk may be increased in patients with the spongious part of the tumor attached to the OG.

Objectives: Aim was to investigate the innovative method of direct acoustic bone conduction (BC) stimulation applied directly to the otic capsule and measured intraoperatively by promontory displacement in living humans. The objective was to find the best stimulation site that provides the greatest transmission of vibratory energy in a living human and compare it with the results previously obtained in cadavers., Design: The measurements were performed in 4 adult patients referred to our department for vestibular schwannoma removal via translabyrinthine approach. The measurements were performed in the operated site. The cadaver data were obtained in our previous study and here they are reanalyzed for comparison. Promontory displacement was measured using a commercial scanning laser Doppler vibrometer. The laser Doppler vibrometer points located on the promontory were used to analyze the promontory displacement amplitude. Cochlear stimulation was induced with BC stimulation through an implant positioned at three sites. The first site was on the skull surface at the squamous part of the temporal bone (BC No. 1), the second at the bone forming the ampulla of the lateral semicircular canal (BC No. 2), and the third between the superior and lateral semicircular canals (BC No. 3). BC No. 2 and BC No. 3 were located directly on the otic capsule. Four frequencies in total were tested (500, 1000, 2000, and 4000 Hz), one at a time., Results: In patients, the detailed analysis of promontory displacement amplitudes revealed the BC No. 1 magnitude to be the smallest and significantly different from BC No. 2 and No. 3 at all measured frequencies. Transmission of vibratory energy at BC No. 2 and BC No. 3 was the most effective and similar with a small and insignificant difference at 500, 1000, and 4000 Hz, and a significant difference at 2000 Hz. The results observed in cadavers were similar to those in living humans. However, a few differences were observed when comparing patients and cadavers. Small and insignificant differences were found for BC No. 1. Almost the same results were obtained for BC No. 2 and BC No. 3 in cadavers as in living humans, with only BC No. 3 measurements results at 500 Hz at the limit of statistical significance, with no other significant differences observed., Conclusions: The results of this study indicate that the promontory vibration amplitude increases when the BC stimulation location approaches the cochlea. BC No. 1 stimulation located on the squama caused overall smaller displacement than both BC No. 2 and No. 3 screwed to the ampulla of the lateral semicircular canal and to the midpoint between the semicircular canals, respectively. In our opinion, the results of BC stimulation applied directly to the otic capsule present a potential new stimulation site that could be introduced in the field of BC hearing rehabilitation.

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

&lt;b&gt;Background:&lt;/b&gt; Patients with vestibular schwannoma (VS) most commonly present with hearing threshold reduction for high frequencies and a falling type of audiometric curve. However, it is doubtful whether all Pure Tone Averages described in the literature characterize patients with VS correctly, as the type of PTA which comprises higher frequencies may be more appropriate for hearing status assessment in those patients. &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this study was to analyze 3 common methods of calculating Pure Tone Averages (PTA1 - 500, 1000, 2000 and 3000 Hz; PTA2 - 500, 1000, 2000 and 4000 Hz; PTA3 - 500, 1000 and 2000 Hz) and to determine which of them is the most reliable for the assessment of VS patients. &lt;br&gt;&lt;b&gt;Material and Methods:&lt;/b&gt; The study group included 86 patients operated on due to vestibular schwannoma accessed via the middle cranial fossa. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Regarding the method of calculating Pure Tone Averages (PTA1, PTA2 and PTA3) identical or similar correlations were found between the preoperative values of Pure Tone Averages (PTA1, PTA2 and PTA3) and surgery-related hearing loss, as well as individual parameters of audiologic tests. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Pure Tone Averages calculated according to 3 different methods (PTA1, PTA2, PTA3) may be used interchangeably in the assessment of hearing in VS patients.

&lt;b&gt;Introduction:&lt;/b&gt; Microvascular free tissue transfer enables the reconstruction of complex head and neck defects. The aim of the study was to assess the results of treatment of patients undergoing reconstructive surgery and to identify factors affecting these results, with particular reference to patient's age. &lt;br&gt;&lt;b&gt;Materials and Methods:&lt;/b&gt; All patients who underwent free-flap head and neck reconstruction in our institution between 2010 and 2017 were included in this retrospective study. A series of 66 patients met the inclusion criteria and were divided into 2 age groups: group G1 aged &lt;65 years (n = 41) and group G2 aged ≥65 years (n = 25). Minor local complications and general complications as well as comorbidities were analyzed. &lt;br&gt; &lt;b&gt;Results:&lt;/b&gt; No correlation was found between advanced age and the risk of free flap failure as well as the incidence of local minor complications. General complications were more frequent in the G2 group (32%) than in the G1 group (19.5%), although this is not a statistically significant difference. A statistically significant difference was found between the age and the patient's health status according to ASA (P = 0.010). In the younger low-risk group, 12 patients (29.3%) had general and local complications, while in the older low-risk group only 1 (4%). General and local complications were found in 5 (12.2%) high-risk G1 patients and in 7 (28%) high-risk G2 patients. &lt;br&gt;&lt;b&gt;Conclusion(s):&lt;/b&gt; Patients with advanced head and neck malignant tumors should undergo reconstructive microsurgery regardless of age.

Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx.

The aim of this study was to evaluate the morphology of the stapedius muscle and its tendon with the use of microCT and to describe their anatomic relationship with facial nerve and incudostapedial joint. The study was performed on 16 fresh cadaveric temporal bones scanned in microtomography (microCT). Stapedius muscle and its tendon were identified in each set of images. The length of the medial and lateral border of the stapedius tendon (STL-med, STL-lat), width at the insertion to stapes (STW-s), at the point it emerges from the pyramidal eminence (STW-p) and in the half way from the pyramidal eminence to stapes (STW-m), and the length and the width of the belly of stapedius muscle (BSML and BSMW) were measured in modified axial plane. The shortest distance between the facial canal and incudostapedial joint (FN-isj), and between the facial canal and stapedius tendon (FN-st) were measured in the Pöschl plane. The average values of all distances measured were: STL-lat 1.29 ± 0.50 mm, STL-med 1.27 ± 0.44 mm, BSML 2.98 ± 0.51 mm, STW-s 0.47 ± 0.10 mm, STW-p 0.46 ± 0.12 mm, STW-m 0.35 ± 0.12 mm, BSMW 1.26 ± 0.29 mm, FN-isj 1.72 ± 0.33 mm, FN-st 1.35 ± 0.30 mm. The stapedius muscle complex consists of the tendon and the belly, and the border between them in microCT scans is not always evident. The distance between the facial nerve and the incudostapedial joint is greater than the distance between the facial nerve and the stapedius muscle tendon.

