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Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep-related breathing disorder. Untreated OSAS leads to significant health consequences, disturbed functioning in society, decreased efficiency in a workplace and increased risk of accidents at work and while driving. The main patomechanisms of OSAS development are hypoxia, oxidative stress and inflammatory process. Intermittent hypoxia in OSAS patients is associated with subsequent episodes of reoxygenation with simultaneous increase of reactive oxygen species and reactive nitrogen species that stimulate secretion of extracellular metalloproteinases (MMPs). These compounds belong to a group of endogenous proteolytic enzymes produced by structural cells of extracellular matrix (ECM) and by cells of inflammatory response as well. ECMs are made of collagen proteins and glycoproteins. They form a scaffold for tissues of the soft palate. MMPs break down collagen molecules, which results in flaccidity of tissues, including tissues of the soft palate. The results of scientific studies have shown that expression, secretion, and activeness of MMPs increase during hypoxia. Thus metalloproteinases may be involved in the process of upper airway tissue damage during the intermittent hypoxia in OSAS.

Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered a risk factor for cardiovascular diseases, depression, accidents, and stroke. Recent clinical practice guidelines for OSA expressed the need for a new clinical tool that establishes the Apnea–Hypopnea Index (AHI) to determine the disease burden. The serum and plasma concentrations of Osteoprotegerin (OPG), Chitinase 3-like protein 1 (YKL-40), and Cardiotrophin-1 (CT-1) in 80 subjects—52 OSA patients, 27 moderate (15 ≤ AHI ˂ 30) and 25 severe (AHI ≥ 30), and 28 non-OSA controls (AHI 0–5)—were determined. Moreover, the Total Oxidative Status (TOS), Total Antioxidative Status (TAS), and Oxidative Stress Index (OSI) were assessed in the serum and plasma to evaluate whether the severity of OSA and the concentrations of OPG, YKL-40, and CT-1 correlate with the oxidative/reductive status. The serum and plasma concentrations of YKL-40 and CT-1 were higher in the OSA group, whereas the serum and plasma concentrations of OPG were lower compared to the control group. The concentrations of OPG, YKL-40, and CT-1 in the serum and plasma correlated with AHI; however, a better correlation of the concentrations was obtained for the above-mentioned proteins in the plasma. The concentrations of YKL-40 and CT-1 in the serum and OPG in the plasma show better diagnostic capabilities for moderate and severe OSA than the concentrations of YKL-40 and CT-1 in the plasma and the concentrations of OPG in the serum.

Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease that imposes a significant impact on the health and wellbeing of patients and a financial burden on individuals, their families, and society. Development of new methods of testing other than an overnight sleep study, such as measurement of serum or plasma biomarkers, may provide an easier diagnostic process to identify patients with OSA and allow earlier initiation of treatment, which might prevent serious comorbidities. We conducted a systematic review and quality assessment of available meta-analyses regarding potential diagnostic and monitoring biomarkers of obstructive sleep apnea. A total of 14 sets of candidate biomarkers displayed differences in levels or concentrations in OSA patients compared to non-OSA controls, and decreased after OSA treatment: CRP, IL-6, TNF-α, Il-8, HCY, ICAM-1, VCAM-1, VEGF, TC, LDLc, HDLc, TG, leptin, MDA, ALT, AST, IGF-1, adiponectin, and cortisol. This review summarizes the evidence for OSA-associated potential biomarkers and demonstrates that the quality of available studies, as measured by AMSTAR2, is often low and associated with a high risk of bias.

