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Background and Objectives : The objective of this study was to present a rare case of non-keratinizing squamous cell carcinoma (SCC) of the lacrimal sac (LS). Neoplasms of the lacrimal drainage system are extremely rare. These lesions are predominantly malignant and are associated with a high mortality rate. Case Presentation: A 51-year-old woman was referred to an ophthalmologist with a history of unilateral epiphora, presbyopia, and abnormal eye discharge. Antibiotic therapy was applied and modified later due to persisting symptoms. After five months, edema of the medial left eye angle occurred. A lacrimal sac incision was performed, and a subsequent magnetic resonance imaging (MRI) scan revealed a 2 cm, contrast-enhanced solid tumor. The patient was qualified for dacryocystectomy, which was conducted by the otolaryngology department. Postoperative histopathologic findings indicated the presence of non-keratinizing SCC. During a reoperation, margins were extended, and the surgery was found to be radical. Following the reoperation, no alarming symptoms were observed. However, a follow-up MRI and positron emission tomography (PET) scan six weeks later revealed metastases. Further treatment is being planned. Conclusions: LS tumors are life-threatening conditions that are challenging to diagnose at an early stage. Surgical excision is the preferred treatment option. Imaging studies play an important role in post-operative follow-up because of the possibility of recurrence and metastasis, even after radical surgery.

Photodynamic therapy (PDT) is a medical treatment with the use of a photosensitizing agent (PS), which, when activated by light, results in selective tissue damage with a cytotoxic effect on tumor cells. PDT leads to the induction of an acute-phase response, which results in the involvement of adrenal glucocorticoid (GC) hormones. PDT, by activating the hormonal response, affects the treatment of cancer. GC release is observed due to adrenal activity, which is driven by changes in the hypothalamic pituitary-adrenal axis triggered by stress signals emanating from the PDT treated tumor. The hormones released in this process in the context of the PDT-induced acute-phase response perform many important functions during anticancer therapy. They lead, among other things, to the systemic mobilization of neutrophils and the production of acute-phase reagents, and also control the production of immunoregulatory proteins and proteins that modulate inflammation. GCs can radically affect the activity of various inflammatory and immune cells, including the apoptosis of cancer cells. A better understanding of the modulation of GC activity could improve the outcomes of cancer patients treated with PDT.

Background: The cellular inflammatory pattern of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is heterogeneous. However, data on the heterogeneity of non-eosinophilic asthma (NEA) with aspirin hypersensitivity are scanty. By examination of N-ERD patients based on clinical data and eicosanoid biomarkers we aimed to identify NEA endotypes potentially guiding clinical management., Methods: Induced sputum was collected from patients with N-ERD. Sixty six patients (49.6% of 133 N-ERD) with NEA were included in the hierarchical cluster analysis based on clinical and laboratory data. The quality of clustering was evaluated using internal cluster validation with different indices and a practical decision tree was proposed to simplify stratification of patients., Results: The most frequent NEA pattern was paucigranulocytic (PGA; 75.8%), remaining was neutrophilic asthma (NA; 24.2%). Four clusters were identified. Cluster #3 included the highest number of NEA patients (37.9%) with severe asthma and PGA pattern (96.0%). Cluster #1 (24.2%) included severe only asthma, with a higher prevalence of NA (50%). Cluster #2 (25.8%) comprised well-controlled mild or severe asthma (PGA; 76.5%). Cluster #4 contained only 12.1% patients with well-controlled moderate asthma (PGA; 62.5%). Sputum prostaglandin D 2 levels distinguished cluster #1 from the remaining clusters with an area under the curve of 0.94., Conclusions: Among identified four NEA subtypes, clusters #3 and #1 represented N-ERD patients with severe asthma but a different inflammatory signatures. All the clusters were discriminated by sputum PGD 2 levels, asthma severity, and age of patients. The heterogeneity of non-eosinophilic N-ERD suggests a need for novel targeted interventions., (© 2023 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)