Introduction: The aims of this study included: (a) to develop a method of direct acoustic bone conduction (BC) stimulation applied directly to the otic capsule, (b) to investigate the effect of different stimulation sites on the promontory displacement amplitude, and (c) to find the best stimulation site (among 2 located directly on the otic capsule and 1 standard site approved for clinical use) that provides the greatest transmission of vibratory energy., Methods: Measurements were performed on 9 cadaveric whole human heads. A commercial scanning laser Doppler vibrometer was used. The promontory displacement was recorded in response to BC stimulation delivered by an implant at 3 sites: BC1 on the squamous part of the temporal bone, BC2 on the ampulla of the lateral semicircular canal, and BC3 between the semicircular canals. The displacement of the promontory was analyzed in detail., Results: The results show that BC1 caused an overall smaller promontory displacement than both sites BC2 and 3. BC3 stimulation is more efficient than that at BC2., Conclusions: BC is an effective method of acoustic stimulus delivery into the inner ear, with the effectiveness increasing when approaching closer to the cochlea. Placing the implant directly on the labyrinth and thus applying vibrations directly to the otic capsule is possible and very effective as proved in this study. The results are encouraging and represent the potential of new stimulation sites that could be introduced in the field of BC hearing rehabilitation as the possible future locations for implantable BC hearing devices., (© 2020 S. Karger AG, Basel.)

Background and Objectives: Controversial prognostic factors of primary CO 2 laser cordectomy are anterior commissure involvement (ACI) and status of margin., Study Design/materials and Methods: Retrospective analysis of oncological outcomes in 102 patients with early glottic cancer undergoing laser cordectomy between 2013 and 2015., Results: The T stages distribution included: 72.6% T1a, 14.7% T1b, and 12.7% T2. The ACI was diagnosed in 26 patients. The primary cordectomy was radical in 72 patients. The 2- and 5-year disease free survival (DFS) for all patients were, respectively, 83.3% and 77.3%.The 2-year DFS rates for T1a, T1b, T2 were, respectively, 91.7%, 66.7%, and 53.9% and the differences were statistically significant (P < 0.001). The 2-year DFS rates according to the ACI and free anterior commissure tumors were, respectively, 65.4% and 89.2%, and the ACI indicated worse prognosis (P = 0.057). The 2-year DFS rates according to margins status were higher for patients with close or positive margins, who had second resection (88.9%) compared with those of negative margins (80.9%) (P = 0.340). Lasers Surg. Med. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

Background: Ocular vestibular-evoked myogenic potential (oVEMP) is one of recently introduced tests used to assess the function of the equilibrium system. It is still under research and no consensus has been reached yet., Aim: To analyze AC-oVEMP response parameters in subjects with no history of neurological or vestibular deficits., Material and Methods: The AC-oVEMPs collected from 50 subjects (100 ears) were analyzed in this prospective study for the response presence in the time domain, the latencies and amplitudes of the waves., Results: No statistically significant differences were observed between the right and left ear considering both N1 latency, and amplitude. Significant differences were noted when comparing the groups &lt;40 yo vs ≥40 yo (shorter latencies and higher amplitudes were observed in subjects &lt;40)., Conclusions and Significance: This thorough AC-oVEMP analysis in a group of healthy volunteers facilitated the proposal of reference ranges with a simultaneous indication of age-related differences. Shorter oVEMP latencies and higher amplitudes were observed in subjects &lt;40 yo, while in the subjects ≥40 yo the latencies were longer and the amplitudes lower.

Objectives: Two major classifications of frontoethmoidal cells, Lee and Kuhn and the IFAC (International Frontal Sinus Anatomy Classification), distinguish anterior, posterior and medial cells. The European anatomical position paper includes also lateral cells. According to the IFAC, anterior cells push the frontal sinus drainage pathway (FSDP) medially, posteriorly or posteromedially. Posterior cells push the FSDP anteriorly. The only medial cell, pushing the FSDP laterally is the frontal septal cell, which is attached to or located in the interfrontal sinus septum. The aim of this study was to verify the IFAC and characterise cells, which are inconsistent with this classification., Design: A radioanatomic analysis., Setting: Tertiary university hospital., Participants: One hundred and three Caucasian adult patients with no inflammatory changes in paranasal sinuses CT., Main Outcomes Measure: Results of assessment of multiplanar reconstruction of thin slice CT., Results: Two types of cells that cannot be classified using the IFAC were found: (a) Lateral cells extending between the skull base and the anterior buttress, pushing the FSDP anteromedially or medially, present in 34 (16.5%) of the sides, (b) Paramedian cells: medially based, not adjacent to the interfrontal septum, pushing the FSDP laterally and posteriorly, present in 33 (16%) of sides. Suprabulla cells and suprabulla frontal cells were found to push the FSDP in directions other than anterior 28% and 31% of the time respectively., Conclusions: Neglecting lateral and paramedian cells may lead to inconsistent results between radioanatomical studies and impede communication between surgeons. They should be included in existing classifications of frontoethmoidal cells., (© 2019 John Wiley & Sons Ltd.)

Objectives: The aim of this study was to investigate the following: (1) the vibration pattern of the round window (RW) membrane in human cadavers during air (AC) and bone conduction (BC) stimulation at different excitation sites; (2) the effect of the stimulation on the fluid volume displacement (VD) at the RW and compare the VD between BC and AC stimulation procedures; (3) the effectiveness of cochlear stimulation by the bone implant at different excitation sites., Design: The RW membrane vibrations were measured by using a commercial scanning laser Doppler vibrometer. The RW vibration amplitude was recorded at 69 measurement points evenly distributed in the measurement field covering the entire surface of the RW membrane and a part of the surrounding bony surface. RW vibration was induced first with AC and then with BC stimulation through an implant positioned at two sites. The first site was on the skull surface at the squamous part of the temporal bone (implant no. 1), a place typical for bone-anchored hearing aids. The second site was close to the cochlea at the bone forming the ampulla of the lateral semicircular canal (implant no. 2). The displacement amplitude (dP) of the point P on the promontory was determined and used to calculate the relative displacement (drRW) of points on the RW membrane, drRW = dRW - dP. VD parameter was used to analyze the effectiveness of cochlear stimulation by the bone implant screwed at different excitation sites., Results: RW membrane displacement amplitude of the central part of the RW was similar for AC and BC implant no. 1 stimulation, and for BC implant no. 2 much larger for frequency range >1 kHz. BC implant no. 2 causes a larger displacement amplitude of peripheral parts of the RW and the promontory than AC and BC implant no. 1, and BC implant no. 1 causes larger than AC stimulation. The effect of BC stimulation exceeds that of AC with identical intensity, and that the closer BC stimulation to the otic capsule, the more effective this stimulation is. A significant decrease in the value of VD at the RW is observed for frequencies >2 kHz for both AC and BC stimulation with BC at both locations of the titanium implant placement. For frequencies >1 kHz, BC implant no. 2 leads to a significantly larger VD at the RW compared to BC implant no. 1. Thus, the closer to the otic capsule the BC stimulation is located, the more effective it is., Conclusions: Experimental conditions allow for an effective acoustic stimulation of the inner ear by an implant screwed to the osseous otic capsule. The mechanical effect of BC stimulation with a titanium implant placed in the bone of the ampulla of the lateral semicircular canal significantly exceeds the effect of an identical stimulation with an implant placed in the temporal squama at a conventional site for an implant anchored in the bone. The developed research method requires the implementation on a larger number of temporal bones in order to obtain data concerning interindividual variability of the observed mechanical phenomena.

