[Severe injury within the splanchnocranium and neck with penetration of foreign bodies in wood processing]. / Ciezki uraz okolicy twarzoczaszki i szyi polaczony z wniknieciem cial obcych podczas obróbki drewna.

INTRODUCTION: The aim of this work was to describe the patient with severe injury within the splanchnocranium and neck connected with the penetration of large foreign bodies in his wood processing activity, and their impaction in soft tissues and life-threatening localisation. MATERIAL AND METHODS: The authors describe the case of a 37-year-old male patient whose splanchnocranium and neck were injured while he was processing the wood with a mechanical saw. Two enormous wooden strips staved in his face while one was boring towards the nose and paranasal sinuses and the other was penetrating through the soft tissues of the cheek and neck from side of the oral cavity, with a visible prominent ending at the nape. RESULTS: On diagnostic tests, the patient underwent tracheotomy media under neuroleptoanalgesia and infiltration anaesthesia, then, under intratracheal anaesthesia, he was intubated through tracheostomy. The two foreign bodies (enormous wooden strips) were removed by a multispecialty team of surgeons. Further, repositioning and osteosynthesis of the fractured ramus of the mandible on the left side were performed. The minititanium plate, 5 holes, 8 holes and 3 holes, was used. The wound within the nasal passages, maxillary sinuses and anterior surface of the maxilla was cleaned from fragments and chips of wood. The reconstruction of the tissues and repositioning of the bony fragments were conducted. The Redon drainage tube was implemented in the postoperative cavity, anterior and posterior nasal tamponade (Bellocq type) was required, the wounds in the left cheek and neck were debrided. The patient was discharged in general good condition 7 days on surgery. CONCLUSIONS: The patients with severe injuries within the splanchnocranium and the neck, connected with the penetration of foreign bodies huge in size, should be treated in specialist centres by a multispecialty team of surgeons according to therapeutic standards.

[Comparative assessment of cryosurgical treatment results in allergic and non-allergic rhinitis]. / Porównawcza ocena wyników leczenia alergicznych i niealergicznych niezytów nosa za pomoca kriochirurgii.

INTRODUCTION: The aim of the work was to assess the treatment efficiency in patients with allergic and non-allergic vasomotor rhinitis after cryoablation procedures. MATERIAL AND METHODS: The study covered 60 patients, including 32 women and 28 men, aged 18-66. The patients were divided into two groups: I - 30 patients with chronic allergic rhinitis, II - 30 patients with non-allergic vasomotor rhinitis. The study methodology involved: an otorhinolaryngological interview with a questionnaire and an allergological interview, an objective otolaryngological and rhinomanometrical examination with Homoth apparatus, a subjective evaluation questionnaire for nasal blockage intensification (the scale ranging from 0 to 10), skin tests to aeorallergens and food allergens (Allergopharma Co.), nasal endoscopy with a straight rigid Eleps endoscope before the treatment and 3 months following it. The cryoablation of nasal conchas was performed under local infiltration anesthesia (1% Xylokaina solution) using the Cryo-S apparatus from CryoFlex Poland Company and a flat probe in a spatula shape (L-50) that was placed on the outer surfaces of the inferior nasal concha. RESULTS: The inferior nasal concha cryoablation resulted in a statistically significant improvement in the subjective assessment scale in group I by 82.6% and group II by 141.2%. In the endoscopic examination 3 months following the cryoablation a good nasal patency was achieved in 63.3% patients from group I and 76.7% patients from group II. The conducted studies show a better nasal passages patency in patients with non-allergic rhinitis than in those with allergic rhinitis. CONCLUSIONS: Cryoablation procedures on the inferior nasal conchas are not the primary therapy, but together with other methods they can immensely improve the life comfort of a rhinitis patient.

[Clinical analysis in patients with cervical vertigo in ENT]. / Analiza kliniczna chorych z zawrotami glowy pochodzenia szyjnego w materiale wlasnym.

