[Tinnitus as the first symptom of Arnold-Chiari-Syndrome]. / Szumy uszne jako objaw zespolu Arnolda-Chiariego.

The Arnold-Chiari malformation is very rare hindbrain abnormalities characterized by herniation of the hindbrain through the foramen magnum. It usually does not present until adulthood, and then its symptoms may be varied and subtle. Patient 49 years was diagnosed in Foniatrics and Audiology Clinic because of tinnitus in left ear lasting 3 months. She underwent audiological diagnostic, that did not reveal any abnormalities, except for electrogustometry and hyporeflexia of stapedial reflex and labyrinth on the left side. In MRI scan we have noticed hindbrain abnormalities characteristic for Chiari type I malformation. Treatment consisted of immediate supportive care as needed but without surgical decompression, which was found unnecessary.

Poznan's program of cochlear and brainstem implantation: a general review.

The cochlear implantation program in Poznan started in January 1994. Within 8 years, 151 patients were implanted (149 cochlear and 2 auditory brain-stem implants). The implanted group comprised 111 children and 40 adults. We have extended the lower age limit for cochlear implant candidates, and the youngest implanted patient was 18-months-old at the time of surgery. We have also implanted six multi-handicapped subjects. All patients were implanted with different nucleus devices (22, 24 M, 24 K, 24 Contour, 24 Double Array and 24 ABI). Insertion of the Nucleus 24 Contour electrode carrier requires a little larger cochleostomy in comparison with conventional straight array. After insertion, the intraoperative measurements are taken (impedance telemetry, electrically evoked stapedius reflex and NRT). The day after surgery, each patient undergoes an X-ray examination (the cochleogram or cochlear view). The calculated length of the electrode array insertion was 12.75-24.0 mm (mean: 22.05 mm) and the degree of electrode rotation was 180-540 degrees (mean: 292.82 degrees). After speech processor switch-on, we performed NRT measurements. Our results indicated that the NRT threshold was in 51.4% of the dynamic range within the group of examined patients. The adults' progress of rehabilitation was checked during individual sessions. The rehabilitation of children included two rehabilitation schedules: continuous ones and weekly rehabilitation camps. The progress of the recovery process of implanted children enabled them to change their school profile from hearing impaired to mainstream. Voice rehabilitation is often monitored by acoustic analysis using the Multi Dimensional Voice Program (MDVP).

[Proposals of rational procedures for certifying occupational voice disorders]. / Propozycje racjonalnego postepowania w orzekaniu o chorobie zawodowej narzadu glosu.

Following a long period of experience acquired in assessing occupation-related voice disorders, the proposals of objective measures, facilitating the certification of occupational disease of the voice organ in accordance with the binding legal regulations, are presented. The importance of documentary evidence of at least two years of treatment and phoniatric rehabilitation is stressed. A need to prevent occupation-related voice disorders through phoniatric diagnostic procedures is highlighted.

[An attempt to identify the most frequent genomic mutations responsible for isolated deafness in patients after cochlear implantation]. / Próba identyfikacji najczestszych mutacji genowych odpowiedzialnych za gluchote izolowana u pacjentów nieslyszacych zaopatrzonych w implant slimakowy.

The aim of this study was to identify subjects with 35delG mutation of GJB2 gene as the most frequent genetic cause of deafness. Deaf patients receiving cochlear implantation at the ENT Clinic at University of Medical Sciences in Poznan and their family members were recruited to the study. Peripheral blood lymphocytes DNA was amplified in allele-specific PCR and analysed for single strand conformation polymorphism (SSCP) to detect mutation at DFNB1 locus. 35delG mutation at both alleles was found at 42.9% of deaf patients and 29.4% of health relatives were found to be carrier of the mutation at one allele. The study is thought to be a first step in analysis of typical mutations in Polish deaf population.

Low birth weight as a risk factor of hearing loss.

The purpose of this study was the audiological evaluation of low birth weight children as well as to investigate any possible relation between very low birth weight and the associated risk factors and the subsequent hearing loss. A group of 110 children was examined audiologically. The prenatal, perinatal and postnatal risk factors were related to the audiological diagnosis. Depending on the patient's age, audiological examination consisted of auditory brainstem responses, pure tone audiometry and impedance audiometry. The presence of more than two risk factors in the perinatal and postnatal categories was connected with profound hearing loss in later life. No such relation was found with the cumulation of the prenatal risk factors. In our material the greatest risk of the acquired profound hearing loss and deafness occurring in low birth weight children was connected with the general physical status of the neonates and the treatment programme in the neonatal intensive care unit.