Introduction: The endoscopic methods are progressing and becoming more common in routine clinical diagnosis in the field of otorhinolaryngology. Relatively large amount of researches have proved high accuracy of narrow band imaging endoscopy in differentiating benign and malignant lesions within vocal folds. However, little is known about learning curve in narrow band imaging evaluation of laryngeal lesions., Objective: The aim of this study was to determine the learning curve for the narrow band imaging evaluation of vocal folds pathologies depending on the duration of the procedure., Methods: Records of 134 narrow band imaging that were analyzed in terms of the duration of the procedure and the accuracy of diagnosis confirmed by histopathological diagnosis were enrolled in the study. The narrow band imaging examinations were performed sequentially by one investigator over a period of 18 months., Results: The average duration of narrow band imaging recordings was 127.82s. All 134 studies were divided into subsequent series of several elements. An evident decrease in time of investigation was noticed between 13th and 14th series, when the examinations were divided into 5 elements series, which corresponds to the difference between 65th and 70th subsequent narrow band imaging examination. Parallel groups of 67 examinations were created. Group 1 included 1st to 67th subsequent narrow band imaging examination; Group 2 - 68th to 134th narrow band imaging examinations. The non-parametric U Mann-Whitney test confirmed statistically significant difference between the mean duration of narrow band imaging examination in both groups 160.5s and 95.1s, respectively (p<10 -7 ). Sensitivity and specificity of narrow band imaging examination in the first group were respectively: 83.7% and 76.7%. In the second group, these indicators amounted 98.1% and 80% respectively., Conclusions: A minimum of 65th-70th narrow band imaging examinations are required to reach a plateau phase of the learning process in assessment of glottis lesions. Analysis of learning curves is useful for the development of training programs and determination of a mastery level., (Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objectives: This study aimed to assess absorbance using a thorough analysis of individual points of its plot in ears with intraoperatively confirmed otosclerosis. To the best of our knowledge, until recently no analyses have been performed that concerned the shape of an absorbance plot and a detailed analysis of its individual points. This study is the first to undertake such an issue., Methods: A total of 77 otosclerotic ears were included in the study. Pure tone audiometry, low frequency tympanometry, and wide band tympanometry including absorbance were performed preoperatively. The average patients' age in the group was 43.49 years (standard deviation = 10.44). Individual points of absorbance plot were thoroughly analyzed. Parameters were analyzed, such as resonance frequency; number of peaks; maximum absorbance (Height); and plot Width at the following Heights: 1/3, 1/2, and 2/3 (Width1/3, Width1/2, Width2/3, respectively), as well as associated absorbance parameters and frequencies., Results: Data analysis revealed five different types of absorbance plots. Numerous statistically significant differences regarding the parameters of individual points of the plots were found among the distinguished types., Conclusions: There are five types of absorbance plots in otosclerotic ears: type I, characterized by two distinct peaks, closely resembling normal ear absorbance plot; type II with a single distinct peak reaching high values of absorbance; type III with reduced absorbance for frequencies <2000 Hz; type IV with reduced absorbance for all frequencies; and type V with reduced absorbance for frequencies >2000 Hz. Absorbance measurements may play an important role in the diagnostics of otosclerosis; however, further research is necessary in this area., Levels of Evidence: 4 Laryngoscope, 129:E365-E376, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient's medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.

In the present study, the effect of the static and alternating magnetic field applied individually and in combination with an algal extract on the germination of soybean seeds ( Glycine max (L.) Merrill) and chlorophyll content was examined. The exposure time of seeds to the static magnetic field was 3, 6, and 12 min, whereas to the alternating magnetic field was 1, 2.5, and 5 min. The static magnetic field was obtained by means of a permanent magnets system while the alternating magnetic field by means of magnetic coils. Algal extract was produced from a freshwater macroalga- Cladophora glomerata using ultrasound homogenizer. In the germination tests, 10% extract was applied to the paper substrate before sowing. This is the first study that compares the germination of soybean seeds exposed to the static and alternating magnetic field. The best effect on the germination and chlorophyll content in seedlings had synergistic action of the static magnetic field on seeds for 3 min applied together with the extract and alternating magnetic field used for 2.5 min. It is not possible to clearly state which magnetic field better stimulated the germination of seeds, but the chlorophyll content in seedlings was much higher for alternating magnetic field., Competing Interests: The authors have declared no conflict of interest., (© 2019 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: Postoperative hearing loss after vestibular schwannoma (VS) removal still remains a lifelong problem for the patients. The present study analyzes the problem of hearing preservation after VS removal from a different angle than available professional literature on this topic., Objectives: To identify audiologic factors which determine the extent of hearing loss in patients operated on for VS., Material and Methods: The study group included 86 patients operated on due to VS accessed via the middle cranial fossa. The analyses involved the effect on absolute hearing loss, which was calculated on the basis of the results of pure-tone audiometry performed preand postoperatively, and factors included in the preoperative audiologic tests, such as pure-tone audiometry, speech audiometry, auditory brainstem response (ABR), and impedance audiometry., Results: The following parameters were demonstrated to have a prognostic value: 1. hearing thresholds at 125 Hz, 500 Hz and 1,000 Hz for the operated ear, Pure Tone Average (PTA) - calculated specifically at 500 Hz, 1,000 Hz and 2,000 Hz and at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz for the operated ear, and normal audiometric curve; 2. speech discrimination ranging from 55 dB to 75 dB for the operated ear, speech detection threshold (SDT) in the operated ear and interaural difference at 25-35 dB (non-operated vs operated ear); 3. presence of wave V, the values of I-V and III-V intervals for the operated ear, the amplitude of wave V, and the interaural ratio of wave V amplitudes; 4. intensity level for obtaining stapedial reflex or an abnormal reflex at Ipsi 500 Hz, 1,000 Hz and 2,000 Hz, and Contra 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz., Conclusions: The better the preoperative hearing status, the more substantial surgery-related hearing loss was observed. A number of preoperative parameters of the basic diagnostic set of audiologic tests present a prognostic value for the degree of surgery-related hearing loss in VS patients.

The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF). An improvement in mean value of LVS ratings was obtained in all three groups; however, only in benign lesion group was it consistently statistically significant for each time period (P < 0.001). Perceptual evaluation revealed significant improvement of G, R, and B parameters in benign lesions for each time period. In malignant neoplasms R and B parameters improved 3 and 6 months post microsurgery. In patients with benign lesions the maximum phonation time increased, but the improvement was significant only after 3 months. The acoustic parameters improved in all three groups. VHI significantly improved in patients with benign lesions after 3 and 12 months. VHI in the malignant neoplasm group significantly worsened on the first follow-up visit. Considering quality of life (QoL) results, only in patients with benign lesions was there a significant improvement in overall assessment of their QoL and general health., (Copyright © 2019 The Voice Foundation. All rights reserved.)