Obstructive sleep apnea syndrome (OSAS) is a common but underdiagnosed condition with significant health and economic implications for society. Inflammatory mediators are proposed to be associated with the presence and severity of OSAS and contribute to morbidity and mortality. This paper details a prospective non-randomized case control study of a cohort of subjects, who underwent surgical treatment of OSAS and were enrolled to assess the sleep parameters and blood levels of selected inflammatory markers at pre-operative and post-operative time points, also comparing them to the levels in a control group. A total of 25 study subjects and 18 control subjects were enrolled. Median values and interquartile range (IQR) of the apnea–hypopnea index (AHI) in the study group pre-operatively and post-operatively were 34 (18.5–45.5) and 13.3 (7.5–27.3), while in the control group 1.4 (1.0–2.1) per hour. The mean (IQR) hs-CRP levels (mg/L) were 1.782 (0.941–5.594) and 1.980 (0.990–5.445) in the study group, pre-operatively and post-operatively, respectively, while 0.891 (0.767–1.436) in the control group. The mean (IQR) TNF-α levels (pg/mL) were 7.999 (6.137–9.216) and 6.614 (5.534–7.460) pre-and post-operatively, respectively, and were 6.000 (5.026–6.823) in the control group. Results demonstrated that both inflammatory markers, hs-CRP and TNF-α, are higher in subjects with OSAS compared to the controls, and their levels decrease, but are still higher than the controls, after successful surgical treatment. Further analysis including the body mass index and age demonstrated that these changes were significant for TNF-α, but not hs-CRP.

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

Objective Does nasal surgery affect multilevel surgical success outcome. Methods Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery. Results There were 575 patients in nose group, 160 patients in no nose group. The mean age for nose group 44.6 ± 11.4, no nose group 44.2 ± 11.8. Mean preoperative BMI for nose group 27.5 ± 3.6, no nose group 27.5 ± 4.1, mean postoperative BMI nose group 26.3 ± 3.7, no nose group 27.1 ± 3.8 (P = .006). Mean preoperative AHI nose group 32.7 ± 19.4, no nose group 34.3 ± 25.0 (P = .377); and mean postoperative AHI nose group 13.5 ± 10.2, no nose group 17.1 ± 16.0 (P = .001). Mean preoperative ESS nose group was 11.3 ± 4.7, no nose group was 10.4 ± 5.4 (P = .051); and mean postoperative ESS nose group was 5.3 ± 3.2, no nose group was 6.7 ± 2.8 (P = .001). The nose group had higher percentage change (adjusted for age, gender, BMI) in AHI (33.7%, 95% CI 14% to 53.5%) compared to the no nose group (P = .001); the nose group also had more percentage change in ESS (37%, 95% CI 23.6% to 50.3%) compared to the no nose group (P

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

OBJECTIVES/HYPOTHESIS Our objective was to determine whether drug-induced sleep apnea (DISE) affects the successfulness of the surgical outcome. STUDY DESIGN Prospective, seven-country, nonrandomized trial. METHODS There were 326 consecutive obstructive sleep apnea (OSA) patients who had nose, palate, and/or tongue surgery included in the study. DISE was performed in only one group. RESULTS There were 170 patients in the DISE group and 156 patients in no-DISE group. The mean preoperative body mass index (BMI) for the DISE group was 27.6 ± 4.6, whereas in the no-DISE group it was 28.1 ± 3.9 (P = .23). The mean preoperative systolic blood pressure (SBP) for the DISE group was 130.4 ± 16.7, whereas in the no-DISE group it was 142.9 ± 15.5 (P < .001). The mean preoperative diastolic blood pressure (DBP) for the DISE group was 81.4 ± 9.7, whereas in the no-DISE group it was 89.1 ± 9.7 (P < .001). The mean preoperative apnea-hypopnea index (AHI) for the DISE group was 32.6 ± 18.8, whereas in the no-DISE group it was 33.7 ± 19.6 (P = .61). The mean postoperative AHI for the DISE group was 15.9 ± 12.6, whereas in the no-DISE group it was 13.2 ± 8.8 (P = .023). The age-, gender-, BMI-adjusted percentage change in AHI for the DISE group was -48.4 ± 31.9, whereas in the no-DISE group it was -59.8 ± 18.6 (P < .001). The age-, gender-, and BMI-adjusted success rate for the DISE group was 66.5%, whereas in the no-DISE group it was 80.8% (P = .004). The age-, gender-, and BMI-adjusted change in SBP for the DISE group was -6.1 ± 8.6, whereas in the no-DISE group it was -13.3 ± 11.1 (P < .001). The age-, gender-, and BMI-adjusted change in DBP in the DISE group was -5.2 ± 12.1, whereas in the no-DISE group it was -12.4 ± 11.7 (P < .001). The mean age- and gender-adjusted change in BMI for the DISE group was -4.6 ± 12.9, whereas in the no-DISE group it was -6.3 ± 18.5 (P = .34). The Cohen effect of BMI on the overall AHI, lowest oxygen saturation, and blood pressure changes was 0.08. CONCLUSIONS DISE may not significantly affect surgical success in OSA. LEVEL OF EVIDENCE 2c Laryngoscope, 130:551-555, 2020.