Audiological assessment of unilateral deafness.

Unilateral deafness constitute medical (aetiological diagnosis, treatment, hearing aid fitting) and social problems (no certification of disability). Following audiological examinations were performed in the study: pure tone audiometry (PTA), impedance audiometry, auditory brainstem responses (ABR), otoacoustic emissions (OAE), as well as balance, taste, examinations and electric sensitivity of the acoustic nerve. In cases of tinnitus the parameters of its character were done. All of our patients underwent X-ray investigations, i.e. ear X-ray by Schüller and Stenvers methods, computerized tomography or magnetic resonance imaging. In some cases phoniatric and logopaedic examinations were performed. For aetiological diagnosis electrophoresis and immunological test (IgG and IgM against mumps) were carried out. The results were presented in two groups of patients with sudden and those of long lasting progressive unilateral deafness. Some of the patients were pharmacologically treated before the evaluation. It is concluded that the statistic analysis could be a basis for the management and prognosis of the unilateral deafness.

[Laryngological experiences in treatment of Bell's palsy]. / Laryngologiczne doswiadczenia w leczeniu obwodowych porazen nerwu twarzowego typu Bella.

Between 1990-2000 15 cases of unilateral Bell paresis of the VIIth nerve were treated using local injection of hydrocortisone in the region of the foramen stylomastoideum. Paralelly were administered iontophoresis, galvanisation of the facial mimic muscles together with vasodilating drugs. Early introduced treatment gave complete return of facialis function. The usefulness of treatment monitoring with topodiagnostic tests is stressed.

[Does the electrodes insertion depth influence speech rehabilitation progress in CI patients?]. / Czy glebokosc wprowadzenia elektrod ma wplyw na postepy w rehabilitacji mowy u osób z wielokanalowym wszczepem slimakowym?

Many interdisciplinary teams from difference CI centers are studying speech rehabilitation process of implanted patients. Speech rehabilitation progress depend on many conditions like: duration of deafness, age at implantation, cause of deafness. Rehabilitation of postlingually deafened patients is very short. These subjects return very fast to the world of sounds. By the other side speech rehabilitation of prelingually deafened patients needs much more time (years). There are although well seen differences in language skills acquisition inside these groups. It confirmed, that speech rehabilitation after cochlear implantation could depends on others conditions as well. The aim of this study was electrodes insertion depth evaluation (cochleograms) and its influence on speech rehabilitation progress.

[Cochleography and cochlear view as the way of assessment of successful surgical inner ear implantation]. / Kochleogram i projekcja slimakowa jako sposoby oceny skutecznosci chirurgicznej implantacji ucha wewnetrznego.

115 cochlear implantation were performed in ENT Department Karol Marcinkowski University of Medical Sciences in Poznan in 1994-2001. Nucleus Mini System 22 and Nucleus 24 of Cochlear Ltd were used in these operations. Two approaches were performed: middle fossa approach in one case and traditional one. The aim of this study was evaluation of cochleogram and cochlear view as the ways of assessment of successful inner ear implantation. One of X-ray projection were performed in implanted patients 24 hours after implantation. In cochleograms the degree of electrodes rotation in cochlea was calculated. The number of inserted electrodes in cochlea was calculated in cochler view projection. Described X-ray projection were performed in 70 patients. On X-ray projection (cochleograms) rotation degree of electrodes in majority were equal or higher than 250 grades (according to literature it is sufficient for successful speech rehabilitation). X-ray projection--cochlear view confirmed full insertion of electrode.

[Cochlear implantation through the middle fossa approach]. / Implantacja wszczepu slimakowego z dojscia przez srodkowy dól czaszki.

The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding.

[Bone anchored hearing aids (BAHA) used for treatment of conductive hypoacusis--current problems in Poland]. / Aktualne problemy protezowania niedosluchów przewodzeniowych aparatami zakotwiczonymi w kosci skroniowej (BAHA) w Polsce.

Basic principles, indications and limitations of BAHA implantation as well as different kinds of operation techniques are presented. The beginning and the development of BAHA use in Poland are mentioned together with some difficulties in broadening of this kind of implantation.