Objectives: The aim of the study was the analysis of the epidemiology of laryngeal cancer over 10 years in relation to known risk factors and to assess the current survival rates in this group of patients., Methods: The data were retrospectively collected from patients' medical records, then entered in the database using dedicated software and a statistical analysis was performed., Results: 512 subjects - 443 men (86.5%) and 69 women (13.5%) were enrolled into the study. The male-to-female ratio was 6.4:1. There were 97.1% smoking women and 98% smoking men, however the history of more than 20 cigarettes per day smoking admitted 81.1 % of women and 94.6% of men. Heavy alcohol consumption was the case in 14 (20.3%) women and in 307 (69.3%) men. For both the size of heavy alcohol consumption and the size of excessive tobacco use, there was found statistically significant difference between women and men with laryngeal cancer (p&lt;0.05). In the majority of male and female subjects, the tumour was located in the supraglottis/glottis area. Apparently this tumour location was much more common among women, accounting for 60.9% of cases , while in men was confirmed in 39.3% of cases. The stages of the laryngeal cancer were similarly of high advancement for both the men and women - stages III and IV were confirmed in 82.6% of women and in 77.6% of men. The over 5-year survival rate was 39.1% among women and 37.2% among men. Conclusions Contradictory to decreased exposure to risk factors and the shorter period for diagnosis, the higher stages of cancer were observed in women. Although in women the advancement was higher and the majority of cases were located in unfavourable supraglottic area, the survival rates were higher. Key words: laryngeal cancer, epidemiology, men and women, risk factors.

Objective: The promotion of neovascularisation is a crucial aspect of carcinogenesis. The study evaluates the microvascular density (MVD) and expression of hypoxia-induced factor (HIF-1α) in hypertrophic vocal fold (VF) lesions of different histopathological states including non-dysplastic, low-grade, high-grade dysplasia and invasive glottic cancer., Materials and Methods: Histological specimens collected from patients diagnosed and treated in a single centre with different histological grades were immunohistochemically stained with CD31, CD34 and HIF-1α. Of the total number of 77 analysed VF specimens, 20 were non-dysplastic, 20 had low-grade dysplasia, 17 high-grade dysplasia and 20 were invasive cancers., Results: The highest mean value for MVD evaluated with expression of CD31 (MVD CD31) was 21.23 ± 14.46 and identified in the low-grade dysplasia group. The average MVD CD31 was 13.74 ± 5.56 and 20.11 ± 9.28 in the high-grade dysplasia and invasive cancer group, respectively. The highest MVD evaluated with CD34 (MVD CD34) was revealed for invasive cancer 35.64 ± 17.21. The MVD CD34 was higher for low-grade than in high-grade dysplasia (25.87 ± 12.30 vs 24.65 ± 15.92, respectively). The expression of HIF-1α was strong or very strong in 60% of non-dysplastic lesions, 100% of low-grade dysplasia cases, 53% of high-grade dysplasia cases and 50% of invasive cancer cases. The comparison of MVD CD31 with MVD CD34 revealed a strong positive correlation (ρ value 0.727). The comparison of both MVD CD31 and MVD CD34 with HIF-1α resulted in no linear relationship (ρ value of 0.143 and 0.165, respectively)., Conclusion: The stage of low-grade dysplasia in intraepithelial vocal fold lesions is related to significant advancement of angiogenesis together with the highest hypoxia level.

Objective: To provide the normative values for laryngeal stroboscopy (LS) concerning amplitude, open quotient, asymmetry and phase difference in healthy, young subjects., Study Design: Prospective case-control study., Setting: Patients treated at a single institute., Methods: A total of 68 healthy subjects were included in the study (35 women, 33 men), aged 18-35 years. After obtaining LS recordings, image processing was performed to attain parameters of vocal fold vibration., Results: In women, the location of the maximum vibration amplitude is approximately in the 1/3 posterior part of the glottis, while in men, the location is moved to the glottis centre. In males, the relative amplitude vibration of the vocal folds in the 1/3 anterior part of the glottis was significantly higher than in females (P = 0.029). Women showed significantly higher open quotients (OQ) at the posterior part of the glottis than the male subjects (P < 0.001) and men presented significantly higher OQ at the anterior part of the glottis than the females (P < 0.001). The average OQ values for both sexes were almost the same. Females showed significantly higher relative glottal gap area (P = 0.044). Women presented a significantly lower amplitude asymmetry than men (P = 0.002). The weighted absolute left-right phase difference reached up to 24° and remained insignificantly higher in the men than the women (P = 0.142)., Conclusions: The study provides normative values for LS in young adults for the measurement of therapy outcomes in patients with voice disorders and realisation of evidence-based medicine. The LS parametrisation is easy to perform in clinical practice., (© 2018 John Wiley & Sons Ltd.)

Obstructive sleep apnea syndrome (OSA) is a form of sleep disordered breathing. The key phenomena are multiple repetitive pauses or restriction of airflow in the airway, defined as apnea and hypopnea. This study was based on a retrospective analysis of the results of polysomnographic (PSG) recordings of 230 adult patients (62 women and 168 men), being evaluated for OSA. The mean age, body mass index (BMI), apnea-hypopnea index (AHI), and pulse oximetry (SO 2 nadir) of all patients were 50.4 ± 12.7 years, 30.4 ± 5.4 kg/m 2 , 33.6 ± 26.6 1/h, and 80.7 ± 12.1%, respectively. Statistical analysis was performed taking into account the moment of obstructive apnea occurrence and duration, sleep stage, and the SaO 2 nadir associated with these events. We found a lengthening of apneic episodes with progressing of sleep-time, which depended on the sleep-time. There was rather a fast increase in apnea duration in the first quartile of sleep-time. In the later sleep phases, the dynamics of the increase were four-fold weaker. The lengthening of apnea duration was dependent on the severity of AHI, but was hardly related to the sleep stage or arterial desaturation. In conclusion, the results revealed two time scales of a lengthening of apneic episodes as a function of sleep-time in OSA patients. Sympathetic activation and spleen reflex may be involved in the observed phenomenon. Although the exact mechanisms of increasing duration of apneic episodes with the passage of sleep remain elusive, we believe these mechanisms are liable to be multifaceted.

Purpose: Bone conduction stimulation applied on the otic capsule may be used in a conductive hearing loss treatment as an alternative to the bone conduction implants in clinical practice. A finite element study was used to evaluate the force amplitude and direction needed for the stimulation., Methods: A finite element model of a female temporal bone with a precisely reconstructed cochlea was subjected to a harmonic analysis assuming two types of stimulation. At first, the displacement amplitude in the form of air conduction stimulation was applied on the stapes footplate. Then the force amplitude was applied on the otic capsule in the form of bone conduction stimulation. The two force directions were considered: 1) the primary direction, when a typical opening is performed during mastoidectomy, and was coincident with the axis of an imaginary cone, inscribed in the opening, and 2) the direction perpendicular to the stapes footplate. The force amplitude was set so that the response from the cochlea corresponded to the result of air conduction stimulation applied on the stapes footplate., Results: The amplitude and phase of vibration and the volume displacement on the round window membrane were considered as well as vibrations of the basilar membrane, spiral lamina, and promontory., Conclusions: The cochlear response was comparable for the two types of stimulation. The efficiency of bone conduction stimulation depended on the force direction. For the primary direction, the force was a few times smaller than for the direction perpendicular to the stapes footplate.

