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Background: Skull bone defects in the region of middle ear are usually observed in the cases of chronic otitis media. Such loses can also be congenital, posttraumatic, iatrogenic or due to hyperplasia. They can potentially lead to development of otogenic intracranial complications., Aim: We present the patients who were not observed during otosurgery to have any pathological changes to the mucous of the middle ear and were diagnosed as having bone defects in the middle and/or posterior cranial fossa. We discuss also methods of reconstruction during otosurgery., Material and Methods: The prospective analysis involves the patients operated on middle ear in the Department of Otolaryngology at the Jagiellonian University of Krakow in the years 2007-2011. 495 first-time otosurgeries were performed in this period of time., Results: Skull bone defects were diagnosed in 46 patients who had undergone surgery and 25% of these patients had no changes to the middle ear mucous. This points to congenital etiology of the defects. In this group the most common cause for otosurgery was chronic otitis media (10 patients). In 1 patient, bone defect occurred along with otosclerosis. In patients with congenital skull bone defects otogenic intracranial complications were described in 4 cases., Conclusions: Nearly 80% of skull bone defects remain asymptomatic; they are revealed incidentally during the surgery of the middle ear. The above observations emphasize the significant role of preoperative imaging diagnostics. The methods of bone defects reconstruction using the fascia, strengthened with the pedicle muscle flap where larger defects occurred, as well as with either bone lamella or cartilage in particular cases, proved successful., (2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o.)

Introduction: Osteomas are relatively common, benign, slow-growing neoplasms. Mainly occurring in frontal and ethmoid sinuses. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas., Aim: We discuss our experiences in endoscopic treatment of giant osteomas., Results: In giant osteomas Draf III or Lothrop approaches are prefered. Periostium of the orbit was intact in all cases. Discharge of cerebrospinal liquid was not observed., Conclusions: Size of tumor determines type of surgical aprroach. Endoscopic surgery is more and more popular way in surgical treatment of giant osteomas., (.)

Background: Primary inverted papilloma of the sphenoid sinus is rare. The tumor is considered locally aggressive. In selected cases inverted papilloma can be associated with squamous cell carcinoma. Radiologic imaging is a key to an accurate diagnosis., Aim: We analyzed patient with inverted papilloma in sphenoid sinus which was removed with endoscopic surgery., Material and Methods: We discuss patient with isolated inverted papilloma located in the sphenoid sinus., Results: Performed endoscopic treatment enabled removal of tumour with no complications., Conclusions: Transnasal endoscopic large sphenoidotomy remains an effective modality for management of patients with inverted papilloma. This method does not require external approach and it is performed with no scars, with minimal injury of tissues., (Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.)

Background: Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too., Aim: This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty., Material and Methods: Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009., Results: 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars., Conclusions: The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operator's preferences, as well as the availability of given material for transplanting., (Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.)

Introduction: Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors., Aim: This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations., Material and Methods: Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004-2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media., Results: 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens., Conclusions: The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.

The primary objective of surgical treatment of chronic otitis media is to remove the pathological changes and restore the biology of the middle ear. Subsequently, ossicular chain reconstruction is performed in order to restore hearing. The aim of the study was to evaluate the efficacy of mathematical models (artificial neural networks) in postoperative hearing improvement prognosis. The models based on preoperative anamnesis and data concerning the operative procedure. The analyzed group comprised of 135 patients operated for chronic otitis media in the Department of Otolaryngology CM UJ in Krakow. The measure of postoperative hearing improvement was cochlear reserve (air-bone gap) closure depending on the type of ossicular chain reconstruction. The artificial neural networks provided 100% correct predictions basing on preoperative clinical examination, pathological changes found in the middle ear and description of the surgical procedure. The study proves that artificial neural networks are effective in functional result prognosis in tympanoplastic surgery.

Background: Dysphagia is a common symptom of amyotrophic lateral sclerosis (ALS) and leads to increased risk of aspiration, malnutrition and dehydration. Swallowing mechanism in ALS patients has not been systematically studied., Material and Methods: Based on the manometry analysis of upper investigate tract we have measured base of tongue contraction, resting pressure of the upper esophageal sphincter and average pharyngeal bolus velocity 10 ALS patients with slight dysphagia and have compared them to control group., Results: All parameters measured were significantly changed in ALS patients indicting disturbances of oro-pharyngeal phase of swallowing even in ALS patients with slight dysphagia., Conclusion: Early diagnosis of the swallowing disturbances is important for symptomatic therapy.