[First experiences in Neural Response Telemetry in patients with Nucleus 24 cochlear implant system]. / Wstepne doswiadczenia w stosowaniu telemetrii odpowiedzi nerwowych u pacjentów z wszczepem slimakowym Nucleus 24.

Nucleus 24 Cochlear Implant System enables bidirectional communication with the implant-telemetry. Information about implant function can be obtained using telemetry. Neural Response Telemetry is a measurement of neural activity in the cochlea as a response to electrical stimulation. Principle of NRT recording, classification of responses and examples of responses obtained in patients implanted in Poznan are presented.

Assessment of smell and taste in patients with allergic rhinitis.

We examined the senses of smell and taste in 240 patients with verified hypersensitivity reactions of the respiratory tract. Olfactometry was performed according to Elsberg and Levy's method and followed by electrogustometry. The examinations revealed that the incidence of smell and taste disorders in patients with allergic rhinitis is 21.4% and 31.2%, respectively. No significant relationships between smell and taste dysfunction were found. We evaluated statistically positive correlations between the olfactory and gustatory thresholds compared with 78 qualitative and quantitative factors assessed in the study. There was a statistically significant relationship between the olfactory thresholds and levels of eosinophils in blood and in nasal discharge. acid reaction of the nasal mucosa, coexisting nasal polyps and X-ray changes in the ethmoid sinuses. There was a positive influence of pharmacotherapy as well as specific desensitization and surgery on the impairment of the sense of smell in allergic rhinitis.

[Dysphagia and speech disorders]. / Dysfagia a zaburzenia mowy.

Swallowing disorders in oral and pharyngeal phase after surgery of mouth, pharynx or larynx are very often interrelated with speech and voice disorders. The results of diagnostic methods of dysphagia and voice/speech disorders based on own material of patients after total laryngectomy, partial tongue resection and cleft palate surgery were presented. Attention was also paid to other etiological factors of swallowing disorders observed in phoniatric practice.

[Critical evaluation of the audiological test results in children]. / Krytyczna ocena wyników badan audiologicznych u dzieci.

Factors influencing results of objective hearing examination in children, i.e. auditory evoked potentials, based on own experiences are presented. "Cross-check" principle as well as observation of dynamic changes concerning development of communicative process should be taken into the consideration.

[Phoniatric remarks on microsurgery of vocal cords]. / Uwagi foniatryczne do zabiegów mikrochirurgicznych na faldach glosowych.

Own experience in microsurgery of vocal folds are presented. The necessity and importance of photographic and acoustic documentation (MDVP) as well as phoniatric pre- and postoperative rehabilitation are stressed.

[Phoniatric interpretation of evaluation principles in professional voice disorders]. / Foniatryczna interpretacja zasad orzekania o chorobie zawodowej narzadu glosu.

The critical assessment of the existing regulations of professional voice evaluation are presented. The necessity of the use of essential phoniatric principles is stressed in order to make respective legal decision more realistic and responsible.

[The electrophysiological examination of hearing with some metabolic disorders in children]. / Badania elektrofizjologiczne sluchu u dzieci w niektórych schorzeniach metabolicznych.

Electrophysiological examinations of hearing (ABR, SP) in 60 children with insulin-dependent diabetes mellitus and 39 children with obesitas simplex were done. In both groups with normal hearing threshold in pure tone audiometry disturbances in intrastem conduction were noticed.

[Electrophysiological hearing examination in children and teenagers with insulin-dependent diabetes mellitus]. / Badania elektrofizjologiczne narzadu sluchu u dzieci i mlodziezy z cukrzyca i mlodziezy z cukrzyca insulinozalezna.

In 60 children and youngsters aged 14-19 (average 16.5) with insulin dependent diabetes (lasting on average 5.5 years) and normal hearing in pure tone audiometry electrophysiological examinations (ABR, SP) were performed; 48% of the cases revealed changes in latencies of I, III, V waves, especially as an elongation of I and V waves. In the peripheral interlatencie (III-I; V-I) shortening and in V-III elongation were observed. In SP examination most often shortening of N1 (67%) and P2 (87%) were found. Statistically significant dependence of latency changes on the state of metabolic balance was stated. It was not found referring to the duration of diabetes, age and gender of the patients.