The aim of this work was a clinical analysis of patients suffering from vertigoes of neck origin, conducted within the own study. The study covered a group of 120 patients, including 76 females and 44 males, aged 20-85, who were diagnosed and treated due to vertigoes of neck origin in the Clinic of Otolaryngology and Laryngological Oncology the Medical University of Lódz between 2005-2006. Criteria for all the patients treated for vertigoes of neck origin include: an interview, subject otolaryngological treatment, complete audiological tests, laboratory tests, computerized tomography of the head or classical and functional x-ray of the cervical spine, blood flow in vertebral arteries and the basilar artery due to the Doppler method (using Transport-TCD apparatus, 2 Mhz head through the great foramen and using the torsion of the neck test). The electronystagmographic examination (ENG) covered registration of: position nystagmus detected in five classical positions according to Nylen, neck nystagmus in the torsion of the neck test. All the patients suffering form vertigoes of neck origin were treated with physical therapy and kinesitherapeutic exercises. The major part of the studied material of the patients with vertigoes of neck origin constituted: office workers (56.76%), aged 41-60 (59.16%), smoking (50.83%), suffering from hypercholesterolemia (35.29%), with abnormal x-ray of the cervical spine (93.37%) and injuries in this segment (13.33%), using non-steroid anti-inflammatory (69.17%) and vascular (52.59%) drugs, thus not young people with some additional pathological history. On the grounds of the obtained results it is claimed that the registration of the neck nystagmus in the torsion of the neck test as well as the position nystagmus examination according to Rose were most useful in this study, which facilitated reliable diagnostics of the vertigoes of the neck origin and monitoring of their intensity after applied treatment.

[Early hearing evaluation in patients treated by surgery due to chronic otitis]. / Wczesna ocena sluchu u chorych leczonych operacyjnie z powodu przewleklego zapalenia ucha srodkowego.

INTRODUCTION: The aim of the study was the comparison of hearing before and after ear surgery in patients with chronic otitis media according to Fowler and Sabine criteria. MATERIAL: The study comprised 42 patients (42 ears), aged 19-72 (26 females and 16 males). The patients were divided into three groups, considering the type of surgery; Group I--20 ears after myringoplasty, group II--14 ears after mastoidectomy with canal up and myringoplasty and group III--8 ears after the mastoidectomy with canal down. METHODS: Audiologic examination was performed together with the evaluation of hearing loss according to the criteria of Fowler and Sabine (CPT), before and 3 months after the ear surgery. The difference of 20% (CPT) was considered improvement or deterioration of the hearing. RESULTS: On the basis of the intraoperative examination, chronic otitis media with perforation was found in 18 patients, granulating otitis media in 16 patients and the chronic otitis with cholesteatoma in 8 patients. The myringoplasty was performed in 20 patients, the mastoidectomy with canal up and myringoplasty in 14 patients and the mastoidectomy with canal down in 8 patients. In 14 ears of group I (70%) hearing improvement was noticed, and in 6 (30%) remained unchanged. The mean hearing loss according to CPT in this group was 40.39% before ear surgery and 24.26% after. In group II in 6 ears (43%) hearing improvement was observed, whereas in 8 (57%) remained unchanged. The mean hearing loss according to CPT in this group was 71.40% before and 61.85% after surgical treatment. In group III, hearing improvement was noticed in 37% of ears and in 5 (63%) did not change after the ear operation. The mean hearing loss (CPT) in this group was 81.57% before treatment and 71.37% after. CONCLUSIONS: Considering early evaluation of hearing the best results were obtained in patients subjected to myringoplasty and conservative operations of the middle ear with canal up procedure.

[Comparative assessment of results in cervical vertigo pharmacotherapy vs physiotherapy treatment]. / Porównawcza ocena wyników leczenia zawrotów glowy pochodzenia szyjnego za pomoca farmakoterapii lub fizjoterapii.