The goal of this review is to advance the understanding of the muscular and soft tissue palatal anatomy as it relates to palatal surgery for sleep apnea and the phenotypic variations that generate the shape and collapsibility of the retropalatal airway. Anatomically, the soft palate has both a proximal and distal segments separated by the palatal genu. The proximal palatal segment has a variable angle from the hard palate (ie, alpha angle) determined by the position and length of the levator veli palatini muscle. The palatopharyngeus muscle (PP) is a major defining element of the palate and lateral pharyngeal wall and forms the medial wall of the lateral palatal space. It is composed of two divisions: the longitudinal palatopharyngeus fasciculi which acts to elevate the pharynx and depress the soft palate and the transverse palatopharyngeus fascicle (Passavant's ridge) which function is a nasopharyngeal sphincter. The lateral palatal space incorporates the supra-tonsilar fat, and is bounded by muscles that determine the structure of the palate and associated lateral pharyngeal walls. Understanding of palatal muscles and pharyngeal airway phenotypes provides insight into the steps and mechanisms of pharyngoplasty procedures. Level of evidence N/A.

The hypothesis that individuals with obstructive sleep apnea syndrome (OSAS) demonstrate oxidative stress in the uvular mucosa that correlates with OSAS occurrence was investigated. A total of 128 participants (mean age 45.8, mean body mass index 30.7, female–male ratio 1:20) were divided into the non-OSAS group (apnea–hypopnea index—AHI < 5) and OSAS-group (AHI ≥ 5), in which mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30), and severe (AHI ≥ 30) sub-groups were distinguished. Laryngological examination, Epworth Sleep Scale questionnaire, and home sleep study were performed to obtain AHI, mean oxygen saturation, and lowest oxygen saturation. Total oxidative status (TOS) and total antioxidative status (TAS) were assayed in the uvular mucosa taken during palatoplasty or palatopharyngoplasty. The severity of oxidative stress was expressed as oxidative stress index (OSI). Oxidative/reductive imbalance was noted in the mucosa of the uvula of OSAS individuals, and TAS of the uvular mucosa negatively correlated with the severity of this syndrome. TOS and OSI in the mild, moderate, and severe OSAS were higher than in the non-OSAS group, whereas TAS of the uvular mucosa in the OSAS group was lower compared to the non-OSAS group. In conclusion, oxidative stress in the uvular mucosa is associated with the occurrence of OSAS.

Purpose: The risk of epiphora after medial maxillectomy with lacrimal duct transection is difficult to assess. The data available in the literature are inconclusive due to various operating techniques used by the authors of medical publications, different additional procedures aimed at improving tear drainage after maxillectomy, and a variety of lacrimal duct patency assessment techniques. The aim of our work was to assess the anatomical and functional patency of lacrimal ducts after medial maxillectomy without performing additional procedures to improve tear drainage as well as comparison of the results obtained with different assessment tests. Materials and methods: 21 patients who underwent medial maxillectomy in the years 2016&ndash, 2019 were assessed for discomfort and epiphora based on patients&rsquo, own reports and basic clinical examination, lacrimal duct rinse test, the Munk score, and a modified endoscopic Jones I test. Results: Gradually increasing the sensitivity of the assessment method resulted in an increase in the number of patients with potential tear drainage disorders, starting from 0% in the rinsing test, 4.8% self-reported tearing complaints, 14.3% Munk score, and 19% modified endoscopic Jones I test. Conclusions: The study results revealed that a small fraction of patients tend to report epiphora as a consequence of medial maxillectomy themselves. Subtle functional disorders, which are not particularly bothersome to patients, are more common. More sensitive lacrimal duct patency tests reveal more cases of tear drainage disorders. The results of studies assessing the incidence of epiphora after medial maxillectomy appear to depend on the type of test used.