Background: Among the elderly, instability leading to falls (and consequences of them) is one of the most important problems. The etiology of falls is usually complex, but balance, posture and gait problems are considered to be the most important risk factors., Objectives: The objective of this study was to assess the usefulness of the Sensory Organization Test (SOT) in differentiating multi-fallers from single-fallers., Material and Methods: The studied group included 92 patients aged >60 years with balance disorders and falls in their history. The patients were divided into 2 groups: multi-fallers and single-fallers. The control group (non-fallers) included 21 individuals. The SOT was performed on the 1st day (SOT1) and on the last day (SOT2) of rehabilitation. Mean equilibrium score (ES) of 1-3 and 4-6 sensory conditions and composite score (CS) of the SOT1 and SOT2 were analyzed. The falls were analyzed as a total number of falls while performing SOT and a number of falls in all 3 repetitions of both conditions 5 and 6 separately. In SOT conditions 1-4 there were no falls observed., Results: The importance of SOT to differentiate fallers from non-fallers and single-fallers from multi-fallers is ambiguous., Conclusions: The SOT may or may not indicate the differences between the groups - it does not fully explain those differences. It shows only postural dysfunction without indicating any localization in particular part of vestibular organ. The basic diagnostic evaluation in the elderly with a proneness to falls should include clinical examination and the Dix-Hallpike maneuver, supplemented with a videonystagmography (VNG), which would assess the structure of damage in vestibular organ. Posturography is of less validity in the differentiation of fallers from non-fallers.

Objectives: The objective of the study was to assess the outcomes of cochlear implantation in patients deafened following blunt head trauma., Material and Methods: Retrospective case series review of seven patients post-lingually deafened following blunt head trauma and aided with cochlear implants. The following data were analyzed: Cause of injury, computed tomography results, surgical information, intra- and post-implantation complications, audiometric and speech perception assessment, processor mapping, and data from follow-up appointments., Results: The median age of patients at the time of cochlear implantation was 29 years. The median time elapsed between head trauma and cochlear implantation was 5.77 months (minimum 0.8 and maximum 6.73 months). The median post-implantation follow-up time was 11.97 years. No facial nerve stimulation was observed in any case. All patients significantly improved their audiology and speech perception performances within a short time following cochlear implantation and CI performance did not decrease with long-term follow-up in any case., Conclusion: The results of this study showed that cochlear implantation is an effective treatment method for patients deafened following blunt head trauma.

Objective: The purpose of this study was to assess the voice quality and the vocal tract function in popular singing students at the beginning of their singing training at the High School of Music., Design: This is a retrospective cross-sectional study., Methods: The study consisted of 45 popular singing students (35 females and 10 males, mean age: 19.9 ± 2.8 years). They were assessed in the first 2 months of their 4-year singing training at the High School of Music, between 2013 and 2016. Voice quality and vocal tract function were evaluated using videolaryngostroboscopy, palpation of the vocal tract structures, the perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, the Voice Handicap Index, and the Singing Voice Handicap Index (SVHI)., Results: Twenty-two percent of Contemporary Commercial Music singing students began their education in the High School, with vocal nodules. Palpation of the vocal tract structure showed in 50% correct motions and tension in speaking and in 39.3% in singing. Perceptual voice assessment showed in 80% proper speaking voice quality and in 82.4% proper singing voice quality. The mean vocal fundamental frequency while speaking in females was 214 Hz and in males was 116 Hz. Dysphonia Severity Index was at the level of 2, and maximum phonation time was 17.7 seconds. The Voice Handicap Index and the SVHI remained within the normal range: 7.5 and 19, respectively. Perceptual singing voice assessment correlated with the SVHI (P = 0.006)., Conclusions: Twenty-two percent of the Contemporary Commercial Music singing students began their education in the High School, with organic vocal fold lesions., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Numerous studies have proven that both stimulation and blockade of 5-HT 1A and the blockade of 5-HT 7 receptors might cause the anxiolytic-like effects. Biased agonists selectively activate specific signaling pathways. Therefore, they might offer novel treatment strategies. In this study, we investigated the anxiolytic-like activity, as well as the possible mechanism of action of 1-[(2,5-dimethylphenoxy)propyl]-4-(2-methoxyphenyl)piperazine hydrochloride (HBK-17). In our previous experiments, HBK-17 showed high affinity for 5-HT 1A and 5-HT 7 receptors and antidepressant-like properties. We performed the four plate test and the elevated plus maze test to determine anxiolytic-like activity. Toward a better understanding of the pharmacological properties of HBK-17 we used various functional assays to determine its intrinsic activity at 5-HT 1A , 5-HT 2A , 5-HT 7 , and D 2 receptors and UHPLC-MS/MS method to evaluate its pharmacokinetic profile. We observed the anxiolytic-like activity of HBK-17 in both behavioral tests and the effect was reversed by the pretreatment with WAY-100635, which proves that 5-HT 1A receptor activation was essential for the anxiolytic-like effect. Moreover, the compound moderately antagonized D 2 , weakly 5-HT 7 and very weakly 5-HT 2A receptors. We demonstrated that HBK-17 preferentially activated ß-arrestin signaling after binding to the 5-HT 1A receptor. HBK-17 was rapidly absorbed after intraperitoneal administration and had a half-life of about 150 min. HBK-17 slightly penetrated the peripheral compartment and showed bioavailability of approximately 45%. The unique pharmacological profile of HBK-17 encourages further experiments to understand its mechanism of action fully.

Background: This study investigates relevance of narrow band imaging (NBI) in stratifying risk of malignant transformation within leukoplakia., Methods: We conducted a prospective analysis that included 62 patients with 91 changes of leukoplakia on vocal folds. The NBI was obtained before microsurgery. Categorization of the lesion as benign was made when vessels of surrounding epithelium were classified as type I, II, or IV according to Ni classification. If there were visualized intraepithelial papillary capillary loops of type V, the lesion was classified as malignant. Results were compared to the histopathological diagnosis., Results: The NBI assessment classified 75 lesions (82.4%) as benign and 16 (17.6%) as malignant. Histopathological results revealed the diagnosis of no dysplastic changes or low grade dysplasia in 77 cases (84.6%). Another 14 cases (15.4%) occurred with high-grade dysplasia, carcinoma in situ, and invasive cancer. Sensitivity, specificity, and accuracy of NBI in predicting malignancy within leukoplakia were 100%, 97.4%, and 97.8%, respectively. The kappa index was 0.92 (95% confidence interval 81.1%-100%)., Conclusion: The noninvasive procedure of an NBI endoscopy may be recommended as an accurate method in predicting the risk of malignant transformation within the vocal fold leukoplakia and, therefore, would be useful in the clinic for planning the patient's therapy., (© 2018 Wiley Periodicals, Inc.)

The European Anatomical Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses distinguishes anterior, posterior, medial and lateral frontoethmoidal cells. The lateral cells have not been characterized yet. Other classifications (Lee and Kuhn, International Frontal Sinus Anatomy Classification) neglect them. The aim of this study is to describe lateral frontoethmoidal cells in rhinosinusitis patients., Method: Analysis of medical records and computed tomography (CT) examinations using multiplanar reconstruction with adjustable planes. The lateral cell extending between the frontal beak and the skull base pushing the frontal sinus drainage pathway medially/anteromedially was identified in 6 patients. These cells could not be classified as anterior, posterior or medial according to existing classifications. Four patients were operated on previously due to sinonasal symptoms. The lateral frontoethmoidal cell is an underestimated anatomical variation that may contribute to the persistence of inflammatory disease and can be easily overlooked preoperatively.

