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Körner's septum (KS) or petrosquamosal lamina is a bony lamina beginning at the articular fossa, extending above the middle ear, and running inferiorly and laterally to the facial nerve canal as it proceeds to the mastoid apex. This septum marks the junction of petrous and squamous bones. The paper presents details of the anatomical structure of KS, which is most often present at the level of the head of the malleus and/or the anterior semicircular canal. Attention is paid to embryological aspects of temporal bone development that lead to the formation of KS. Two imaging techniques most frequently used to diagnose KS are described, high resolution computed tomography (HRCT) and cone-beam computed tomography. Also presented is a case report of a 6-year-old patient suffering from chronic otitis media who developed a cholesteatoma due to presence of KS, illustrated with HRCT images and intraoperative capture. The authors describe diagnostic difficulties associated with this anatomical variant in the middle ear. The article also discusses the more frequent occurrence of this clinical problem in ears operated on due to chronic inflammation, retraction pocket or tympanosclerosis in comparison to healthy ears.

Persistent measles virus infections play a crucial role in the pathomechanism of otosclerosis. The study was undertaken to investigate the role of tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β) and osteoprotegerin (OPG) in otosclerotic bone remodeling and to assess the relation of TNF-α, OPG and IL-1β expression levels in otosclerotic stape footplates to the occurrence of measles virus infection. 61 patients with otosclerosis were treated surgically. Thirty-one stapes obtained from cadavers of people, who had died from a sudden cause were used as a control group. The presence of measles virus RNA and the expression levels of TNF-α, IL-1β and OPG in otosclerotic foci were assessed using one-step RT-PCR. The presence of measles virus RNA was noted in 80.3 % of otosclerotic stapes (49 out of 61) and 9.7 % of normal tissues (3 out of 31). Transcript of TNF-α, IL-1β and OPG was detected in 40, 46 and 18 virus-positive stapes, respectively. The transcript level of TNF-α and IL-1β was significantly higher in otosclerotic tissues comparing to normal tissue. The OPG expression level was significantly lower in otosclerotic tissues comparing to controls. The presence of measles virus RNA in the stapes may indicate its role in the pathogenesis of otosclerosis. The presence of TNF-α and IL-1β mRNA in the virus-positive stapes could be the result of viral antigen stimulation and may be a marker of inflammation the otosclerotic focus. The lack of OPG mRNA and the presence of TNF-α and IL-1β mRNA in the majority of otosclerotic tissues reflect the bone remodeling process occurring in the stapes.