Aim: The aim of this study is the assessment the occurence of facial nerve canal (Fallopian canal) dehiscence in patients operated due to chronic medial otitis (depending on the location and type of inflammatory lesions) and in patients operated due to otosclerosis. Facial nerve paresis in patients with dehiscence found during surgery was also assessed., Material and Methods: The study group consisted of 456 patients operated at the Department of Otolaryngology at the University Hospital in Krakow, 359 due to chronic otitis media and 97 due to otosclerosis. Facial nerve canal dehiscence was found during surgery in 26 patients (6% of operated patients) more frequently in men., Results: In most cases (54%) dehiscence was observed in patients with chronic medial otitis with cholesteatoma (27% with choleseatoma and 27% with cholestatoma and granulation), and equally (23% each) dehiscences were observed in patients with granulation and even in patients with otosclerosis and chronic simple otitis media. In over than half (54%) of patients with dehiscence inflammatory lesions involved all the middle ear spaces, in 15% the tympanic cavity, attic and antrum while in 4% of patients inflammatory lesions were limited to the tympanic cavity, attic or antrum., Conclusions: The facial canal nerve dehiscence is observed in majority in patients with cholestatoma and granulation, especially in tympanic region. In some cases its coexistence with circuit canals dehiscence.

Pus collection between dura matterand arachnoidis not an abscess but an empyema. Complains of severe headache, a lack of cooperation is observed, sometimes high fever, seizures, which may lead to an epileptic like condition. Patient gives an impression of a severely ill person. We report four different cases of intracranial complications, in the form of dural empyema diagnosed and treated in our Department. In the pre antibiotic therapy era, cerebrospinal meningeal empyema inevitably led to paralysis, paresis and death.

Background: Otitis media is a frequent condition. Chronic infections of the middle ear can lead to defects of bony walls and development of complications., Material and Methods: We performed prospective analysis of patients operated on chronic otitis media in ENT Department Jagiellonian University of Krakow between 2004-2008. Nearly 650 operations on ears were performed in that period of time., Results: Labyrinthine fistule was observed in 40 patients: 36 with COM, 3 with otosclerosis and 1 after head trauma. Vertigo was mentioned in ca. 30% of individuals in preoperative history. Labyrinthine fistule was usually noticed in the course of chronic cholesteatoma otitis media and chronic granulomatous otitis media and almost always it was located on lateral semicircular canal. In these patients defects of facial nerve bony canal were more frequent but the frequency of skull base defects was like in patients without labyrinthine fistule. The fistules were sealed routinely with a fragment of fascia. This procedure proved effective.

Background: Chorda tympani nerve is a branch of the facial nerve which enables perception of taste of 2/3 anterior part of tongue and it is responsible for unilateral parasymphatetic nerve supplying of the submandibular and sublinqual salivary glands., Material and Methods: Prospective analysis of patients operated on middle ear in ENT Department Jagiellonian University of Krakow between 2004-2008 was performed. Nearly 650 operations were done in that period of time. Chorda tympani nerve was cut in 96 individuals. Most of them were treated for chronic otitis media., Results: When chorda tympani nerve was cut--the majority of cases did not complain of dysgeusia. Disturbance of taste was observed in ca. 2% of patients but it was transitory. The subject experienced sour/metallic taste., Conclusions: Taste disturbance following unilateral injury to the chorda tympani nerve was usually the most intense in the first few weeks and improves with time.

Introduction: Otogenic intracranial complications are rare. Misdiagnosed and untreated can be dangerous for health and life. They should be always kept in mind., Aim: We discuss patients in whom defects of skull base were observed during operation. These defects can lead to serious intracranial complications., Material and Methods: We analyse patients with chronic otitis media operated in our department between 2004-2006. 250 operations on ears were performed in that period of time. We discuss patients with intracranial otogenic complications and patients in whom defects of skull base were noticed by chance during operations., Results: Defects of skull base were observed in 24 cases. Intracranial complications were in 3 patients. 1 patiens died because of abscess of cerebellum, others were treated with good distant effect. Used methods of reconstruction were effective, we observed no discharge of cerebro-spinal fluid and no other intracranial complications., Conclusions: It exists group of patients with chronic otitis media that have asymptomastic defects of cranial fossa. These defects can be responsible for intracranial complications. MRI and TC are very important in preoperative diagnostics.