Surgical techniques for obstructive sleep apnea syndrome (OSAS) constantly evolve. This study aims to assess the effectiveness and safety of a new surgical approach for an OSAS pharyngoplasty with a dorsal palatal flap expansion (PDPFEx). A total of 21 participants (mean age 49.9, mean BMI 32.5) underwent a type III sleep study, an endoscopy of the upper airways, a filled medical history, a visual analog scale for snoring loudness, an Epworth Sleepiness Scale, and a Short Form Health Survey-36 questionnaire. A follow-up re-evaluation was performed 11 ± 4.9 months post-operatively. The study group (4 with moderate, 17 with severe OSAS) showed an improvement in all measured sleep study characteristics (p &lt, 0.05), apnea-hypopnea index (pre-median 45.7 to 29.3 post-operatively, p = 0.009, r = 0.394), oxygen desaturation index (pre-median 47.7 and 23.3 post-operatively, p = 0.0005, r = 0.812), mean oxygen saturation (median 92% pre-operatively and median 94% post-operatively, p = 0.0002, r = 0.812), lowest oxygen saturation (p = 0.0001, r = 0.540) and time of sleep spent with blood oxygen saturation less than 90% (p = 0.0001, r = 0.485). The most commonly reported complications were throat dryness (11 patients) and minor difficulties in swallowing (5 patients transient, 3 patients constant). We conclude that a PDPFEx is a promising new surgical method, however, further controlled studies are needed to demonstrate its safety and efficacy for OSAS treatment in adults.

Cholesteatoma is a serious otolaryngologic condition that to date remains an important problem and poses a challenge to otolaryngologists around the world. To improve the approach pertaining to the diagnosis and management of middle ear cholesteatoma, clear, clinically applicable, and useful definition and classification of cholesteatoma are required. This review aimed to evaluate the current and most accepted descriptions and opinions concerning cholesteatoma. A review of the literature concerning different definitions and classifications of cholesteatoma was used in the preparation of the Cholesteatoma Guidelines, a project implemented by the European Academy of Otology - Neuro-otology.

The European Academy of Otology and Neurotology (EAONO) has previously published a consensus document on the definitions and classification of cholesteatoma. It was based on the Delphi consensus methodology involving the broad EAONO membership. At the same time, the Japanese Otological Society (JOS) had been working independently on the "Classification and Staging of Cholesteatoma." EAONO and JOS then decided to collaborate and produce a joint consensus document. The EAONO/JOS joint consensus on "Definitions, Classification and Staging of Middle Ear Cholesteatoma" was formally presented at the 10th International Conference on Cholesteatoma and Ear Surgery in Edinburgh, June 5-8, 2016. The international otology community who attended the consensus session was given the chance to debate and give their support or disapproval. The statements on the "Definitions of Cholesteatoma" received 89% approval. The "Classification of Cholesteatoma" received almost universal approval (98%). The "EAONO/JOS Staging System on Middle Ear Cholesteatoma" had a majority of approval (75%). Some international otologists wanted to see more prognostic factors being incorporated in the staging system. In response to this, the EAONO/JOS steering group plans to set up an "International Otology Outcome Working Group" to work on a minimum common otology data set that the international otology community can use to evaluate their surgical outcome. This will generate a large database and help identify relevant prognostic factors that can be incorporated into the staging system in future revisions.

