Immense Tumor of Maxillary Sinus with Exophthalmos-A Rare Underlying Cause.

Sinus tumors are arduous to diagnose due to often prolonging asymptomatic course until the infiltration of the adjacent structures occurs. Therefore, patients are diagnosed with advanced-stage disease, which negatively affects the treatment outcomes. A 60-year-old male was referred to our ward from an outpatient clinic. The patient presented with double vision, right-side lacrimation, and exophthalmos. He also reported significant weight loss: 15 kg in 2 months. Physical examination revealed achiness and edema of the right temporal area, and subconjunctival hemorrhage of the right eye, and surprisingly no anosmia, no nasal obstruction, and no head/neck lymphadenopathy were present. The histopathology examination identified diffuse large B-cell lymphoma (CD20+ CD3- p63- bcl-2+ CD23-/+ bcl-6+ CD 10- MUM1+ Tdt- CD38- cyclin D1- CD30- c-myc+). The patient was qualified for R-CHOP immunochemotherapy (rituximab, cyclophosphamide, and hydroxydaunorubicin hydrochloride), which was well tolerated. After 3 months of treatment, all of the symptoms reversed and a whole-body PET scan showed no abnormal metabolic activity.

[Küttner's tumor (chronic sclerosing sialadenitis) - a rare cause of submandibular gland enlargement]. / Guz Küttnera (chronic sclerosing sialadenitis) - rzadka przyczyna powiekszenia slinianki podzuchwowej.

Küttner's tumor is a benign tumour-like lesion of the salivary glands. Predominantly affects the submandibular gland. It is also known as chronic sclerosing sialoadenitis or cirrhosis of submandibular gland. This is an underrecognized entity in the surgical pathology and cytology literature. Most patients experience recurrent pain, discharge and swelling that is often associated with eating, but others only have asymptomatic hard swelling of the submandibular gland. Histologic examination of the excised submandibular glands revealed preserved lobular architecture, thickening of interlobular septa by sclerotic tissue, dense lymphoplasmacytic infiltrate, preservation of ducts with periductal fibrosis, and variable loss of acini. The morphologic appearance, in conjunction with the elevated IgG4 expression, distinguishes chronic sclerosing sialadenitis from other inflammatory diseases of the salivary glands. Chronic sclerosing sialadenitis belongs to the spectrum of IgG4-related diseases. We present a case of Küttner's tumor in a 62-year-old female treated by surgery. Although this disease was first described by Küttner in 1896, this clinical entity which masquerades as carcinoma is underdiagnosed by many surgeons. There is not enough evidence to support any diagnostic means that could help in the differential diagnosis of this benign condition. Given the high rate of malignancy in firm, painless lesions of the submandibular gland, surgical excision is often advocated and Küttner's tumor is usually diagnosed by the histopathologist.

[Magnetic resonance tractography in neuroradiological diagnostic aspects]. / Traktografia rezonansu magnetycznego w diagnostyce neuroradiologicznej.

Diffusion tensor imaging is unique in its ability to non-invasively visualize white matter fiber tracts in the human brain in vivo. White matter fiber bundles of the human brain form a spatial defined by the anatomical and functional architecture. Determination of axonal pathways provides an invaluable means to study the connectivity of human brain and its functional network. Comparison of fiber tract properties across subjects requires comparison at corresponding anatomical locations. In this paper, we present application of white matter tractography method based on incoherent motion of water molecules in fiber tissue, mainly in central nervous system. This motion is itself dependent on the micro-structural environment that restricts the movement of the water molecules. In white matter fibers there is a pronounced directional dependence on diffusion. With white matter fiber tracking or tractography, projections among brain regions can be detected in the three-dimentional diffusion tensor dataset according to the directionality of the fibers. The authors indicate diagnostic possibilities of MR tractography in otolaryngology for imaging the nervous tracts of sense of hearing, smell and taste with particular consideration of otoneurological evaluation of patients with cochlear implants and bone anchored hearing aid (BAHA). White matter tracts can be evaluated independently by using diffusion tensor tractography, which appears to be a promising technique for determining changes in white matter in degenerative disease. The authors also indicate that method as a beneficial in the surgical planning for patients with intrinsic brain tumors.

