Selected structures of middle ear relevant to cochlear implantation on the basis of computer tomography.

BACKGROUND: The primary objective of this study was to analyze middle ear structures critical for cochlear implantation using computed tomography. MATERIALS AND METHODS: Patients who underwent cochlear implantation at the Department of Otolaryngology in Szczecin between 2015 and 2022 were eligible for the study. We analyzed computed tomography images of 57 ears in 52 patients. The following parameters were assessed: mastoid aeration, tegmen tympani height, sigmoid sinus position, posterior tympanotomy width, the distance between the facial nerve and chorda tympani, modified facial recess distance, and the prediction line described by other authors. RESULTS: In 69% of patients, after the removal of the round window bony overhang, the round window membrane became fully visible. There were no statistically significant correlations found for parameters describing mastoid process anatomy or those rating the width of the posterior tympanotomy concerning round window access. The prediction lines, according to Kashio and Jwair, were found to be relevant. In cases where patients' access to the niche and membrane of the window was rated as good or very good during clinical evaluation, they were more likely to describe the window as being located posteriorly or medially in the radiological evaluation. Using a binary Jwair scale provided a better correlation with the clinical assessment. In cases where the windows were graded as posterior, the clinical assessment indicated better surgical access, especially to the RWM (Round Window Membrane). CONCLUSIONS: Evaluating middle ear anatomy on a computed tomography scan is useful for preparing for middle ear surgery but does not significantly affect the ability to access the round window. For such access, the position of the window in relation to the facial nerve is the most relevant factor, and measurements based on this relationship hold the highest clinical value.

Sleep-Disordered Breathing in Pregnancy.

Sleep-disordered breathing (SDB) is a spectrum of abnormal respiratory events including habitual snoring and increased upper airway resistance and obstructive episodes. The uncertainties concerning the incidence and recognition of SDB during pregnancy and the importance of the issue for fetal and maternal health prompted us to screen pregnant women for SDB. The study included 312 women in the third trimester of pregnancy aged 17-46 of whom 51 were preselected, based on the results of SDB questionnaires, for a nighttime home screening using a portable ApneaLink Air device. We found that single or multiple episodes of apnea were present in 35 (69%) women. The mean apnea/hypopnea index (AHI) was 1.8 ± 1.8 episodes/h of sleep, which did not exceed the prevalence in the general young-adult female population. However, we noticed a substantial number of inspiratory airflow limitation (IFL) episodes most often accompanied by snoring and more frequent in pregnant women with a greater weight gain. IFLs, although not fulfilling the quantifiable criteria of hypopnea, raise the possibility of hardly recognizable oxygenation and cardiovascular disturbances in pregnancy, reflected in an increased risk index for SDB. We conclude that pregnancy encompasses the risk of revealing or intensifying pre-existing SDB which can jeopardize maternal and fetal health. The risk particularly applies to overweight women. We submit that women in late pregnancy should be carefully screened for possible SDB.

Diagnosis of Sleep-Disordered Breathing in the Home Environment.

Polysomnography, a gold standard for the diagnosis of sleep-disordered breathing, is a complex investigation requiring access to the sleep laboratory. Thus, sleep-disordered breathing could be underdiagnosed. The aim of this paper was to investigate the feasibility and effectiveness of self-performed investigation of obstructive sleep apnea (OSA) in the home setting, using a portable device, and to assess the comfort and simplicity of the procedure from the patient's perspective. The study included 68 middle-aged patients (21 women and 47 men), who were examined at home with the ApneaLink Air device in search for the underlying reason of reported nighttime snoring and occasionally disordered breathing pattern. The apnea-hypopnea index was quantified and matched with body mass index (BMI), age, and other characteristics. OSA was diagnosed in 37 patients (27 men and 10 women): 22 had mild, 4 had moderate, and 11 patients had severe OSA. All cases of severe OSA were present in men. Patients with severe OSA had significantly higher BMI than those from the other groups. All of the patients pointed to the comfort and ease of the diagnostic device. We conclude that home diagnosis of OSA is a relatively easy and cost-effective way to substitute for the hospital-linked polysomnography, particularly in severely ill patients who have a movement difficulty. A wider implementation of home-based diagnosis of OSA may substantially increase the number of patients investigated in a short time span, also leading to the plausibly upward correction of the disease prevalence.