Introduction: COVID-19 pandemic has had a significant impact on healthcare systems around the world. The rapid spread of the virus caused several restrictions, including limited access to outpatient clinics. The purpose of the study was to compare the characteristics and reasons of the visits of otolaryngological patients conducted during the first three waves of the COVID-19 pandemic with those of the prepandemic period., Materials and Methods: Volume, demographic data, type of visits, additional tests, referral types, and reasons for consultation were analyzed., Results: There were 1578 visits performed before the pandemic and, respectively, 434, 1198 and 1299 during the first, second and third waves. The patients in the first and second waves were older than the patients before the pandemic (mean age 59, 56, and 52 years, respectively, for both comparisons p<0.0001). Regarding the type of visit, the vast majority were in-person visits in all groups. The highest percentage of teleconsultations was in the first wave and was equal to 3.46%. Before the pandemic, patients were admitted mainly due to upper respiratory system diseases (52.15%), while during the first wave the main reasons were tumors (39.86%, malignant and benign tumors comprised 29.26% and 10.6%, respectively)., Conclusions: The COVID-19 pandemic, especially the first wave, changed the profile of ambulatory patients. In the first wave, a higher prevalence of tumor patients and a lower prevalence of patients with diseases of the upper respiratory system were observed. The COVID-19 pandemic caused an increase in number of teleconsultations, but its role was limited.

Aim: The aim of the study was to compare the flow disturbances in computational fluid dynamics (CFD) technique based on computed tomography (CT) to the results of active anterior rhinomanometry (RMM), in patients with nasal septum deviation (NSD)., Material and Methods: In 24 patients with NSD, RMM and CT of the paranasal sinuses were performed as a part of typical clinical management. For each patient, 3D models of air-filled spaces in the nasal cavity were created, based on CT images, and air flow simulations during inhalation were performed using CFD technique. Correlations between RMM, both before and after anemization, during inspiration, and CFD were tested, independently for the left and right side., Results: The obtained correlation coefficients for the comparison of flow in RMM during inspiration and in CFD during simulated inspiration were: before anemization 0.46 for the left side and 0.52 for the right side, after anemization 0.65 for the left side and 0.61 for the right side (p < 0.05)., Conclusions: Moderate correlation was found between the results of real and virtual rhinomanometry, with higher correlation coefficients obtained after anemization, compared to the values before anemization.

Objectives: The aim of the study was to evaluate the frequency of vertigo symptoms and potential labyrinth damage in patients with diagnosed Lyme disease (LD). LD can affect the vestibulocochlear nerve, leading to hearing loss and vertigo/dizziness., Material and Methods: The study included a group of 38 patients between the ages of 20 and 77, who were hospitalized due to vertigo/dizziness between 2018 and 2019. All of the patients underwent a detailed medical interview and an otolaryngological and neurological examination, including video electronystagmography (VENG), in addition to audiological and diagnostic tests. Additionally, ELISA and Western blot tests were performed to confirm the diagnosis of LD., Results: In 20 patients (53%), the Romberg trial was positive ( p < 0.001). The degree of vestibular dysfunction as shown by the VENG test was associated with the rate of hearing loss as confirmed by the Auditory Brainstem Response (ABR) test ( p = 0.011), and it mainly concerned high-frequency sounds ( p = 0.014)., Conclusion: Vertigo can be a symptom of LD. It is often associated with labyrinth and hearing-organ damage, which can imply that the inner ear or nerve VIII is dysfunctional in the course of this disease. Antibiotic therapy is effective in reducing otoneurological symptoms.

Objectives: Sudden sensorineural hearing loss (SSNHL) is defined as sensorineural hearing loss of 30 dB or more over at least three adjacent audiometric frequencies occurring within a 72-h period of time. One of the causes of SSNHL could be the progressive inflammatory state caused by an infection. The aim of this study was to assess the prevalence of SSNHL caused by various factors, most importantly those potentially related to Lyme disease., Material and Methods: The study includes a group of 86 patients between the ages of 20 and 70 who were hospitalized due to SSNHL between 2017 and 2018. All of these patients underwent a detailed medical interview and an otolaryngological examination, including audiological and diagnostic tests. Additionally, ELISA and Western blot tests were performed to confirm the diagnosis of Lyme disease., Results: In this group of 86 patients, nine patients presented with positive antibodies toward Borrelia burgdorferi sensu lato . This group was treated with antibiotics and experienced partial or complete regression of their deafness. This may suggest a relationship between SSNHL and Lyme disease., Conclusion: Infections caused by Borrelia burgdorferi may contribute to the development of inflammatory and angiopathic lesions, which are a possible cause of SSNHL. The longer the duration of the infection, the greater the likelihood of permanent and irreversible changes in the vessels of the cochlea or auditory nerve. Therefore, serological tests for Borrelia burgdorferi should be performed during the diagnosis of SSNHL as a possible cause of this illness.