[A 20-year retrospective histoclinical analysis of parotid gland tumors in the ENT Department AM in Katowice]. / Analiza histokliniczna guzów slinianek przyusznych u chorych operowanych w okresie 20 lat w Klinice Laryngologii SlAM w Katowicach.

INTRODUCTION: Salivary gland neoplasms represent the diverse group of tumours encountered by the head and neck surgeons. MATERIAL AND METHODS: The study is analysis of 531 patients with parotid gland tumours in patients treated in ENT Department during 1986-2006. We analysed surgical treatment and intraoperative tumour stage. The results of histological diagnosis were presented. RESULTS: The frequency of incidence of benign neoplasm was 80%. The most frequent tumour was pleomorphic adenoma--75% and adenolymphoma--16%. Malignant tumours constituted 20% of all gland tumours. Mucoepidermoid (27%) and adenoid cyst (22%) carcinomas were the most common malignant tumour. Tumour stages T3-T4 was in 90%.

[Analysis of results of stapedotomy in patients with obliterative otosclerosis]. / Ocena wyników stapedotomii u chorych z obliteracyjna postacia otosklerozy.

INTRODUCTION: In obliterative type of otosclerosis the stapes footplate is greatly thickened and diffusely replaced by a massive otosclerotic masses that fill in the oval window niche, often annular ligament cannot be visualized. In the case of obliterative otosclerosis the only effective way of treatment is surgery. MATERIAL AND METHODS: The analysed group consisted of 53 patients with primary obliterative otosclerosis. In the control group there were 30 consecutive patients treated for otosclerosis. The auditory organ was assessed on the ground of the following criteria for the frequencies 0.5, 1, 2 and 4 kHz.: 1. Change of pure tone thresholds of air conduction (AC) 2. Change of pure tone thresholds of bone conduction (BC) 3. Change of pure tone thresholds of air-bone gap (ABG) as the difference between the mean AC and BC thresholds before the operation (AC0 and BC0) and 12 months after the operation (AC1 and BC1). RESULTS: Postoperatively mean value of change of AC thresholds in the analysed group was about 24 +/- 2 dBHL and in the control group about 25 +/- 2 dBHL (no significant difference). In the analysed group the mean value of BC thresholds varied about 8 dBHL and in the control group about 11 dBHL (no significant difference). The average values of ABG after the operation varied about 14 +/- 1 dBHL in both--the analysed and the control group. Postoperatively the mean value ABG was amounted to 20 +/- 1 dBHL in the analysed group and in the control group to 18 +/- 1 dBHL (no significant difference). On the basis of the subjective assessment completely subsidence of aural tinnitus reported 70% patients in the analysed group and 80% patients in the control group. CONCLUSION: 1. The incidence of obliterative otosclerosis represents 9,6% of all otosclerotic patients treated surgically. 2. Stapedotomy is the treatment of choice in patients with obliterative otosclerosis, because significant improvement of AC, BC and ABG 12 months after the operation was reported, mean values did not differ between the above and control group. 3. Complete subsidence of aural tinnitus was reported in 70% patients with obliterative otosclerosis.

[Long term results stape surgery]. / Wyniki odlegle w otosklerozie.

For many years otosclerosis has been an interesting otologic problem in regard to pathological and clinical aspects. Many various conceptions of otosclerosis development which finally lead to the stapes immobility in the oval window were discussed. Resent genetic studies indicate that genetic factors as a cause of otosclerosis possibly in combination with other factors localize 3 genes responsible for otosclerosis to chromosom 15q25q-q26, 7q34-36, 6p21-22. The aim of the study was audiometric evaluation of 1380 patients out of 1716 stapes operations performed in years 1973-2004. Audiometric assessment for air and bone conduction was performed according to the European Academy of Otology and Neuro-Otology (EAO-NO) criteria. Postoperative air-bone gap 11-20 dB for speech frequencies (500, 1000, 2000, 4000 Hz) was obtained in 64.8% and in 28.9% was less than 10 dB. Postoperative air-bone gap (11-20 dB) recognized as a good result is determined by factors such as preoperative hearing loss, onset and duration of the disease, advanced and multiple otosclerotic foci, patient's age etc. Actually postoperative air-bone gap shows the improvement of air and bone thresholds obtained post stapedotomy versus preoperative air bone gap. In previous years an "over-closure" effect was taken into consideration. Hearing improvement post stapes surgery which included the "over closure" effect was obviously better. The authors indicate the necessity of standardization of audiometric results post ear surgery.