Introduction: Amyloidosis' are the heterogeneous group of diseases characterized by extracellular accumulation of secondary protein structures causing progressive disturbances of the organs. Amyloid deposits are localized mainly in the tissues of parenchymal origin (spleen, kidneys, liver) and as far as otorhinolaryngologic organs are concerned the primary pathological process is rare., Aim: The case presentation and the diagnostic and surgical procedure analysis with the assessment of the effects of therapy in patients in elderly age with amyloidosis of larynx., Material and Methods: A 82-year-old patient with a tumor of the larynx hospitalized in Otorhinolaryngology Clinic in Cracow. The first symptom of the pathologic process in this patient was an increasing laryngeal dyspnoe and the preliminary macroscopic assessment based on indirect laryngoscopy and endoscopy suggested the proliferative process from the group of non-epithelial neoplasm., Results: In this case tracheotomy was performed and four days later the pathologic change was endoscopically removed from larynx. The improvement of the local state was achieved which enabled to decannulate the patient., Conclusions: The amyloid deposits in otorhinolaryngologic organs are rare. Isolated changes in larynx suggesting malign neoplasm are the benign changes but on account of the specificity of the organ they can be a real threat to life.

We discuss a retrospective study of patients with malignant tumors of the external and middle ear operated at the Otolaryngology Department of the Jagiellonian University in Cracow between 1992-2001. We performed 56 operations of malignant lesions in that period of time. We evaluate primary localization of the tumors, local progression, histopathological recognition, performed treatment and distant results of therapy. In our population the most common tumor was basal cell carcinoma located on the auricle in T1 stage. The most common lesion located in the middle ear or middle and external ear was the squamous cell carcinoma in T2 stage. Only surgical treatment was performed in about 60% of patients. 40% required combined therapy with surgery and postoperative radio and chemiotherapy. 80% of patients survived 5 years after performed treatment.

26 patients with benign tumors of the external and middle ear were treated at the Otolaryngology Department of the Jagiellonian University in Cracow between 1992-2001. Benign tumors of the external and middle ear are rare diseases, and it is usually easy to establish final diagnosis. Various histopathological types of these tumors are found. We discuss different kinds of tumors, their location and performed treatment. In our population the most common tumor was osteoma located in external ear canal. The best kind of treatment is radical surgical resection of the lesion. In cases when surgical treatment is impossible because of local progression of the disease, radiotherapy should be considered.

Introduction: Otitis media chronica is the most common disorders encountered in otolaryngology. The great multitude of different bacteria which may couse otitis media constitutes the need for bacteriological diagnostics, especially in cases where classical conservative treatement of the inflammatory process fails., Material and Methods: Bacterial culture results procured from hospitalized and ambulatory patients which chronic otitis media, admitted from 2003 to 2006 at the otolaryngological department were analyzed., Results: In total 47 patients were found to have their middle ear infected with Pseudomonas species and 1 patient with Alcaligenes xylosoxidans rods., Conclusions: In cases of ear infection which fails conservative treatment, especially in immunocomprimised can be caused by pathogens which are resistant to most commonly administered antibiotics.

Background: Otogenic intracranial complications are rare diseases. If misdiagnosed and untreated they can lead to serious condition of patient and life-threatening. This group of complications ought to be kept in mind in patients with chronic otitis media., Aim of the Study: We discuss types of otogenic complications and performed treatment., Material and Methods: Retrospective analysis of patients treated in our department between 1998-2006 was made. About 700 ear operations were performed in that period of time., Results: Intracranial otogenic complications were noticed in 9 cases. Despite performed treatment one patient with cerebellum abscess died. The rest patients were operated with good result., Conclusions: Precise otolaryngological examination with additional investigations like CT and MRI are very important to establish the final diagnosis and save patient's health or life.