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

The aim of this study was to assess the expression of MMP-9 and TIMP-1 in cancerous tissue as well as in the serum and plasma concentrations of these proteins in patients with laryngeal cancer and compare the results to the inflammatory reaction in healthy subjects. Twenty-seven patients who were diagnosed with laryngeal carcinoma and selected for total laryngectomy were included in the study group. MMP-9 and TIMP-1 expression in tissues was assessed using immunohistochemical assays. Immunoenzymatic ELISA methods were used to measure MMP-9 and TIMP-1 concentrations in serum and plasma. MMP-9 and TIMP-1 were identified in tumor cells and in the tumor stroma compartment, as well as in macroscopically healthy mucous membrane. MMP-9 expression was more significant in tumor stroma than in the perimatrix of the mucous membrane (p=0.047). TIMP-1 expression was significantly higher in the matrix and perimatrix of the mucous membrane than in cancer tissue (p=0.0093) and the tumor stroma compartment (p<0.0001). Expression of TIMP-1 was observed more frequently in tumors without infiltrated lymph nodes (p=0.009). Serum concentrations of MMP-9 and TIMP-1 as well as plasma TIMP-1 concentration were significantly higher in the study group than in the control group (p=0.0004, p=0.002, and p=0.0001, respectively). A significantly higher TIMP-1 level in plasma was found in patients with poorly differentiated tumors compared to G1 and G2 (p=0.046). MMP-9/TIMP-1 rate in serum was significantly higher in the study group than in the control group. The balance between the level of MMP-9 and TIMP-1 is disrupted in laryngeal cancer. The significant correlation between TIMP-1 expression and the presence of lymph node metastases, as well as that between TIMP-1 plasma concentration and stage of cancer histological differentiation, might indicate the importance of this molecule as a prognostic factor during carcinogenesis.

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

Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease and is considered an independent risk factor for cardiovascular disease. The exact mechanism of cardiovascular complications (CVC) development as a complication of OSA is not entirely understood. Oxidative stress is suspected to be the essential factor in initiating various comorbidities in OSA. Biomarkers of nonenzymatic lipid and protein peroxidation, DNA repair and antioxidant capabilities measured in serum, plasma and urine are frequently used to assess the presence of oxidative stress. We conducted a systematic review and quality assessment of available observational analytic studies to determine whether there is an association between oxidative stress and OSA in patients with prevalent CV disease compared to (a) patients with prevalent CV disease but no OSA, (b) patients with prevalent CV disease and less severe OSA and (c) patients with OSA and no overt CV disease. This systematic review demonstrated that, while oxidative stress is associated with OSA, there was no clear difference in the severity of oxidative stress between OSA patients with or without cardiovascular complications.

The goal of this review is to advance the understanding of the muscular and soft tissue palatal anatomy as it relates to palatal surgery for sleep apnea and the phenotypic variations that generate the shape and collapsibility of the retropalatal airway. Anatomically, the soft palate has both a proximal and distal segments separated by the palatal genu. The proximal palatal segment has a variable angle from the hard palate (ie, alpha angle) determined by the position and length of the levator veli palatini muscle. The palatopharyngeus muscle (PP) is a major defining element of the palate and lateral pharyngeal wall and forms the medial wall of the lateral palatal space. It is composed of two divisions: the longitudinal palatopharyngeus fasciculi which acts to elevate the pharynx and depress the soft palate and the transverse palatopharyngeus fascicle (Passavant's ridge) which function is a nasopharyngeal sphincter. The lateral palatal space incorporates the supra‐tonsilar fat, and is bounded by muscles that determine the structure of the palate and associated lateral pharyngeal walls. Understanding of palatal muscles and pharyngeal airway phenotypes provides insight into the steps and mechanisms of pharyngoplasty procedures. Level of Evidence N/A

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

1-(N,N-substituted-aminiomethyl)spirobi[3-oxo(2,5-dioxa-1-silacyclopentan)]ates were investigated using NMR, X-ray, and quantum-chemical methods. The free activation parameters for the inversion of “ammonium-amine nitrogen” and the chirality change at the pentacoordinated silicon were determined by dynamic NMR spectroscopy. The latter proceeds via the dissociation of SiO bonds. The results were confirmed by quantum-chemical calculations, the experimental observation of cross-peaks in 2D-EXSY NMR spectra, and the spirocycle exchange reactions. Transition pathways between the different diastereomers in solution were analyzed.