[Long-term results of stapes surgery--over 1000 patients]. / Wyniki odlegle leczenia chirurgicznego otosklerozy--seria ponad 1000 pacjentów.

Authors present audiometric results of 1200 patients with otosclerosis post stapedotomy. Air-conduction, bone-conduction and air-bone gap was measured prior the surgery and 12 months post stapedotomy for frequencies 0.5, 1.0, 2.0 and 3.0 kHz. In the analysed group of 1200 patients a postoperative air-bone gap 0-10 and 11-20 dB was obtained in 93.7% patients. The result of stapedotomy in reference to tinnitus based on the patients' subjective opinion showed that 78.0% patients were either free from tinnitus or tinnitus was subjectively decreased. Authors stress that some anatomical abnormalities in the tympanic cavity might influence on the result of stapes surgery.

[Results of stapedotomy in the cases of "floating footplate"]. / Wyniki stapedotomii w przypadkach "plywajacej plytki".

One of the problems in the stapes surgery is the floating footplate. The frequency of incidence of this complication is 2% to 5.8% of all operations. The authors present the results of stapes operations in a group of 28 cases (2.5%) from all the 1120 operations, in which the surgeon experienced a floating footplate. The hearing results were evaluated on the base of the average gain of air-conduction thresholds and air-bone gap levels at 500, 1000, 2000 and 3000 Hz. The improvement of hearing we observed in 24 patients, 4 patients heard worse.

[The evaluation of distortion product otoacoustic emissions after stapedotomy]. / Ocena pomiarów otoemisji akustycznej produktów znieksztalcen nieliniowych slimaka (DPOAE) po stapedotomii.

34 patients with otosclerosis operated at the ENT Clinic, were enrolled in this study. Prior and 4 months after stapedotomy the signal of DPOAE and the threshold levels for air and bone conduction were evaluated. No signal of otoacoustic emissions was registered in any of the patients prior stapedotomy. After operation DPOAE was registered in 23 out of 34 examined patients (67.6%).

[The estimation of air--conduction threshold in extended range of high frequencies in young adult patients suffering from primary arterial hypertension]. / Pomiary progowe przewodnictwa powietrznego w rozszerzonym zakresie wysokich czestotliwosci u mlodych doroslych chorych na pierwotne nadcisnienie tetnicze.

The aim of the study was evaluation of the hearing ability on the base of air conduction threshold at extended range of high frequencies in young subjects with primary arterial hypertension. Lack of internationally accepted reference value of air conduction hearing threshold at extended frequency range resulted in own evaluation of the audiometric zero point for air conduction at the range 8-18 kHz in "otologically healthy" subjects younger than 20 years. Detection of impaired hearing of the extended high frequencies range in young subjects with primary arterial hypertension may be useful in diagnostics of hypertension as well as in prophylactic examinations in the group of individuals with high risk of primary hypertension. Evaluation of air conduction threshold at extended frequency range allows to detect sensorineural hearing impairment undetectable with application of conventional frequency range.

[Results of myringoplasty and type I tympanoplasty with the use of fascia, cartilage and perichondrium grafts]. / Wyniki myringoplastyk i tympanoplastyk typu I z uzyciem ochrzestnej, chrzastki i powiezi miesnia skroniowego.

Since the publication of Miodonski, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplasty. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplasty in comparison with the material used. The studies included a selected group of 142 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. The comparison group consisted of 30 patients when fascia of the musculus temporalis was used to close a defect of the eardrum. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery. The comparison of operation results showed that there was no significant difference between the two groups.

[30 years of stapes surgery]. / 30 lat chirurgii strzemiaczka.

