[Bone dehiscences in the middle ear in patients operated on ear diseases in the Otolaryngology Department of Jagiellonian University, Poland from 2008 to 2012]. / Uszkodzenia scian kostnych ucha srodkowego u chorych operowanych z powodu schorzen ucha w Klinice Otolaryngologii CM UJ w latach 2008-2012.

BACKGROUND: We perform the middle ear operation to remove pathological tissue and in the next step present ossicular chain reconstruction. Otosurgeon has to also identify bone dehiscences, as a potential way to develop otogenic intracranial and intratemporal complications. AIM: We analyzed the patients with bone defects in the middle and/or posterior cranial fossa who present also defects of the bony wall of the facial nerve canal and lateral semicircular canal. MATERIAL AND METHODS: We observed 537 patients who were operated on middle ear for the first time in the Department of Otolaryngology at the Jagiellonian University of Cracow from 2008 to 2012. We used a special questionnaire that includes diagnostics of the ear's disease, method of the operation and short- and long-term effects. RESULTS: We discuss 45 patients with the skull base defects in the middle and/or posterior cranial fossa. Dehiscence of the bony wall of the facial nerve canal was present in 7 patients. In 4 cases semicircular canal fistula coexisted. The most common cause of bone dehiscence was granulation tissue, less frequently cholesteatoma.

[Response changes of inner ear observed after middle ear surgery]. / Zmiana odpowiedzi ucha wewnetrznego obserwowana po operacjach na uchu srodkowym.

BACKGROUND: Relationship beetwen middle ear surgery and function of the inner ear is known. This problem is often discussed in determination of hearing improvement after otosurgery. AIM: Usefulness of the click evoked otoacoustic emissions (CEOAE) in evaluation of the inner ear function and effectiveness of tympanoplasties is discussed. MATERIAL AND METHODS: Prospective analysis of 70 individuals operated on middle ear problems was performed. Patients were divided into four groups of otosurgeries: stapedoplasty, myringoplasty, type II tympanoplasty, type III tympanoplasty. Otoacoustic emissions and pure tones audiometry were performed before middle ear surgery and 3 months after ear operation. RESULTS: In all established groups improvement in ABG (air bone gap) was observed. Improvement of bone conduction thresholds in the ranges of 5dB was observed in individuals with otosclerosis and type I and type III tympanoplasty. Patients with type II tympanoplasty developed no changes of bone conduction threashold after otosurgery. CONCLUSIONS: Behind routine audiometric diagnostics otoacoustic emissions can be useful in postoperative evaluation of effectiveness of middle ear surgery (especially in patients operated on otosclerosis and in individuals with chronic otitis media with intact ossicular chain).

[Skull base defects in the middle and posterior cranial fossa with unchanged mucous lining middle ear spaces]. / Ubytki kosci podstawy srodkowego i tylnego dolu czaszki przy niezmienionej wysciólce ucha srodkowego.

BACKGROUND: Skull bone defects in the region of middle ear are usually observed in the cases of chronic otitis media. Such loses can also be congenital, posttraumatic, iatrogenic or due to hyperplasia. They can potentially lead to development of otogenic intracranial complications. AIM: We present the patients who were not observed during otosurgery to have any pathological changes to the mucous of the middle ear and were diagnosed as having bone defects in the middle and/or posterior cranial fossa. We discuss also methods of reconstruction during otosurgery. MATERIAL AND METHODS: The prospective analysis involves the patients operated on middle ear in the Department of Otolaryngology at the Jagiellonian University of Krakow in the years 2007-2011. 495 first-time otosurgeries were performed in this period of time. RESULTS: Skull bone defects were diagnosed in 46 patients who had undergone surgery and 25% of these patients had no changes to the middle ear mucous. This points to congenital etiology of the defects. In this group the most common cause for otosurgery was chronic otitis media (10 patients). In 1 patient, bone defect occurred along with otosclerosis. In patients with congenital skull bone defects otogenic intracranial complications were described in 4 cases. CONCLUSIONS: Nearly 80% of skull bone defects remain asymptomatic; they are revealed incidentally during the surgery of the middle ear. The above observations emphasize the significant role of preoperative imaging diagnostics. The methods of bone defects reconstruction using the fascia, strengthened with the pedicle muscle flap where larger defects occurred, as well as with either bone lamella or cartilage in particular cases, proved successful.