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

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

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

Background Lysosomal exoglycosidases, such as α-mannosidases (MAN) and β-galactosidases (GAL), are found in different glycoside hydrolase sequence-based families. Considerable research has proved plays the role of MAN, which play a key role in the modification and diversification of hybrid N-glycans, processes with strong cellular links to cancer. Therefore the study aim was to investigate the activities of MAN and GAL in larynx cancer compared to controls. Material and methods Larynx cancer (n = 21) and normal healthy tissue (n = 21) were collected from patients during total laryngectomy. A biopsy of macroscopically healthy tissue in the area of the lower 1/3 of omohyoid muscle was taken for frozen sections in each case and these served as controls. The release of p-nitrophenol from p-nitrophenol derivatives of MAN and GAL was used. Results In all specimens we observed significantly higher activity of investigated enzymes in larynx cancer compared with controls. The mean release of MAN from activated cells was 3.702 ±1.3245 nkat/g wet tissue compared to controls (1.614 ±0.8220 nkat/g wet tissue). The mean release of GAL from the activated cells was 3.383 ±2.1980 nkat/g wet tissue compared to controls (2.137 ±1.3685 nkat/g wet tissue). Differences in observed activity were statistically significant. Conclusion The present data indicate that MAN and GAL are significantly and consistently elevated in larynx cancer growth. It also means that catabolic reactions involving glycoproteins, glycolipids and proteoglycans may play a role in larynx cancer. Further research should also evaluate the relative importance of these particular exoglycosidases in indicating the progress of the disease in considering the spectrum of identified marker mediators.

The pineal region is the most common area for germ cell tumours. They are mostly observed in children. In adults they are more common in men in the second or third decade of life. Pineal tu mours have a diverse histopathology. Their growth is slow and the symptoms result from the compression of adjacent cerebral structures. One of the histopathological forms is germinal tumours, including mild or malignant teratoma. They have the ability to release neoplastic markers, e.g. AFP, β-HCG, which are used to evaluate the effectiveness of surgical and oncological treatment. The paper presents a case of a 24-year-old man di agnosed as teratocarcinoma. The treat ment protocol consisted of both surgery and conventional fractionation radio therapy (Df = 1.8 Gy, 5 ◊ weekly) to the total dose of 50.4 Gy. After a few months, there was a recurrence of the cancer process. The patient received 2 courses of chemotherapy, which did not yield the expected therapeutic effect. The patient’s prognosis is unfavourable due to rapid local relapse and failure after treatment. The case is presented due to the rarity of pineal teratocarcinoma tu mours and the age of the patient.

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

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

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

Summary Diode laser due to emitted wavelength and achieved tissue effect appear to be universal tool for broad range of applications in laryngological surgery. The aim of the study was to present variety of applications of this type of laser in the treatment of selected pathologies of the nose, pharynx and oral cavity. Material and method 45 patients with various pathologies of the nose, pharynx and oral cavity were subjected to diode laser treatment under control of endoscopes and video routing system. In the studied group diode laser was used for hyperplastic turbinates treatment, correction of concha bullosa and septum deformations, ablation of nasal polyps and synechiae inside nasal cavity including cicatrical stenoses in the orifice of common lacrimal canalliculus, coagulation of vascular hemorrhagic diathesis, ablation of bleeding granulomas and polyps and treatment of vascular malformations. Results Endoscopic diode laser surgery enabled for precise and save removal of the pathology accompanied only by minimal intraoperative bleeding. Healing and reepithelization process were normal and even in large postoperative defects do not exceeded 12 weeks. Postoperative complications in the form of cicatrix and synechiae were found in 3 patients. Conclusions Various pathologies may be treated effectively with diode laser if appropriate laser beam parameters and surgical technique is applied.