To detect the variations of esophageal peristalsis in amyotrophic lateral sclerosis (ALS) patients with predominantly bulbar or predominantly pseudobulbar clinical presentation by using esophageal manometry (EM). Fifteen ALS patients with pseudobulbar clinical presentation (PBP) and 13 patients with bulbar presentation (BP), fulfilling WFN Criteria, were studied. EM was performed in all subjects using a flexible catheter with solid-state transducers. Swallowing was initiated with 5 to 10 mL of water (wet swallows) and saliva (dry swallows) and repeated at 30 s intervals. The manometric parameters were measured automatically and visualized by the computer system. The tracings were analyzed using Synectics software. In PBP patients, an increase of resting pressure value in the upper esophageal sphincter (UES) >45 mmHg, a wave-like course of resting pressure, and toothed peristaltic waves were observed. In BP patients, a low amplitude of peristaltic waves <30 mmHg (mean: 17 ± 5) was recorded, without signs of esophageal motility disturbance at onset or during progression. EM procedure allows objectively distinguishing dysphagia in ALS patients due to bulbar syndrome from the dysphagia due to pseudobulbar syndrome. It is important to identify PBP patients because of their high risk of aspiration.

&lt;b&gt;Introduction:&lt;/b&gt; Upon hearing that the "little" patient has trouble with hearing, we are mostly interested in the level of his hearing threshold. When the child is in the first year of life, results can only be achieved by means of ABR test. Subsequent control tests, especially in children from the hearing loss risk groups selected in this study, show that the obtained outcomes are subject to fluctuations. Their fluctuating nature is manifested by the instability of wave V threshold in subsequent diagnostic periods. Such variability often delays the implementation of the appropriate proceeding. Knowledge of the dissimilarity of behavior of the wave V threshold occurring in individual groups at risk of hearing loss allows for the correct interpretation of the obtained results, and thus, effective therapeutic measures. &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of the paper is to analyze the stability of wave V threshold during the first year of life in children from selected risk groups for congenital hearing disorders. &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; From the patient population of 2,114 individuals examined in 2015-2016 at a reference center participating in the Universal Neonatal Hearing Screening Program in 2015-2016, the results of 250 children were subjected to retrospective analysis. Furthermore, 4 groups of little patients were formed (children with Down syndrome; children with other diseases or damage to the nervous system; children with cleft palate or cleft lip and cleft palate; children with congenital cytomegaly) in whom diagnostic practice revealed variable results of the wave V threshold. We analyzed the results of tests obtained during the first year of the child's life divided into 4 diagnostic periods. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; The highest percentage of instability in the established threshold of wave V between individual diagnostic periods occurred in the group of children with cleft palate or cleft lip and cleft palate. In the group of children with Down syndrome, it was observed that the instability of the ABR test results decreased over time. In the group of children with other diseases or damage of the nervous system, the highest percentage of the lack of stable ABR wave V thresholds was observed between the 1st and 2nd as well the 1st and 4th diagnostic periods. On the other hand, in the group of children with congenital CMV, there was a relatively low percentage of instability of results. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; (1) Although the ABR test is a diagnostic standard, in particular groups of patients the study is burdened with high variability of measurement results in subsequent diagnostic periods. Such a group of patients are children with cleft palate or cleft lip and cleft palate; therefore, it must receive particular attention in treatment planning; (2) in selected groups at risk of hearing loss, due to the high percentage of children with hearing impairment (70%), the validity of performing newborn hearing screening tests was confirmed.