Evaluation of Nocturnal Respiratory Complaints in Pregnant Women.

Snoring during pregnancy increases the risk of low Apgar score and low birth weight of newborns. Snoring women are twice as likely to be diagnosed as having preeclampsia when compared to non-snoring ones. Snoring may also be linked to, albeit it is not a prerequisite for, apneic events at sleep. The aim of this survey-type study was to evaluate the occurrence and severity of nocturnal respiratory complaints in a group of 312 pregnant women. Problems associated with snoring and other nasopharyngeal symptoms were reported by 60% of women. Complaints were more frequent in patients with a higher body mass index. The symptoms were significantly more frequent in the group of snorers. The results of this study suggest a pattern of basic features in pregnancy, such as snoring, overweight, and upper airway symptoms, which all ought to direct attention of care givers to the diagnostics of sleep-related breathing disorders. The early diagnosis would enable to undertake the measures to prevent preterm labor and to avoid postpartum complications in both mother and newborn.

Adenoid Cystic Carcinoma of the Cavernous Sinus - Otolaryngological Sequelae of Therapy: Case Report.

A 60-year-old woman, otherwise in a good health condition, was first admitted to the hospital with a year-long tingling sensations of the right half of the face, which gradually turned into severe neuralgia corresponding to maxillary (V2) and mandibular (V3) branches of the right trigeminal nerve. MRI scans of the head revealed an unusual hyperplastic or inflammatory changes along the brain base, cavernous sinus extending toward the pterygopalatine fossa, and lateral pterygoid on the right side. Meningioma was suspected and neuralgia was treated conservatively. About 2 years later, due to severe facial and eye pain, the patient underwent decompression of trigeminal nerve roots - Janetta's surgery. The following MRI scans revealed a tumor of cavernous sinus, arousing suspicion of malignancy. Histological specimens obtained after a biopsy and then partial transnasal tumor resection yielded a diagnosis of adenoid cystic carcinoma. The patient was treated with proton radiation therapy. The therapy caused burns in the oropharyngeal soft tissues extending from the oral cavity to the throat and esophagus. The additional adverse effect of the therapy was hypoacusis and a damage to the right cornea. A radiation-induced sinusitis appeared that required surgical intervention. The patient suffered a string of further complications, including pneumonia and a transient kidney failure. In the end, the patient survived. The adenoid carcinoma in the currently 64-year-old woman is visibly reduced, but she still suffers from the trigeminal neuralgia. The patient remains under constant laryngological outpatient care as she requires a periodic cleansing of nasal cavities and hypoacusis monitoring.

Influence of physiological stress on the presence of hypoplasia and fluctuating asymmetry in a medieval population from the village of Sypniewo.

This study aims to estimate the levels of physiological stress in the medieval rural population of Sypniewo by evaluating patterns of fluctuating asymmetry (FA) and enamel hypoplasia (EH), and provide information on the influence of physiological stress during the prenatal and perinatal period on early childhood development. Stress is defined as any external or internal condition that challenges homeostasis of an organism. FA is associated with physiological stress occurring mainly during prenatal development and early childhood. The level of FA is thought to reflect the intensity of the stressor(s). EH is caused by physiological stress such as nutritional instability during the first years of life. The studied material consisted of 126 skulls from the village of Sypniewo (Poland). Cranial radiographs were taken in postero-anterior (P-A) and basal views. The images were scanned and calibrated. Measurements of the cranium were used to estimate FA. The presence of EH was assessed using standard anthropological methods The highest levels of FA were observed in the region of the cranial base. EH was observed in 29% of individuals from the rural skeletal series. There was no statistically significant correlation between FA and EH occurrence or between sex and the studied stress indicators.

[Evaluation of the dietary habits of polish medical students in their first year of studies]. / Ocena nawyków zywieniowych studentów polskich pierwszego roku medycyny.