[How can an otolaryngologist benefit from artificial neural networks?]. / Co moze uzyskac otolaryngolog, stosujac sztuczne sieci neuronowe?

Artificial neural networks are informatic systems that have unique computational capabilities. The principle of their functioning is based on the rules of data processing in the brain. This article discusses the most important features of the artificial neural networks with reference to their applications in otolaryngology. The cited studies concern the fields of rhinology, audiology, phoniatrics, vestibulology, oncology, sleep apnea and salivary gland diseases. The authors also refer to their own experience with predictive neural models designed in the Department of Otolaryngology of the Jagiellonian University Medical College in Krakow. The applications of artificial neural networks in clinical diagnosis, automated signal interpretation and outcome prediction are presented. Moreover, the article explains how the artificial neural networks work and how the otolaryngologists can use them in their clinical practice and research.

[Prognostic factors in patients operated on eardrum perforation with intact ossicular chain]. / Czynniki prognostyczne u chorych leczonych operacyjnie z powodu perforacji blony bebenkowej przy nieuszkodzonym lancuchu kosteczek sluchowych.

BACKGROUND: Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. AIM: This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. MATERIAL AND METHODS: Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. RESULTS: 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. CONCLUSIONS: The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operator's preferences, as well as the availability of given material for transplanting.

[Neurothekeoma of the orbit]. / Przypadek neurothekeoma oczodolu.

AIM: The aim of this study was to present a rare benign tumour of neural origin located in the orbit. MATERIAL AND METHODS: Authors describe case of six-year-old boy with tumour of the right orbit, upper eyelid and right zygomatic fossa. Medical history revealed gradually increasing in size, painless tumour. Before admission to the hospital computed tomography was taken to assess the size, localization of the tumour and to plan the proper treatment. RESULTS: The patient was operated on using Krönlein approach. Tumour was removed in macroscopically radical limits without need to incise the muscles responsible for eye movement. Histopathological examination revealed: Neurothekeoma, classic type. During one year follow-up there was no recurrence. CONCLUSION: Neurothekeoma may occur in young boys in eyelid and orbit. A unique localization of neurothekeoma in the orbit, close to the lacrimal gland shows that this kind of histopatological tumours may infiltrate deeper tissues. Surgical treatment of neurothekeoma is the same as in other benign tumours.

[Reoperations in patients with chronic otitis media cholesteatomatosa]. / Reoperacje w przebiegu otitis media chronica cholesteatomatosa.

INTRODUCTION: Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. AIM: This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. MATERIAL AND METHODS: Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004-2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. RESULTS: 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. CONCLUSIONS: The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.

[Applicability of artificial neural networks in postoperative hearing improvement prognosis in patients with chronic otitis media]. / Przydatnosc sztucznych sieci neuronowych w prognozowaniu pooperacyjnej poprawy sluchu u chorych z przewleklym zapaleniem ucha srodkowego.

The primary objective of surgical treatment of chronic otitis media is to remove the pathological changes and restore the biology of the middle ear. Subsequently, ossicular chain reconstruction is performed in order to restore hearing. The aim of the study was to evaluate the efficacy of mathematical models (artificial neural networks) in postoperative hearing improvement prognosis. The models based on preoperative anamnesis and data concerning the operative procedure. The analyzed group comprised of 135 patients operated for chronic otitis media in the Department of Otolaryngology CM UJ in Krakow. The measure of postoperative hearing improvement was cochlear reserve (air-bone gap) closure depending on the type of ossicular chain reconstruction. The artificial neural networks provided 100% correct predictions basing on preoperative clinical examination, pathological changes found in the middle ear and description of the surgical procedure. The study proves that artificial neural networks are effective in functional result prognosis in tympanoplastic surgery.