Background: Otitis media is a frequent disease in childhood. Infections of ear in children depend on differences in anatomical structure. Clinical picture of otitis media is similar in all age groups., The Aim of Study: We performed prospective analysis of patients at the age below 16-year-old treated surgically because of chronic otitis media between 2004-2006., Material and Methods: 250 operations of ear were performed in that period of time. We operated 28 patients below 16 year-old: 26 with chronic otitis media and 2 with otosclerosis., Results: The therapy gave positive results. In 3 cases destruction of bone of skull base was noticed. Delaminations were closed during ear operation successfully., Conclusions: In children with chronic otitis media we use the same surgical procedures as in adults. We tend to make closed tympanoplasties in children. We should keep in mind possibility of asymptomatic lack of skull base bone as a consequence of chronic otitis media.

Background: The important question in primary eye socket tumors surgery is total surgery and saving the patient's sight., The Aim of the Study: It was assessment of the data of primary non malignant tumor therapy in Cracovian Department of Otolaryngology., Material and Methods: 145 patients (79 male and 66 female), aged 7 months-84 years, were treated in Otolaryngological Department Jagiellonian University in years 1991-2001. In 118 cases primary benign orbital tumors were removed, in remaining patients tumors were malignant. In 89 patients lateral orbitotomy by Kronlein was performed and in other cases different types of orbitotomy were used. 5 years otolaryngological and ophtalmological catamnnesis wascomplete., Results: In all patients eyeball was preserved, even in 6 with optic nerve glioma. Reccurent tumors were observed in 2 cases, diplopia in 15 patients and sight's lost in 8 (in 6 with optic nerve glioma)., Conclusions: In the majority of patients with radical oncological surgery it is possible to preserve eyesight.

Background: Not many data concerning the laryngological evaluation of Amyotrophic Lateral Sclerosis (ALS) patients exist., The Aim of Study: The profile of laryngological disturbances in patients with ALS was evaluated., Material and Methods: We have studied 25 ALS patients (10 with bulbar signs and 15 with limb signs only) in the standard laryngological examination. Vocal folds motion was examined fiberoscopically., Results: In bulbar onset ALS cases we have showed different changes of the uni- or bilateral position of the vocal folds. In 9 out of 15 ALS patients with limb signs (without clinical bulbar signs) we also have discovered the slight disturbance of vocal folds movement or unilateral decrease of tension and mobility., Conclusions: The careful laryngological examination can shows the subtle, objective signs of the early dysfunction of vagus nerves in ALS patients before the clinical presentation of bulbar failure.

Background: The occurrence of the disturbances of oropharyngeal phases of swallowing in Amyotrophic Lateral Sclerosis (ALS) patients has been well documented., The Aim of Study: Assessment of the oesophageal manometry for detection of the oesophageal phase of swallowing in ALS patients., Material and Methods: The study was carried out in 12 dysphagic ALS patients and 10 sex- and age- matched healthy volunteers., Results: The mean upper oesophageal contractile: amplitude, duration and velocity during the wet and dry swallows in ALS individuals were statistically differ as compared to control subjects. The abnormalities of vocal folds function was also found in the fiberoscopy examination of larynx in all ALS patients., Conclusions: This study reveal the occurrence of disturbances of the oesophageal phase of swallowing in ALS patients with dysphagia.

Introduction: We discuss a case of a 48-year old man admitted to our Department with symptoms of chronic ear infection, that didn't answer to typical conservative treatment. The culture of the discharge was positive for Alcaligenes xylosoxidans., Material and Methods: We report characteristic features of that bacteria and we compare them with features of other pathogens typical for otitis media. We present performed treatment too., Results: Alcaligenes xylosoxidans is a nonfermenting gram-negative rod. It can be confused with other nonfermentive, gram-negative rods, especially Pseudomonas species, in clinical specimens so that its role as a significant pathogen may be underestimated. Alcaligenes xylosoxidans is a part of normal human flora, especially skin and gastrointestinal tract, and can cause serious infections in human (especially in patients with immunodeficiency and premature children)., Conclusions: Reports about Alcaligenes xylosoxidans as a cause of chronic otitis media are very rare and it can be supposed to stay a new kind of ear infection.

We report the case of a 30-year old woman, who was admitted to our hospital because of tumor of the right orbit. It is the first case of metastatic tumor in this localization in the Otolaryngologist Department of the Jagiellonian University in Kraków. It appeared, that mammary cancer was the primary localization of the lesion. We present characteristic features of that tumor and we compare them with features of the metastasis to the left orbit in patients who were treated in our Department. Breast carcinoma is the most common reason of metastasis to orbit in women. Metastatic tumors in the right orbit are rare, but they can appear.