Esophageal manometry (EM) could serve as an objective method for the detection of esophageal peristalsis in patients with amyotrophic lateral sclerosis (ALS). In this group of patients, biofeedback training (BT) using the EM procedure is a promising method for the rehabilitation of swallowing function. A total of 20 ALS patients with clinical evidence of dysphagia and who met WFN criteria were recruited for this study. The standard transnasal EM with solid-state transducers was performed, and swallows with water and saliva were initiated in all subjects and repeated at 30-s intervals. The median upper esophageal contractile amplitude, duration, and velocity results during the wet and dry swallows were evaluated and compared in both the ALS and the control groups. In ALS patients, in contrast to the control, significant abnormalities in all EM parameters were recorded, which implies a specific pattern of esophageal peristalsis. Twelve months after BT, the body mass index (BMI) of ALS patients who underwent BT (ALSBT) was compared to the BMI of those who did not (ALS1)-compared to the ALS1 group, ALSBT patients showed a slightly smaller drop in BMI value. We presume that BT using EM can be a promising tool for the improvement of the swallowing mechanism in ALS patients.

The aim of the study was to analyse the disturbances of the oro-pharyngeal swallowing phase of dysphagia in amyotrophic lateral sclerosis (ALS) patients with the use of specific manometric measurements and to evaluate their plausible association with the duration of the disease. Seventeen patients with ALS were evaluated with manometric examinations of the oral and pharyngeal part of the gastrointestinal tract. Tests were carried out by using the oesophageal balloon-based method with four balloon transducers located 5 cm away from each other. The following manometric parameters were analysed: the base of tongue contraction (BTC) and the upper oesophageal sphincter pressure (UESP), and the hypopharyngeal suction pump (HSP) as well as the oro-pharyngeal, pharyngeal and hypopharyngeal transit time and average pharyngeal bolus velocity (oropharyngeal transit time (OTT), pharyngeal transit time (PTT), hypopharyngeal transit time (HTT) and average pharyngeal bolus velocity (APBV), respectively). Manomatric examinations during swallowing in patients with ALS showed significant weakness of BTC, a decrease of HSP and a decrease of the velocity of bolus transit inside the pharynx which were particularly marked between the first and the third examination. Manometric examinations of the oro-pharyngeal part of the gastrointestinal tract are useful and supportive methods in the analysis of swallowing disturbances in ALS patients.

Background: Postoperative hearing improvement is measured as Air-Bone gap changes. Changes in bone conduction threasholds as a results of otosurgery is also discussed., Aim: We discuss factors that have influence on bone conduction threasholds changes in individuals operated due to chronic otitis media., Material and Methods: The prospective analysis involves the patients operated on middle ear due to chronic infection in the Department of Otolaryngology at the Jagiellonian University of Krakow in the years 2010-2013. 457 otosurgeries were performed in this period of time., Results: 293 first time operated on patients with chronic otitis media were analysed. Statistically significant bone conduction improvement was noticed after myringoplasty and in individuals with intact ossicular chain. No bone conduction threasholds improvement was observed with defects to the ossicles., Conclusions: Unchanged mucous lining middle ear spaces and intact ossicular chain are crucial for bone conduction improvement after otosurgery. Scars, especially in round window, are poor prognostic factor for hearing improvement. Cleaning of the middle ear from granulation has an positive influence for bone conduction threasholds changes.

Objective: Voice abnormalities are among the symptoms occurring in patients with amyotrophic lateral sclerosis (ALS). They are divergent and range from hoarseness, through the excessive adduction of false folds, up to the weakness of the vocal folds. The aim of the study was to analyze the phonatory function of the larynx in ALS patients., Methods: Seventeen patients with ALS were evaluated with subjective perceptual voice assessment (including the GRBAS scale), videolaryngostroboscopy including voice range and maximum phonation time (MPT), and objective acoustic voice analysis with IRIS software (including evaluation of jitter, shimmer, mean fundamental frequency, and noise-to-harmonics ratio (NHR)). Examinations were performed three times at 6-month intervals., Results: Hoarseness, roughness, and breathiness of voice were all found more frequently in the majority of these patients. Voice range, amplitude of vibration, mucosal wave, and glottal closure showed significant abnormalities with repeated examinations. MPT was shortened especially among women with ALS. Acoustic analysis of voice among men showed increased jitter value in the first examination only, while jitter, shimmer, and NHR in women with ALS were increased in all examinations., Conclusions: Analysis of voice qualities among patients with ALS allows for the detection of various abnormalities associated with the natural progression of the disease., (© 2015 S. Karger AG, Basel.)