INTRODUCTION The pathophysiology of OSAS is related with local anatomical predispositions to OSA such as craniofacial anomalies, adenoid and tonsillar hypertrophy, macroglossia, hypertonic oropharyngeal soft tissue, base of tongue proptosis, mandibular hypoplasia, posterior mandibular displacement, maxillary retrusion, enlarged uvula, retrognathia, and inferior positioning of the hyoid. The AIM of the study was to evaluate the usefulness of cephalometric measurements in patients with obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS Eighteen randomly selected patients with snoring and varying degrees of sleep-disordered breathing were included in this study. All patients underwent completed otolaryngological examination, somnographic test using Poly-Mesam device, cephalometric radiographs and craniofacial CT scans. A control group had the same examinations and cephalometric tests. These patients had no snoring or clinical evidence of sleep-disordered breathing. No patients had prior pharyngeal or maxillomandibular surgery. Lateral cephalometric radiographs were obtained on all subjects in standing position using a standard technique. Each subject had also an awake CT scan in supine position on the back. RESULTS According all parameters we gathered from the study, OSAS is associated with significant changes in cephalometric measurements. Cephalometric analysis adds further information regarding the anatomical assessment of OSAS patients however we found craniofacial CT scans easier, more accurate measurements especially applying to soft tissues.

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

Development of a consensus on the definitions and classification of cholesteatoma is essential for scientific community to exchange information on clinical studies and compare their outcomes. The aim of the study is to reach a consensus among members of the European Academy of Otology and Neurotology (EAONO) regarding the definitions and classification related to cholesteatoma. A set of statements was developed by the authors utilizing the literature on the definition and classification of cholesteatoma. A questionnaire was sent to the members of the EAONO, inviting them to state if they are in agreement with each of the statements and if not, then to provide comments or suggestions for revision. Responses were evaluated and modified using online questionnaire and survey software based on the Delphi technique, a cyclical process of gathering information, summarizing, and re-submitting the revised statements to the same target population until a consensus is reached. Target agreement among the responders was set at a minimum of 80%, and the cycle of revision and re-submission of the statements were repeated until a consensus was reached on a majority of the statements. A steering group has been established to evaluate the results of the survey and worked via the process of cognitive debriefing. Out of 364 EAONO members, 123 responded to the first consensus cycle, 77 to the second cycle, and 53 to the third cycle. After three cycles, all statements concerning cholesteatoma definitions reached the target of 80% consensus. However, a consensus on the classification of cholesteatoma could not be achieved. The steering group excluded four statements of cholesteatoma definition and established a consensus on cholesteatoma classification. A consensus on cholesteatoma definitions was reached among the members of the EAONO. The final revision on consensus statements for cholesteatoma definition and classification has been made via the process of cognitive debriefing of the steering group.

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

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

A simple and effective method to deprotect of sterically hindered steroid esters is described. Deprotection was carried out in MeOH in the presence of a catalytic amount of Et3N under high-pressure conditions. Enzymatic, anionite, and high-pressure methods are compared.

Cholesteatoma is a destructive lesion of the temporal bone that gradually expands and causes complications by erosion of the adjacent bony structures. Bone resorption can result in destruction of the ossicular chain and otic capsule with consecutive hearing loss, vestibular dysfunction, facial paralysis and intracranial complications. Surgery is the only treatment of choice. The etiopathogenesis of cholesteatoma, however, is still controversial. This review was designed to understand the reasons for these disparities and to reduce or eliminate them. Future studies focused on developmental, epidemiological, hormonal and genetic factors as well as on treatment are likely to contribute to further understanding of cholesteatoma pathogenesis.

Summary Nasal polyposis affects about 1 to 4% of the population. Polyps develop in oedematous and inflammated mucous membrane. In spite of the intensive research the pathomechanism of their development is not fully understood. The majority of the theories concerning the development of nasal polyps emphasize the role of the inflammatory process causing the rupture of the epithelium and the basal membrane. Cathepsin D is one of important mediators of inflammatory processes, that may be involved in the pathogenesis of nasal polyposis. The aim of the study Was to establish the role of the cathepsin D in the pathogenesis of nasal polyps. Matherial and method Tissues were taken from 39 patients treated with endoscopic sinus surgery due to chronic rhinosinusitis with polyps. The activity of the cathepsin D was assesed with spectrofotometric method using the specific inhibitor (pepstatin) in tissue of nasal polyps, in oedematous and the inflammated mucous membrane of the nasal conchae and the samples of mucous membrane taken from the nasal septum. Results Statistically significant difference in cathepsin D activity between polypoid tissue, inflammated mucosa and the mucous membrane of the nasal septum was detected (t-student test, p Conclusion Increased activity of the cathepsin D in nasal polyps and inflammatory changed mucosa confirm the important role of the cathepsin D in inflammatory processes leading to damage and subsequent remodeling of mucous membrane. We believe that further research on the activity of other proteolytic enzymes is necessary to demonstrate the differences between the inflammable changed mucous membrane and nasal polyps.