Introduction: Parapharyngeal space (PPS) is the anatomical area lateral to the upper pharynx and clinically important due to PPS tumors. They account for less than 1% of head and neck neoplasms. Both benign and malignant neoplasms may arise there and typical for this localization is diversity of histological origin. Complete surgical excision is still the basis of treatment., Aim of the Study: Evaluation of the results of surgical treatment of PPS tumors in the Department of Otolaryngology at the Medical University over the period 2015-2017., Material and Methods: A retrospective analysis of medical records including complaints, physical examination, results of imaging studies, surgical approach, postoperative complication and histopathological results in 22 patients with a diagnosis of a PPS tumors., Results: The most frequent complaints reported by the patients were: discomfort in the throat, dysphagia, hearing disorders and a palpable tumor on the neck. Asymptomatic course of the disease was demonstrated in 4 cases. All patients were treated surgically: 2 with transoral approach, 9 with transparotid-transcervical approach, 11 with transcervical approach. In most cases the tumor was removed radically. In 2 patients intracapsular tumor resection was performed. Based on histopathological examination the benign lesions dominated (18/22). In 4 cases malignant neoplasms were diagnosed: carcinoma ex pleomorphic adenoma, adenoid cystic carcinoma and two cases of squamous cell carcinoma. The most common origin of PPS tumors was deep lobe of parotid gland and for this group 11 patients had diagnosis of pleomorphic adenoma. Other diagnosis included: paraganglioma, neurofibroma, hemangioma, lymphangioma and rhabdomyoma. Postoperative complications occurred in 9 patients and presented as hoarseness and dysphagia due to paresis of the lower group of cranial nerves (IX, X, XII). Significant intraoperative bleeding during surgery occurred in 2 cases and ligation of the external carotid artery was necessary., Conclusion: Due to the anatomical topography of PPS and its content with the essential vessels and the lower group of cranial nerves, the surgical treatment of pathology of this area is still a challenge for head and neck surgeons. The decrease of voice quality and impaired speech and swallowing should always be considered as complications post the surgical resection in PPS.

Background: This is a comparative analysis of the diagnostic accuracy of narrow band imaging (NBI) and laryngovideostroboscopy (LVS) in the assessment of premalignant and malignant vocal fold lesions., Methods: A prospective analysis was performed on 105 consecutive patients with vocal fold lesions. The NBI and LVS were obtained before the microsurgery., Results: The NBI and LVS showed no significant differences in identifying premalignant and malignant pathologies. However, in analysis restricted to identification of only malignant lesions, the specificity (88.9% vs 20.6%), accuracy (90.5% vs 51.4%), and positive predictive value (PPV; 84.8% vs 45.1%) were significantly higher for NBI (P value < .001; .015; and .045, respectively). A comparison of LVS scored results relative to each NBI type revealed statistically significant differences (P < .001). A moderate positive correlation between NBI and LVS was demonstrated (P = .54)., Conclusion: The NBI and LVS are useful, complementary tools in evaluating early potential vocal fold malignancies. The NBI was superior to LVS on several statistical analyses., (© 2018 Wiley Periodicals, Inc.)

The aim of the study was to estimate voice defect and the quality of life deterioration in patients with different laryngeal pathologies qualified for microsurgery treatment. The results of videolaryngostroboscopy (VLS), perception, aerodynamics, acoustics, Dysphonia Severity Index, Voice Handicap Index (VHI), and the World Health Organization Quality of Life Scale Brief Version before microsurgery were analyzed. There were 151 patients enrolled in the study. There were 86 patients in group 1 (benign lesions), 34 in group 2 (premalignant conditions), and 31 in group 3 (malignant neoplasms). Significant differences were found in the mean values of VLS between group 1 and group 3 (P = 0.001), maximum phonation time between group 1 and group 2 (P = 0.001), and between group 2 and group 3 (P = 0.04), men's fundamental frequency between group 1 and group 2 (P = 0.03), and between group 1 and group 3 (P = 0.01), and shimmer between group 1 and group 3 (P = 0.01). The correlation between the methods was analyzed, and there was a strong to moderate correlation between VLS and perception (r = 0.57-0.73) in group 1 and group 2. The jitter and shimmer correlated moderately with perception in group 1: grade of hoarseness (G) (r = 0.52 and r = 0.57, respectively), breathiness (B) (r = 0.58), and asthenia (A) (r = 0.57 and r = 0.53, respectively). In group 3, the strongest correlation was observed between maximum phonation time and phonation quotient and G (r = 0.52; 0.58), B (r = 0.54; 0.55), and strain (S) (r = 0.63; 0.72). The VHI results and life quality outcomes were not significantly different between the groups. The VHI did not correlate with any voice measure method., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Air-conducted and skull-tap cervical vestibular evoked myogenic potentials (AC-cVEMP and Tap-cVEMP) have been shown to be very promising tools in clinical practice. They are noninvasive, easy to obtain and - importantly - they require little time and the cost of the instruments is low., Objectives: The aim of this study was to evaluate the usefulness of the combined use of ACand Tap-cVEMPs as a diagnostic tool for advanced assessment of vestibular schwannoma in determining tumor origin, and to investigate whether the results are helpful for a surgeon as an additional source of information about the tumor before surgery., Material and Methods: ACand Tap-cVEMPs were acquired (with EMG-based biofeedback) from the sternocleidomastoid muscles (SCM) of 30 vestibular schwannoma patients just before surgery. The results were compared to the surgical information about nerve bundle involvement in the tumor and the size of the tumor obtained from magnetic resonance imaging (MRI)., Results: On the tumor side, abnormal corrected amplitude asymmetry ratios were detected in 73.33% of the patients, abnormalities in P1-latencies in 70% of the patients, and both in 90% of the patients. The cervical vestibular evoked myogenic potential (cVEMP) results indicated the affected nerve division to be the inferior in 23.33% of the patients, the superior in 20% of the patients, and both in 46.67% of the patients. No cVEMP abnormalities were found in 10% of cases. The combined results of both ACand Tap-cVEMP were significantly compatible with the surgical information about the tumor origin. The number of abnormalities was significantly correlated with the tumor size., Conclusions: The information provided by the combined application of ACand Tap-cVEMPs might be useful for a surgeon in presurgical planning, providing more detailed information about the tumor and the affected nerve division in the internal auditory canal. It is not a diagnostic replacement for MRI in vestibular schwannoma patients; however, in our opinion, ACand Tap-cVEMPs may serve as additional sources of information about the tumor before the surgery.