Background: The principal objective of ossiculoplasty is to reconstruct the sound-conducting system in the ear to the best possible degree after the elimination of pathological lesions from the middle ear. The ossicular chain is reconstructed with the use of the patient's own properly modelled ossicles and synthetic prostheses. The objective of the study was to assess the degree of hearing improvement after tympanoplasty in patients for whom a ventilation tube was used as a partial ossicular replacement prosthesis (PORP)., Material and Methods: Between 2009 and 2012, 387 patients underwent ear surgery at the Otolaryngological Teaching Hospital of the Collegium Medicum at the Jagiellonian University of Cracow. We focussed on the patients in whom a vibrating element in the form of a properly modelled anvil or a ventilation tube was attached to the preserved and normally mobile stapes., Results: A significant hearing improvement was observed in patients with type 2 tympanoplasty in the course of chronic cholesteatoma otitis media and in patients with simple chronic inflammatory process in whom a ventilation tube was used as a PORP in the reconstruction. Granulation tissue was determined to be an unfavorable factor in the prognosis of hearing improvement following tympanoplasty., Conclusions: Significant hearing improvement was observed after type 2 tympanoplasty in patients with cholesteatoma whose ossicular chain was not appreciably damaged. A ventilation tube used as a PORP is an effective alternative in the reconstruction of the ossicular chain.

Purpose: The objective of this study is to evaluate the impact of changes to the mucous in the middle ear on the outcome of the reconstruction of the ossicular chain exemplified by a type 2 tympanoplasty., Material/methods: A prospective analysis was carried out with regard to patients operated on at the Otolaryngology Department at Collegium Medicum, Jagiellonian University, between 2007 and 2011 due to conditions of the middle ear. The patients who had undergone surgical treatment for the first time because of chronic otitis media were taken into account. The operations involving a type 2 tympanoplasty were earmarked for further analysis. The effectiveness of treatment was measured by the change of the Air-Bone Gap (AGP)., Results: The analysis covered 47 patients, whose own modeled incuses were placed on normal stapes. The patients were divided into two groups (with and without cholesteatoma). A statistically significant hearing improvement was observed in the patients with cholesteatoma. In the group without cholesteatoma and with a prevalence of granulomatous lesions, no statistically significant hearing improvement was observed 6 and 12 months following the ear surgery., Conclusions: In the patients with cholesteatoma and a minor damage to the ossicular chain, a significant hearing improvement is observed after ossiculoplasty. An occurrence of granulomatous lesions is an unfavorable predictor. The Air-Bone Gap measured before the surgery often does not the actual advancement of the pathological process, and hearing improvement after the surgery cannot be prognosticated on the basis of that amount alone., (Copyright © 2014 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Background: Relationship beetwen middle ear surgery and function of the inner ear is known. This problem is often discussed in determination of hearing improvement after otosurgery., Aim: Usefulness of the click evoked otoacoustic emissions (CEOAE) in evaluation of the inner ear function and effectiveness of tympanoplasties is discussed., Material and Methods: Prospective analysis of 70 individuals operated on middle ear problems was performed. Patients were divided into four groups of otosurgeries: stapedoplasty, myringoplasty, type II tympanoplasty, type III tympanoplasty. Otoacoustic emissions and pure tones audiometry were performed before middle ear surgery and 3 months after ear operation., Results: In all established groups improvement in ABG (air bone gap) was observed. Improvement of bone conduction thresholds in the ranges of 5dB was observed in individuals with otosclerosis and type I and type III tympanoplasty. Patients with type II tympanoplasty developed no changes of bone conduction threashold after otosurgery., Conclusions: Behind routine audiometric diagnostics otoacoustic emissions can be useful in postoperative evaluation of effectiveness of middle ear surgery (especially in patients operated on otosclerosis and in individuals with chronic otitis media with intact ossicular chain)., (Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Isolated laryngeal fractures quite rarely can occur following trauma to the neck region, but because of the variety and dynamic growth of symptoms or possible injury of the main structures on the neck may be life-threatening. The appropriate treatment of these patients is quick surgical intervention proceeded by imaging techniques. Here we report the cases of three patients treated in our Department between 2009 and 2012: two of them with penetrating injury and one with blunt trauma. The appropriate treatment of these patients requires that airway patency be the first priority and if possible quick reconstruction. These cases illustrate the individualized treatment and multidisciplinary approach in managing such cases., (Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

The endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine procedure. This study describes the endoscopic closure of CSF leaks in a large series (36 patients) at the Jagiellonian University over 10 years (1999 to 2009). We describe the aetiology, defect location, graft material, presence of encephalocele, history of meningitis, intracranial pressure, recurrence, and follow-up. In our studies the aetiology of CSF leak was spontaneous in 4 cases, traumatic in 9, and iatrogenic in 23. The defect was most commonly located near the ethmoid and sphenoid bones. Our initial success rate after transnasal endoscopic treatment was 88.9% (32/36). However, the overall success rate of 97.2% (35/36) and the low morbidity in this series support the endoscopic approach as the standard of care for CSF leak closure. Follow-up ranged from 3 months to 5 years. Importantly, this high success rate can be achieved without the use of intrathecal fluorescein or a lumbar drain.

The application of computer modelling for medical purposes, although challenging, is a promising pathway for further development in the medical sciences. We present predictive neural and k-nearest neighbour (k-NN) models for hearing improvements after middle ear surgery for chronic otitis media. The studied data set comprised 150 patients characterised by the set of input variables: age, gender, preoperative audiometric results, ear pathology and details of the surgical procedure. The predicted (output) variable was the postoperative hearing threshold. The best neural models developed in this study achieved 84% correct predictions for the test data set while the k-NN model produced only 75.8% correct predictions., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

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.)

Background: Bony wall damages in the region of the middle and posterior cranial fossa are usually observed in cases of chronic otitis media. These defects can also be congenital, post-traumatic, iatrogenic or due to tumors. They can potentially lead to the development of intracranial complications., Material/methods: We analyzed patients who were diagnosed as having bony wall damage in the region of the middle and/or posterior cranial fossa. We also discuss methods of reconstruction during otosurgery. The analysis involves patients who underwent middle ear operations in the Department of Otolaryngology at the Jagiellonian University of Krakow between 2004 and 2008; 495 otosurgeries were performed during this period of time., Results: In 70% of patients the reason for otosurgery was chronic otitis media. In 20%, bone defects occurred simultaneously with otosclerosis. Less than 10% underwent otosurgery for other reasons. Bony wall damage in the region of the middle and posterior cranial fossa were diagnosed in 46 patients who underwent surgery. In patients with bony wall damage, otogenic intracranial complications were described in 14 cases., Conclusions: The performed reconstruction methods for bony wall damage, which used the fascia, strengthened with the pedicle muscle flap for larger defects and with either bone lamella or cartilage in specific cases, proved successful. Nearly 80% of bony wall damages in the region of the middle and posterior cranial fossa remain asymptomatic and are discovered incidentally during middle ear surgery. The above observations emphasize the significant role of pre-operative imaging diagnostics.

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.)

Respiratory epithelial adenomatoid hamartoma is a rare, non-neoplastic tumour characterised by an abnormal mixture of tissues that are indigenous to the region. REAH are shiny, polypoid, exophytic masses with a rubbery to firm texture. They may arise and co-exist in the setting of inflammatory polyps. We present a case of a 49-year-old patient who was referred to the department with a clinical diagnosis of chronic nasal sinusitis. Results of post-op histopathological examination show a mild change of the respiratory epithelium requiring, among others, differentiation from inverted papilloma and adenoid carcinoma.

Aim: The aim of this study was to present a rare benign tumour of neural origin located in the orbit., Material and Methods: Authors describe case of six-year-old boy with tumour of the right orbit, upper eyelid and right zygomatic fossa. Medical history revealed gradually increasing in size, painless tumour. Before admission to the hospital computed tomography was taken to assess the size, localization of the tumour and to plan the proper treatment., Results: The patient was operated on using Krönlein approach. Tumour was removed in macroscopically radical limits without need to incise the muscles responsible for eye movement. Histopathological examination revealed: Neurothekeoma, classic type. During one year follow-up there was no recurrence., Conclusion: Neurothekeoma may occur in young boys in eyelid and orbit. A unique localization of neurothekeoma in the orbit, close to the lacrimal gland shows that this kind of histopatological tumours may infiltrate deeper tissues. Surgical treatment of neurothekeoma is the same as in other benign tumours.