Summary Treatment of the advanced form of rhinophyma causing severe nasal deformity and nasal breathing impairment is reserved mainly for surgical methods. Laser techniques among them play particular role. The aim of the study was to present short series of patients suffering from severe form of rhinophyma, who were treated with CO 2 laser, emphasizing the advantages and disadvantages of the method used. Material and method: Three male patients, aged 51–69, with advanced form of rhinophyma were treated in our clinic with CO 2 laser. The total removal of pathologic tissue was performed during 2–3 sessions of laser therapy with an interval 4–8 weeks in-between. Results The follow-up ranged from 4–12 months. Satisfactory cosmetic and functional result was achieved in all patients. Full reepithelization of the wound took place within 4–6 weeks. Intensive bleeding from dilated vessels during the procedure that required bipolar electrocautery occurred in two cases. There were no postoperative complication in the studied group. Conclusions The CO 2 laser is relatively save and precise surgical tool for rhinophyma ablation. If the resection is not to aggressive, healing process is quick and without excessive scaring. Unfortunately the “dry field” conditions are not always possible to achieve during operation, due to limited coagulative properties of the CO 2 laser towards dilated blood vessels. In advanced stages of rhinophyma to increase safety of the procedure, several sessions of the laser therapy might be necessary to remove all the hypertrophic tissue.

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

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

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

Immunoexpression analysis of p53 and p21 in congenital cholesteatoma with assessing their exact localization in cholesteatoma layers and the level of expression. P53 and p21 are apoptosis-related molecules that regulate cell cycle. These markers have been not completely evaluated in congenital cholesteatoma, and the role of apoptosis in congenital cholesteatoma is also not completely understood.Congenital cholesteatoma samples, a study group (n = 13) and normal auditory meatal skin, a control group (n = 12) from patients who underwent surgery for cholesteatoma were included in the study. Acquired cholesteatoma samples were used as a comparable group (n = 12). Tissue sections were investigated with the immunohistochemistry technique based on binding of biotinylated secondary antibody with the enzyme-labeled streptavidin with using appropriate primary antibodies. Cells with immunoexpression of analyzed antigens: p53 and p21 were defined as antigen positive. In each section, cells were counted, and the percentage of positive cells was determined. The level of significance was set at p0.05.The mean percentage of p21-positive was statistically significant higher in congenital cholesteatoma than in the control group (p0.05). There was no meaningful difference between congenital and acquired cholesteatoma with respect to p21 expression. There was significant difference between congenital and acquired cholesteatoma regarding p53.Up-regulation of p21 protein is expected to play a significant role in CC development. Apoptosis is an important process in the pathogenesis of congenital cholesteatoma. It seems reasonable to perform studies on apoptosis in congenital cholesteatoma in the prospective way taking into consideration more specimens.

Objective: To determine the level of glycoconjugates catabolism by marking α-mannosidase (MAN) and α-fucosidase (FUC) activity in cholesteatoma and serum.Method: Middle ear cholesteatomas (Chol), normal skin specimens (C) and serum of cholesteatoma patients and serum from healthy volunteers were included in the study. The concentration of lysosomal exoglycosidases activity was assessed on the basis of p-nitrophenol release from the derivatives of the substrate (MAN from mannose and FUC from fucose).Results: Mean concentration of MAN activity in Chol was 8.31112 pKat/mL in comparison with C (2.621048 pKat/mL). Pearson correlation (MAN activity) was r = 0.26321. Mean activity concentration of FUC in Chol was 10.03288 pKat/mL in comparison with C: 2.723152 pKat/mL. The average concentration of MAN activity in serum from cholesteatoma patients was 3.05712 pKat/mL, compared to the concentration of MAN activity in the control serum 2.73244 pKat/mL. The average concentration of FUC activity in serum of cholestea...

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