INTRODUCTION: One of the most important factors involved in normal growth, maturation, physical activity and mental state is nutrition. Correct patterns formed in youth are necessary to maintain a healthy lifestyle. The aim of the study was the evaluation of the dietary habits of medical students. MATERIAL AND METHODS: The material consisted of data collected from an anonymous survey distributed among first year students of the Faculty of Medicine and Dentistry (66 men and 177 women). The study used a questionnaire of our own design, consisting of open and multi-choice questions concerning the anthropometric data of subjects and nutritional habits. The questionnaire was developed based on the HBSC international standard questionnaire survey on health behaviour in adolescents. Data were analyzed statistically. RESULTS: The prevalence of obesity was generally not observed in the group of examined students. In most cases body mass index was in the range 18.5-24.99%. Obesity was observed only in men. There were no significant differences between the groups of men and women in terms of the frequency of regular meals during the week. Only about 50% of the study population declared regular consumption of the three main meals. Significantly more women than men used slimming diets, and significantly more men took action to control weight. Analysis of the results showed abnormal patterns in the structure of meals. CONCLUSIONS: It is extremely important to educate future doctors in healthy lifestyle, including correct nutrition, through educational programmes during studies.

Rhinitis as a cause of respiratory disorders during pregnancy.

Rhinitis is a common disease of women during pregnancy. It can start in almost any gestational week and disappears after delivery. The main symptoms are sneezing, nasal congestion or running nose. The diagnosis is usually based on history, physical examination, blood tests, and exclusion of the other more common types of rhinitis. The etiology remains to be clarified. The rhinitis may be caused by numerous substances and hormones secreted during pregnancy (PGH, VIP, estrogen, progesterone). They lead to changes in the nasal mucosa in the form of increased activity of serous-mucous glands and increase of their vasculature. The best treatment is using saline irrigations, exercise, and mechanical alar dilators. The nasal decongestants provide only temporary relief. The aim of this study was to evaluate the prevalence of pregnancy rhinitis. The study was conducted on 117 pregnant women in the province of the West Pomerania in 2009-2010. The information was obtained from interviews, questionnaires, and data contained in pregnancy records. About 39% of pregnant women suffered from pregnancy rhinitis. Most such ailments were found during 13th and 21st week of gestation. Doctors should pay more attention to symptoms which result from pregnancy rhinitis, which are reported by their patients. The quality of prenatal care understood as an education of pregnant women as far as pregnancy rhinitis is concerned, is much insufficient. Pregnancy rhinitis significantly affects quality of life of pregnant women and, as a result, it may affect fetal development.

Mental health of Polish students and the occurrence of respiratory tract infections.

The aim of the paper was to examine the association between the psychological status and the occurrence of respiratory tract infections which constitute the most common group of disorders in the student population. The study comprised 500 Polish students aged 19-21. Two psychological scales were utilized: the Goldberg GHQ-12 scale to examine the general psychological status and the CES-D scale to evaluate the symptoms of depression. In addition a pro-health questionnaire in the examined group of students was performed. We found an increased stress level in 51% of students and the symptoms of depression in 22%. An association between distress and the occurrence of respiratory tract infections was found, based on statistical analyses. The highest stress level and related high distress index were observed in the students suffering from lower respiratory tract infections (7.1 scale value). This group self-evaluated their health status as poor, based on the pro-health questionnaire. In the same group of students, lack of sleep (5.4), lack of regular eating habits (4.2) and lack of physical activity (3.9) were also observed. The study shows that the Polish student population is exposed to increased stress level, which, in turn, increases the occurrence of respiratory tract infections.

[Tuberculosis--a neverending story]. / Gruzlica--niekonczaca sie opowiesc.

It is estimated that over one third of the human population is now exposed or has been exposed in the past to Mycobacterium tuberculosis, and new infections occur in the world at a rate of one per second. The history of tuberculosis is long and very interesting, because before the isolation of mycobacteria and the finding of a cure, the disease mercilessly killed thousands of people and deprived doctors of hope. Robert Koch's momentous discovery was a major breakthrough in the fight against tuberculosis. Unfortunately, the disease has never been fully controlled. Tuberculosis is a chronic infectious disease localized in 90-95% of cases in the lungs, and therefore it is extremely difficult to diagnose unequivocally in paleopathological material. Only the form of osteo-arthritis leaves traces in archaeological material. The earliest evidence of tuberculosis (the location of the spine, Pott's disease) in the form of fossils is dated to before 8000 BC. Another very old trace is considered to be human remains from the Neolithic period (ca 5000 BC), found near Heidelberg, where changes in the thoracic spine are typical for spondylitis in tuberculosa. Constant growth in the incidence of new cases in the world can be observed today. Not everyone infected will develop the full-blown disease. The infection may remain dormant. However, one in ten latent infections will subsequently be activated, leading, if not treated, to the death of almost half of the patients.