Wstęp: Cel badania stanowi ocena efektów długoterminowych augmentacji krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia. Materiał i metody: W badaniu wzięło udział 17 pacjentów, którzy z powodu niewydolności szpary głośni (z powodu jednostronnego porażenia krtani oraz niewydolności mięśni wewnętrznych krtani) zostali zakwalifikowani do przeprowadzenia augmentacji krtani (10 kobiet i 17 mężczyzn), w wieku: 57,6±17,7 lat, mediana 61 lat, z zakresem: 32-83 lata. U wszystkich pacjentów wykonano augmentację krtani w znieczuleniu miejscowym, przez jamę ustną, podając bocznie od fałdu głosowego/ fałdów głosowych hydroksyapatyt wapnia (preparat Radiesse). W celu oceny efektów długoterminowych augmentacji krtani - przeprowadzano ocenę jakości głosu pacjenta przed augmentacją, a następnie 3 i 12 miesięcy po augmentacji krtani, przy pomocy oceny videolaryngostroboskopowej krtani, oceny odsłuchowej, analizy akustycznej, oceny aerodynamicznej oraz samooceny głosu dokonanej przez pacjenta przy pomocy kwestionariusza VRQoL. Wyniki: Uzyskano istotną statystycznie poprawę w ocenie odsłuchowej głosu dla parametrów G i A, po 3 miesiącach, dobre wyniki utrzymywały się w czasie 12-miesięcznej obserwacji. W ocenie akustycznej MDVP&#95;Jitt, MDVP&#95;Shim i MDVP&#95;NHR poprawiły się odpowiednio do wartości: 2,5; 5 oraz 0,1 (3 miesiące po augmentacji) i 1,9; 3,6 oraz 0,1 (12 miesiące po augmentacji). MPTa wydłużył się do 12,2 i 11,9 s., odpowiednio po 3 i 12 miesiącach od augmentacji. Natężenie głosu poprawiło się z 67 do 68 oraz 71 dB(A), odpowiednio po 3 i 12 miesiącach. Wyniki: VRQoL poprawiły się do wartości 19,5 i 20, odpowiednio 3 i 12 miesięcy po augmentacji. Dyskusja Augmentacja krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia daje długotrwałe, dobre efekty leczenia.

Introduction: The most common cause of vocal fold paralysis (VFP) is iatrogenic injury. Patients with symptoms of VFP present to the specialist after a couple of weeks or even months since the onset of symptoms. In the literature, the data regarding speech impairment during the first days after a iatrogenic injury is lacking., Aim: to evaluate the quality of voice during first days of vocal fold paralysis following a iatrogenic injury., Materials and Methods: Twenty-five patients with iatrogenic vocal fold paralysis who presented for phoniatric consultation at the Department of Otolaryngology of the Medical University of Warsaw between May 2015 and December 2016 were enrolled in the study. The patients were examined 1-2 days since the onset of speech deterioration. In all patients, laryngeal videolaryngostroboscopy was performed, based on which the following were assessed: vocal fold mobility, mucosal wave, phonation closure, simultaneity and amplitude of vocal fold vibration. Acoustic analysis was performed, and the following acoustic parameters were evaluated: DSI, F0, Shimmer, Jitter, NHR. Also, the maximal phonation time of [a] sound (MPT a) was assessed and the voice perception analysis with the GRBAS scale was performed. The patients self-evaluated their voice using a 10-point VAS scale., Results: Based on the videolaryngostroboscopy, phonatory insufficiency and asymmetrical vocal fold vibration were observed. On perception assessment with GRBAS scale, we noticed slight to mild degree hoarseness, breathiness of sound and weakened voice. In majority of patients, the maximal phonation time of [a] sound was significantly reduced. All patients showed abnormal acoustic parameters. None of them rated their voice as perfectly normal on VAS scale.

Objectives: To assess the expression of endoglin in head and neck paragangliomas and the soluble endoglin level in serum of paraganglioma patients., Methods: Seven tumor samples of patients operated for cervical paraganglioma were assessed, as well as serum samples collected preoperatively, on days 4 and 28 postoperation. Serum level of endoglin in healthy controls was also determined. Tumor samples were subjected to immunofluorescent staining and examined with confocal microscope. The level of soluble endoglin in serum samples was examined using the immunoenzymatic assay (ELISA)., Results: Endoglin was highly expressed in all tumor samples. The level of soluble endoglin was significantly higher in paraganglioma patients compared to healthy controls and correlated with the tumor size. The serum level of s-endoglin was reduced after surgical excision of the tumor and remained stable after 4 weeks in all patients with complete resection of the tumor., Conclusion: Endoglin is an important factor in the pathophysiology of head and neck paragangliomas and may be a potential diagnostic and prognostic marker in these types of tumors.

Introduction: Injection laryngoplasty (glottis augmentation) is the preferred method in surgical management of unilateral vocal fold paralysis (UVFP). Traditionally, these procedures are performed in the operating room. Nowadays, however, these procedures have moved into the office., Aim: To evaluate the voice quality after transoral injection laryngoplasty under local anaesthesia in patients with unilateral vocal fold paralysis., Material and Methods: Fourteen subjects (5 women and 9 men) with unilateral vocal fold paresis (9 with right vocal fold paresis and 5 with left vocal fold paresis) were included in the study. The mean age of the group was 57.8 ±19.0 years (32-83 years). All of the injection laryngoplasties were performed transorally, under local anaesthesia. The injection material was calcium hydroxylapatite. Before and 1, 3 and 6 months after the procedure the following variables were evaluated: voice perception, videostroboscopy, acoustic analysis, aerodynamic evaluation, and the subjective rating of the voice quality by the patient., Results: After injection laryngoplasty, complete glottal closure was achieved or there was a significant improvement in the glottal closure of each subject. We noted great improvement in the post-injection objective and subjective voice outcomes and patients reported improvement in the voice-related quality of life., Conclusions: The transoral approach for injection laryngoplasty under local anaesthesia is an effective and safe way to treat incomplete glottal closure in patients with UVFP. The transoral approach is an efficient alternative to other surgical techniques used for vocal fold injection., Competing Interests: The authors declare no conflict of interest.

Objective: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds., Material and Methods: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated., Results: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively - 90.7%, 31.4%, 78.9%, 84.1% and 45.8%., Conclusions: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.

The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). Seventy-two consecutive parotid gland tumors were analysed with high-resolution ultrasonography (12 MHz) with color Doppler imagining. The histopathological diagnosis was confirmed after parotidectomy for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for the US were established. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. Area under the curve (AUC) was calculated for each parameter considered. The analysed material included 27 MA, 26 PA, 1 basal cell adenoma, 8 inflammatory conditions, and 10 malignant neoplasms. The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The predictive values were: PPV 66.8% and NPV 93.6%. Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. The predictive values were: PPV 50% and NPV 68.8%, respectively. For distinguishing malignant from benign tumors, the highest AUC values noted were for heterogeneity and vascularization (0.8 and 0.743, respectively). The AUC values were the highest for hypoechogenicity and vascularization in separating PA from MA (0.718 and 0.685, respectively).

Objectives: The purpose of this study was to evaluate vocal tract function and the voice quality in singers with muscle tension dysphonia (MTD) after undergoing combined functional voice therapy of the singing voice., Design: This is a prospective, randomized study., Methods: Forty singers (29 females and 11 males, mean age: 24.6 ± 8.8 years) with MTD were enrolled in the study. The study group consisted of 20 singers who underwent combined functional voice therapy (10-15 individual sessions, 30-40 minutes each). Singers who did not opt for vocal rehabilitation consisted of the control group. Effects of rehabilitation were assessed with videolaryngostroboscopy, palpation of the vocal tract structures, flexible fiberoptic evaluation of the pharynx and the larynx, perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, and the Voice Handicap Index., Results: After combined functional voice therapy in the study group, great improvement was noticed in palpation of the vocal tract structures (P < 0.001), perceptual voice assessment (P < 0.001), phonetograms (P = 0.002), and singing range obtained from acoustic analysis of glissando (P < 0.001). In the control group, no statistically significant differences were found between the first and the second assessments., Conclusions: Combined functional voice therapy proved to be an efficacious treatment method in singers with MTD in singing. Development of palpation and perceptual singing voice examination protocols enables one to compare results before and after rehabilitation in clinics., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