This study reports the results of otosclerosis surgery performed during the past thirty years (1973-2002) in the ENT Clinic in Katowice. The authors present difficult anatomic relationships in the tympanic cavity which might have an influence on stapes surgery. Audiometric evaluation of 100 bilateral stapedotomies performed in 50 patients revealed that a small--hole stapedotomy is a safe technique and could be performed bilaterally. The group of 55 stapedotomies with stapedial tendon preserved was compared to the group of 55 stapedotomies with dissected tendon. SRT was better in the group where the tendon was preserved. In the group of 32 patients ABR before and after stapedotomy was recorded. The latency of V wave after the operation was reduced to the normal values what indicated a correct function of the ossicular chain postoperatively. In the group of 60 patients DPOAE prior and after stapedotomy was evaluated. Prior to the operation no signal of otoacoustic emission was registered, in 37 patients out of 60 the signal was present after the operation. DPOAE obtained postoperatively indicated successful ossicular chain restoration and inner ear function. Audiometric evaluation in reference to the group of 905 stapedotomies performed in years 1992-2001 showed that most of the patients were in group B--443/905 and C--402/905 according, in A group--60/905 according to Shambaugh. A-B gap < or = 10 dB was obtained in 469/905 (51.8%), the mean of the hearing threshold at 500, 1000, 2000 and 4000 Hz was 24.3 dB (+/- 8.3, med. 25.0) in A group and 32.0 dB in B and C group. The result of stapedotomy in reference to tinnitus based on the patients' subjective opinion. We may conclude that the key to the stapes surgery lies in the training and skillfulness of the surgeon using save small hole technique with stapedial tendon preservation to obtain the optimal physiologic function of the middle ear and to gain the best hearing results.

[Ectopic thyroid glad--a case report]. / Odszczepiona tkanka tarczycowa--opis przypadku.

Authors have described the case of 67 years women with an anterior midline neck tumor. The tumor was surgically excited and the microscope examination revealed thyroid tissue with colloid goiter. One must consider a midline ectopic thyroid gland in the differential diagnosis of masses in the neck.

[The evaluation of cartilage and perichondrium grafts for the reconstruction of the tympanic membrane]. / Ocena przydatnosci chrzastki i ochrzestnej w operacjach odtwórczych blony bebenkowej.

Since the publication of Miodonski, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplastic surgery. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplastic surgery with the use of cartilage and perichondrium grafts. The studies included a selected group of 112 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery.

[An extremely rare case of primary lipoma of the middle ear in an 8-year old girl]. / Wyjatkowo rzadki przypadek pierwotnego tluszczaka ucha srodkowego u 8-letniej dziewczynki.

Authors described an extremely rare case of primary lipoma of the middle ear in 8-years old girl. A histological structure, localisation and occurrence of this tumor in the temporal bone was discussed on the basis of the literature. Authors have presented symptomatology, diagnosis difficulties and treatment of primary lipoma of the middle ear. They have paid attention to the course of disease and non-characteristic symptoms, which imitated the symptoms of the chronic otitis media.

[The estimation of hearing threshold for high frequencies in children from the Upper Silesia]. / Wyznaczenie progu slyszenia dla wysokich czestotliwosci u mlodziezy zamieszkalej na Górnym Slasku.

Study was carried out in frequency range 8-18 kHz with audiometer AS 10 HF. Lack of internationally accepted reference value of the hearing threshold of air conduction at extended frequency range resulted in own evaluation of the audiometric zero point for air conduction at the range 8-18 kHz in "otologically healthy" subjects younger than 20 years. They were divided into subgroup A and B according to age. Investigation of the threshold values for air conduction at extended range of high frequencies were base for evaluation of the audiometric zero value for the used equipment.

[Middle ear tuberculosis behind an intact tympanic membrane--a case report]. / Gruzlicze zapalenie ucha srodkowego przy nieuszkodzonej blonie bebenkowej--opis przypadku.

An extremely rare case of the 21 years women with the tuberculosis of the tympanic cavity behind the intact tympanic membrane was presented. The authors have described the clinical picture, diagnosis difficulties and ways of therapy. A surgical treatment and antituberculosis treatment was satisfactory.