[Syphilis in the past and present]. / Kila dawniej i dzis.

Syphilis is a specific inflammation which is extremely difficult to clearly diagnose in archaeological material. The origin of this disease is unclear. Most proponents hold the view that it comes from America, and that it was transmitted to Europe by sailors travelling with Columbus. In addition to the thesis of the American origin of syphilis is a suggestion that a mild form of syphilis existed in Europe before Columbus' expeditions. This form, until the end of the fifteenth century, began to spread epidemics. In Poland, the first officially reported case of the disease was described in 1495. Today, an increase in the incidence of new cases in Poland and globally can be observed. An increasing number of cases of congenital syphilis in newborns is also noted. This situation in Poland is connected with a change in the law in 2001, according to which only insured persons became entitled to free treatment. In view of the rising tide of the disease, and the appearance of advanced forms of the disease, in 2009 the free diagnosis, treatment, and follow up for all patients with syphilis was restored.

A morphometric study of prenatal development of the human larynx.

INTRODUCTION: Precise knowledge of the anatomy and development of the airways in the fetus is needed for advances in neonatal medicine. The aim of this study was to assess the morphometry of the larynx during fetal development. MATERIAL AND METHODS: The study was performed on 47 human fetal larynges (27 male and 20 female) collected between the age of 13-27 weeks of intrauterine life according to Pineau and preserved in 10% buffered formalin. Five measurements of each larynx were performed: total height of the larynx, height of the anterior wall, height of the posterior wall of the larynx, sagittal diameter of the aperture of the larynx, and external sagittal diameter of the cricoid cartilage. Correlations between the results and crown-rump (C-R) length of human fetuses in relation to gender were analyzed. The percentage ratio of laryngeal length to C-R length in subsequent weeks of the fetal period and in relation to gender was determined. RESULTS: Dimensions of the larynx were found to correlate with crown-rump length. Mean lengths of the larynx were greater in male than in female fetuses at some stages of development. CONCLUSION: Ultrasound dimensions of the larynx are greater than dimensions found during postmortem examinations.

[Development of the osseous structures of internal ear in human foetuses]. / Rozwój elementów kostnych ucha wewnetrznego u plodów ludzkich.

PURPOSE: Assessment of development of selected osseous structures of internal ear (cochlea, vestibule, modiolus) in human foetuses aged between 9-32 weeks was the aim of this study. Human osseous labyrinth is a very interesting albeit difficult research subject. Current study represents a trial to summarize the knowledge about its development in prenatal period available so far. At the same time it underlines the importance of research on the development of ear's structures for prevention of hearing disorders as well as for their early development and treatment. METHODS: Descriptive methods: macroscopic, radiological, anthropometric and histological were used in this study. RESULTS: The presence of arcuate eminence as well as subarcuate fossa was established which proves the development of osseous labyrinth inside the petrous part of temporal bone. Points of ossification of the otic capsule were described. Highest dynamics of development and abundance of morphological forms was found in the II group of foetuses including those between 18-24 week of intrauterine life.

Prenatal development of the human trachea.

The tracheas of 46 human foetuses were examined: 26 male, 20 female with C-R length of 99-255 mm. The analysis of the total length of the trachea was carried out and its transverse dimension was presented on three levels: on the first tracheal cartilage, in the mid-length of the trachea, and at the bifurcation into the main bronchi; also the proportions between these dimensions and the C-R length were analysed. The length of the trachea was measured in a straight line--from the end of larynx to the bifurcation of the trachea. Comparing tracheas to a tunnel with two openings, it was observed that the transverse dimension, the "laryngeal", is greater than the "bronchial"--in the case of smaller foetuses by 2 mm, but in foetuses with C-R length of over 250 mm by 1 mm. Moreover, no significant differences between male and female sex were noticed. All the measurements were taken with the use of a slide caliper. The results should be useful in the detection of abnormalities in the structure of the trachea, in problems with respiratory physiology and in endotracheal intubation, endoscopy or tracheostomy.