Unlabelled: Acquired post inflammatory external auditory canal atresia is a rear complication of external ear disease. It is presented as a connective tissue scar in bony part of external auditory canal. The aim of this study is clinical and epidemiological analysis and presentation of diagnostics and treatment results of patients with atresia treated in the Otolaryngology Department of Medical University of Gdansk., Material and Methods: In the period of 3 years (2008-11) 10 patients (8 women and 2 men) aged 30 to 70-years-old (medium 53 years) were treated for acquired atresia. All of these patients had medial closure of EAC with thick connective tissue scar and tympanic membrane involvement. Intrameatal access was performed in 5 patients, intraural access in 3 patients and retroaurical access in 2 patients. In all cases canaloplasty with meato-tympanic angle enlargement was performed, skin defect was replaced with free epidermal flap, silicon foil with fibrinous sponge was used for coverage., Results: In all of our patients external auditory canal widening and hearing improvement was achieved. Due to increasing EAC narrowing four patients underwent second surgery with another free epidermal flap grafting., Conclusion: The selection of surgical access in patients with acquired atresia should comply with the etiology of the disease and the shape of EAC. During surgery we aim at maximal broadening of the bony part of EAC. The success of the treatment depends on meato-tympanic angle enlargement and free epidermal flap grafting., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Unlabelled: Surgery is the most effective method of improving hearing in patients with otosclerosis. The level of improvement depends on the stage of the disease and the chosen surgical method., The Aim of This Study: is to present hearing results in patients treated surgically by means of different types of prostheses and methods of vestibule sealing., Material and Methods: 230 cases (160 men, 70 women) between the age of 21 and 64 (median 36 years) treated for the first time in the Department of Otolaryngology of Medical University in Gdańsk underwent epidemiologic and clinical analysis. The researches took into account the level of hearing improvement based on the reduced air-bone reserve for frequencies 0.5, 1.0, 2.0 i 4.0 kHz in groups with where prostheses type 1 and 2 were used., Results: 230 stapedotomies were performed. In 110 patients prosthesis type 1 was used (PTFE) and in 120 type 2 (piston PTFE with platinum tape). Each vestibule was sealed with homogenic fat tissue or fibrin sponge. After 6 weeks from the operation the air-bone reserve was reduced by 5 to 30 dB, the reserve existed after one year from the operation in some patients. 35% of the patients presented with vertigo after the operation and 5% with tinnitus., Conclusions: Stapedotomy is a method of hearing improvement in patients with otosclerosis. Best results are achieved when prosthesis type 2 is used and homogenic fat tissue serves to seal the vestibule. Broad opening of the vestibule may be the cause for vertigo and lack of hearing improvement occurrence., (Copyright © 2012 Polish Otolaryngology Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Unlabelled: Bone destruction in chronic otitis media with cholesteatoma is a common phenomenon. Expanding growth of cholesteatoma in the middle ear causes ischemia of the mucosa and bones with granulation tissue production., The Aim of This Study: was to assess the expression and distribution of the key regulators of bone destruction: osteoprotegerin (OPG), Receptor Activator for Nuclear Factor kappa B Ligand (RANKL) and tumour necrosis factor alpha (TNF-alpha) in chronic otitis media with cholesteatoma and their role in the pathomechanism of bone resorption., Material and Methods: We performed immunohistochemical study of the cholesteatoma tissue collected from 21 patients suffering from chronic otitis media with cholesteatoma and 16 samples of normal external auditory meatal skin. This material was analysed histopathologically and by means of immunoperoxidase immunohistochemical technique with the use of antibodies against OPG, RANKL and TNF-alpha and their quantitive evaluation., Results: In all patients with cholesteatoma, features of auditory ossicles and temporal bone destruction were demonstrated. We found that cholesteatoma and granulation tissue cells release factors of the OPG/ RANKL/RANK system and TNF-alpha. In cholestatoma a higher expression of RANKL, OPG and TNF-alpha positive was demonstrated when comparing to the skin of external auditory meatus. These factors were relatively higher expressed in the stroma rather than in the epithelium of cholesteatoma. RANKL-positive cells were demonstrated mainly in the stroma cells, whereas OPG-positive ones in the cholesteatoma epithelium. The reaction with the antibodies against OPG, RANKL and TNF-alpha was weak in the external auditory meatal skin., Conclusions: Bone destruction in chronic otitis media with cholesteatoma is a common process dependent on osteoclast activating factors. OPG/ RANKL/RANK system and TNF-alpha play a key role in the process of osteolysis in otitis media with cholesteatoma. We found no positive correlation between bone destruction advancement and the level of examinated proteins.

Authors present a rare case of the papillary thyroid carcinoma in thyroglossal duct cyst in a 40 year-old woman. Preoperative assessment (palpation and ultrasonography) showed symptoms of typical thyroglossal duct cyst and the final diagnosis was established after histopathological examination of the surgical specimen. Epidemiology, diagnostic methods and treatment of this rare disease were also discussed in the study.

Seventy six patients (55 males and 21 females) aged from 39 to 89 (mean 63.7 +/- 9.7) years with multiple primary cancers were described. Larynx cancer was the most commonly seen multiple primary cancer component (35.5%) followed by lung cancer (12.5%). Combination of larynx cancer and lung cancer was the most often observed connection (21.1%). In seventeen patients two cancers were diagnosed concurrently. In other cases the interval between two cancers varied from 1 to 24 (mean 6.9 +/- 6.1) years. Smoking rate was 80.3% at diagnosis of the second cancer and only 10 patients (13.1%) quit smoking when first cancer was recognized. The results of the research indicate the necessity of conducting wide prophylactic actions.

Schwannoma of the head and neck may develop from many nerves, i.e. cranial or spinal. The authors described malignant schwannoma of infraorbital nerve. Patient was treated by combined method: in first step chemotherapy, in second surgical excision with 2 year disease-free survival.

A case of chemodectoma in 58 year old woman is presented. The tumour was located in the parapharyngeal space. During preoperative arteriography and embolization a hemiparesis was noticed, probably caused by the thrombus in the cerebral medial artery. Early radiological examination of brain arteries allowed to perform specific treatment in only two hours time from the onset of the paresis. The treatment was successful--neurological symptoms have receded after 24 hours. Few days later patient was operated on--the tumour was removed with part of the vagus nerve. No serious postoperative complications were observed.