It has been reported that microRNAs (miRNAs) are responsible for acquiring all the hallmarks of cancer cells, as well as have a significant impact on the clinical management of cancers at every stage, including prognosis, remission, relapse, and metastasis. In this study, we investigated the association of miR-29a-3p, miR-202-3p, miR-3713, miR-4768-3p, and miR-548aa expression with clinicopathologic features in patients suffering from laryngeal cancer (LC) and determined the potential role of studied miRNAs in the progression of LC. The study group consisted of 48 patients with untreated primary tumors of head and neck cancer localized in the larynx. Expression of the selected miRNAs was verified by the qRT-PCR technique. We showed that the expression of miR-29a as well as miR-548aa was positively correlated with tumor stage and lymph node metastasis, whereas the expression of miR-4768-3p was negatively correlated with lymph node metastasis. Furthermore, we investigated that exposure to cigarette smoke altered miRNA expression profile in LC. The expression level of miR-202-3p was significantly increased in smoking patients compared with nonsmokers, whereas the miR-4768-3p, miR-548aa, and miR-3713 were markedly decreased. Our research contributed toward better elucidating the mechanisms underlying the progression of LC as well as the use of miRNAs inhibitors as novel agents against progression and metastasis of LC.

Aim: Epidemiological and clinical analysis of lymphoid tissue neoplasms in the neck region over a 15-year period., Material: There was performed retrospective analysis of 97 patients, aged 17 to 88 years, mean age of 60.3 years. The analysis included data from subjective study, physical examination, image and histopathological studies Results: Almost all cases were lymphoid neoplasms - 95 patients (98%). B cell lymphoma was the most commonly diagnosed lymphoma - 74 cases (76%), followed by Hodgkin&apos;s lymphoma- 19 cases (20%). Only two patients had T-cell lymphoma (2%). There was observed prevalence among women, K: M ratio for the whole group was 51: 46, while male predominance was reported in Hodgkin&apos;s lymphoma patients (K: M = 7: 12). Over the 15-year period, there was an increase in the number of lymphoid tumors. The most common location on the neck were lymph nodes - 71 (73.2%). Extranodal localizations (26.8%) were most often associated with salivary glands: parotid and submandibular involvement and with the dominant lymphoma of the marginal zone MALT (14 cases). In 57% of patients the fine needle aspiration biopsy (FNAB) results were false, with positive results only in 32% of patients., Conclusions: Tumors from lymphoid tissue in the neck region are most commonly B-cell lymphomas or Hodgkin,s lymphomas. Non-specific clinical signs and non-specific radiological images, as well as non-diagnostic results o FNAB, make it difficult to effectively differentiate lymphomas with cancer metastasis in neck lymph nodes. Histopathology results of the excised lymph nodes remains a standard for lymphoma diagnosis.

Introduction: In this paper were verified the correlation between the results of the survey SNOT-20 and the results of the objective tests of nasal obstruction which are rhinomanometry and acoustic rhinometry before and after surgical treatment, such as septoplasty, septoconchoplasty, ethmoidectomy and septoethmoidectomy., Material and Methods: The material used in this study was 233 patients diagnosed routinely in the Rhinomanometry Laboratory of the Department of Otolaryngology at the Medical University of Warsaw, reporting rhinological problems. Data were obtained from 70 women (31,4%) ranging in ages from 18 to 81 years of age and 153 men (68,6%) ranging in ages from 16 to 81 years of age. The researches presented in the study were made using the device RhinoMetrics SRE 2100 which combines the Rhinomanometer (RhinoStream) and Acoustic Rhinometer (RhinoScan) Interacoustics AS (Denmark). Survey SNOT-20 (Sino-Nasal Outcome Test-20) in Polish was completed by patients before surgery and during the postoperative control visits., Results: The calculated correlations between the objective parameter, which was the resistance to the flow of air through the nasal cavity , and the subjective feelings of respondents expressed in the survey SNOT-20 were generally weak, and statistical significance was achieved with respect to the first question survey (the severity of the nose obstruction) for all components of resistance flow., Discussion: The feeling of nasal obstruction is the most reproducible and reliable complaint reported by the patient with rhinological problems.

Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy., The Aim: The evaluation of voice results in patients after medialisation throplasty., Material and Methods: In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma., Results: There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement., Conclusions: The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.

Objective: To present outcomes of extensive surgery: lateral, subtotal, total petrosectomies in patients with temporal bone invasion resulting from specific primary cancers., Study Design: Retrospective case review., Setting: Four tertiary referral centers., Material: 89 patients with cancer of the temporal bone treated between January 2006 and December 2010., Intervention: Multidisciplinary team approach including surgical resection, reconstruction, and postoperative radiotherapy., Main Outcome Measure: Disease-specific survival, overall survival., Results: In 27.0% of the patients, relapse was reported, with an average of 6.3 months after surgery; 31 patients (34.8%) died during the follow-up. The average mortality was 22.1 months. Fifty-four patients (58.7%) stayed alive during the time of observation. The average survival time was 42.0 months. The median time of survival with relapse was 12 months (range: 1-51 months). The three-year disease-free rate was 38.0% and the overall survival rate was 58.7%., Conclusions: Petrosectomy is an effective treatment for malignant temporal bone invasion. The probability of a good outcome was statistically decreased with a high T grade, positive margins, and salvage surgery. Younger age is connected with better prognosis. One of the major tasks remains to improve detection and to shorten the time to diagnosis, keeping in mind that symptoms are insidious and in younger people, the time before diagnosis was longer.

Introduction: Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation., Objective: The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation., Methods: An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications., Results: Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31-955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis., Conclusion: Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT) prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT), preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objectives/hypothesis: This study investigated vocal function knowledge and vocal tract sensorimotor self-awareness and the impact of functional voice rehabilitation on vocal function knowledge and self-awareness., Study Design: This is a prospective, randomized study., Methods: Twenty singers (study group [SG]) completed a questionnaire before and after functional voice rehabilitation. Twenty additional singers, representing the control group, also completed the questionnaire without functional voice rehabilitation at a 3-month interval. The questionnaire consisted of three parts. The first part evaluated the singers' attitude to the anatomical and physiological knowledge of the vocal tract and their self-esteem of the knowledge level. The second part assessed the theoretical knowledge of the singers' vocal tract physiology. The third part of the questionnaire assessed singers' sensorimotor self-awareness of the vocal tract., Results: The results showed that most singers indicated that knowledge of the vocal tract's anatomy and physiology is useful (59% SG, 67% control group). However, 75% of all participants defined their knowledge of the vocal tract's anatomy and physiology as weak or inadequate. In the SG, vocal function knowledge at the first assessment was 45%. After rehabilitation, the level increased to 67.7%. Vocal tract sensorimotor self-awareness initially was 38.9% in SG but rose to 66.7%., Conclusions: Findings of the study suggest that classical singers lack knowledge about the physiology of the vocal mechanism, especially the breathing patterns. In addition, they have low sensorimotor self-awareness of their vocal tract. The results suggest that singers would benefit from receiving services from phoniatrists and speech-language pathologists during their voice training., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)