INTRODUCTION: The aim of the study was to assess the effectiveness of pharmacotherapy and physiotherapy in cervical vertigo treatment. MATERIAL AND METHODS: 80 patients with cervical vertigo (41 women and 39 men), aged 20 to 85, were treated by pharmacotherapy or physiotherapy. There were two groups: group I was treated by pharmacotherapy and group II was treated by physiotherapy and kinesitherapy. The effects of vertigo treatment were assessed by positional nystagmus testing according to Cawthorne and Rosen; cervical nystagmus testing in neck rotation test; by everyday task self-control cards and vertigo staging system according to Silvoniemi (0-4 points). The effects of treatment were assessed before therapy, 6 and 12 weeks after therapy. Patients from group I were treated by Nootropil and Betaserc; group II received magnetic Fidel, laserotherapy, massage and kinesitherapy exercises. RESULTS: The obtained results showed that the most useful methods of cervical vertigo diagnosis were neck rotation test and Rose method. The average number of points (according to Silvoniemi scale) on the basis of ten everyday activities, was lower after 6 weeks of treatment than before the treatment and the lowest after 12 weeks of treatment. The difference was higher in group II than in group I. CONCLUSIONS: Patients treated by physiotherapy (group II) performed better in everyday activities than the patients treated by pharmacotherapy (group I). Cervical vertigo treatment by physiotherapy is cheap and underestimated method.

The association between positional vertebral and basilar artery flow lesion and prevalence of vertigo in patients with cervical spondylosis.

OBJECTIVE: The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes, prevalence of vertigo, and decreased blood flow velocity through vertebral arteries (VA) after head rotation. STUDY DESIGN AND SETTING: A prospective, controlled study in academic neurotology was conducted. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained of positional vertigo lasting more than 6 months. Patients were examined by transcranial Doppler ultrasound with head rotations. RESULTS: We showed significant association between velocity flow in basilar artery after neck rotation and age, prevalence of vertigo, grade of radiological changes, and positional vertebral artery flow lesion. CONCLUSION: Spondylotic-induced VA compression may be the reason for decreased blood flow velocity in the basilar artery during head rotation, which may be of particular importance for older patients, especially complaining of vertigo. SIGNIFICANCE: Every patient with high-grade cervical spondylosis, especially complaining of vertigo, should be examined by using TCD (transcranial Doppler) with head rotations. In case of positional blood flow reduction during head rotation, further angiographic examination should be undertaken so as to plan suitable treatment. EBM RATING: C-4.

[Analysis of select diagnostic examination results and their connection with cervical vertigo diagnosis]. / Analiza wyników wybranych badan diagnostycznych i ich zwiazek z rozpoznawaniem zawrotów glowy pochodzenia szyjnego.

Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not established. The aim of present study was to asses diagnostic value of classical radiologic, electronystagmographic (ENG) and transcranial doppler ultrasonographic (TCD) examinations in cervical vertigo diagnostic process. Forty patients with vertigo lasting more than 6 months with radiological evidence of cervical spondylosis participated in the study. All patients had ENG and TCD with neck rotation test. Cervical vertigo was diagnosed in patients with positive neck rotation test in: TCD examination (15% decrease of vertebral artery flow) and/or ENG examination (cervical nystagmus). We diagnosed cervical vertigo in 65% of patients. Multivariate model of logistic regression analysis showed that the best statistical predictors of cervical vertigo were: asymmetry of vertebral artery flow in TCD (OR: 92.2; 95% CI: 6,2-1381) and presence of osteophytes and discopathy in radiological examination (OR: 64.1; 95% CI: 1,3-1107). The transcranial doppler ultrasonographic examinations seems to be useful for diagnosing cervical vertigo.

[Kinesitherapy treatment for patients with cervical vertigo (preliminary report)]. / Wczesna ocena leczenia chorych z zawrotami glowy pochodzenia szyjnego za pomoca kinezyterapii (doniesienie wstepne).

The aim of the study was to assess the effectiveness of kinesitherapy in cervical vertigo treatment. Thirty two patients with cervical vertigo, aged 20 to 75, were examined. The patients performed kinesitherapy exercises three times a day for four weeks. The effects of therapy were assessed by everyday task self-control cards and ENG examinations. In the present study, objective improvement was noticed in 18,7% patients. Subjective improvement assessed by the patients everyday task self-control cards reached 62.5%. Kinesitherapy seems to be the good method of treating neck-related vertigo, but it should be confirmed in further study on the large group of patients.