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.

Aim: The oncology efficiency and quality of life are both important for patients with head and neck cancer in every-day life., Material and Methods: Evaluation of the dysphagia discomfort was made of 240 patients (190 male and 50 female). The primary location of the tumor was: paranasal sinuses, oral cavity, oropharynx, hypopharynx and larynx. The treatment was surgical or sugical and radiotherapy. Patient's quality of life was evaluated according to the self-administered questionnaire (M.D. Anderson Dysphagia Inventory MDADI)., Results: The comparison of the influence of dysphagia on the quality of life was made in two groups of patients. The first group consist of maxillectomy patients wearing obturator protheses, the second one were treated for cancer located in other mentioned area. Patients with primary tumors of the oral cavity, oropharynx, hypopharynx and larynx had significantly greater swallowing disability with an adverse impact on their quality of life compared with patients after maxillectomy. Method of treatment and stage of head and neck cancer greatly affected dysphagia-related quality of life. The longer the interval between completion of treatment and assessment by the MDADI, the higher the total score, thus reflecting a higher quality of life and funcional status as related to swallowing., Conclusion: The MDADI is the validated and reliable self-administered questionnaire designed specifically for evaluating the impact of dysphagia on the quality of life of patients with head and neck cancer.

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: Solitary bone cyst is rarely situated in facial bones., Aim: We discuss clinical view, results of radiological examinations and differential histopathological diagnostics of cases., Results: We present 3 cases of patients: 51 year old man with cyst in frontal sinus; 29 year old man and 46 year old woman--both with changes in bones of the orbit. In all the cases results of histopathological examinations were similar. Cystic-shape pieces of vascularizated connective tissue were observed. Multiple cracks filled with cholesterol, macrophages with hemosiderin and occasionally multinuclear cells were noticed., Conclusions: Solitary bone cyst may be located in the periorbital bone, especially frontal. Excellent laryngological, optic and cosmetic results are results of the surgery. Suspicious of the solitary bone cyst is possible due to MR or CT imaging, but final diagnosis must be confirm by histological examination.

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.

An aneurysmal bone cyst (ABC) is a rare, benign fibro-osseous lesion, considered a vascular phenomenon secondary to fibrous dysplasia or a giant-cell tumour, and occurs mainly in long bones and vertebrae. In this case report a 16-year-old male presented with massive epistaxis. He was admitted with a 3-year history of chronic rhinitis, headaches, right ocular pain and recurrent epistaxis. CT scans showed a predominantly cystic, expansive mass obstructing both nasal cavities, extending to all paranasal sinuses and both orbits, with evidence of anterior cranial fossa skull base destruction. The patient underwent a craniofacial resection of the tumour performed with an external approach and an immediate reconstruction of the dural defect. Histology confirmed the lesion was an ABC associated with fibrous dysplasia. The patient's recovery was complete. A large facial aneurysmal bone cyst can damage the facial skeleton and skull base, and requires excision by a combined external approach.

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.

Swallowing is a complex motor event that is difficult to investigate in man. A slowed ability to eat a meal, loss of salivary control with drooling, episodic coughing, and choking and nasal regurgitation occurred due to the dysphagia. Swallowing disorders can be divided into oropharyngeal dysphagia and oesophageal dysphagia. The most common cause of oropharyngeal dysphagia is cerebrovascular accidents; other causes may include oropharyngeal structural lesions, systematic and local muscular diseases, and diverse neurologic disorders. Oesophageal dysphagia may result from neuromuscular disorders, mobility abnormalities, and intrinsic or extrinsic obstructive lesions. Initial evaluation of patients with suspected oropharyngeal dysphagia includes patient history, laryngological and neurological examination, and careful videofluoroscopic study of pharyngeal dynamics. Initial evaluation of patients with suspected oesophageal dysphagia includes patient history and barium swallow with oesophagography. Classifying dysphagia as oropharyngeal, oesophageal and obstructive, or neuromuscular symptom complexes leads to a successful diagnosis in 80% of patients.

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.