[Defects of facial nerve canal according to a character and localisation of lesions in middle ear]. / Ubytki kostne kanalu nerwu VII a charakter i lokalizacja zmian w uchu srodkowym.

AIM: The aim of this study is the assessment the occurence of facial nerve canal (Fallopian canal) dehiscence in patients operated due to chronic medial otitis (depending on the location and type of inflammatory lesions) and in patients operated due to otosclerosis. Facial nerve paresis in patients with dehiscence found during surgery was also assessed. MATERIAL AND METHODS: The study group consisted of 456 patients operated at the Department of Otolaryngology at the University Hospital in Krakow, 359 due to chronic otitis media and 97 due to otosclerosis. Facial nerve canal dehiscence was found during surgery in 26 patients (6% of operated patients) more frequently in men. RESULTS: In most cases (54%) dehiscence was observed in patients with chronic medial otitis with cholesteatoma (27% with choleseatoma and 27% with cholestatoma and granulation), and equally (23% each) dehiscences were observed in patients with granulation and even in patients with otosclerosis and chronic simple otitis media. In over than half (54%) of patients with dehiscence inflammatory lesions involved all the middle ear spaces, in 15% the tympanic cavity, attic and antrum while in 4% of patients inflammatory lesions were limited to the tympanic cavity, attic or antrum. CONCLUSIONS: The facial canal nerve dehiscence is observed in majority in patients with cholestatoma and granulation, especially in tympanic region. In some cases its coexistence with circuit canals dehiscence.

[Necessity of chorda tympani cutting from data collected at Department of Otolaryngology at the Collegium Medicum of the Jagiellonian University]. / Koniecznosc przeciecia struny bebenkowej w materiale operacyjnym Kliniki Otolaryngologii UJ CM.

BACKGROUND: Chorda tympani nerve is a branch of the facial nerve which enables perception of taste of 2/3 anterior part of tongue and it is responsible for unilateral parasymphatetic nerve supplying of the submandibular and sublinqual salivary glands. MATERIAL AND METHODS: Prospective analysis of patients operated on middle ear in ENT Department Jagiellonian University of Krakow between 2004-2008 was performed. Nearly 650 operations were done in that period of time. Chorda tympani nerve was cut in 96 individuals. Most of them were treated for chronic otitis media. RESULTS: When chorda tympani nerve was cut--the majority of cases did not complain of dysgeusia. Disturbance of taste was observed in ca. 2% of patients but it was transitory. The subject experienced sour/metallic taste. CONCLUSIONS: Taste disturbance following unilateral injury to the chorda tympani nerve was usually the most intense in the first few weeks and improves with time.

[Olfactory neuroblastoma removed under endoscopic guidance]. / Nabloniak nerwowy z komórek wechowych usuniety endoskopowo.

INTRODUCTION: Olfactory neuroblastoma is a rare tumour associated with high rates of recurrence and mortality. Treatment includes surgery, radiotherapy, chemotherapy, or a combination. The ideal treatment modality has yet to be determined. MATERIAL AND METHODS: 46-years old male underwent bilateral endoscopic ethmoidectomy due to chronic sinusitis. During surgery, a 5 mm in diameter tumour was identified in the left superior nasal meatus. On histopathological examination the diagnosis of esthesioneuroblastoma was established and confirmed by immunohistochemistry. The tumour was classified according to Kadish as stage A, according to Biller as T1. MR scans performed two months later disclosed pathological tissues in the left ethmoid region. RESULTS: Multiple biopsies taken on subsequent frontosphenoethmoidectomy did not contain tumour cells. The patient declined radiotherapy. He has been asymptomatic over the 12 monthsí follow-up period. CONCLUSIONS: The exclusively surgical treatment proved effective due to early stage of the tumour and no evidence of infiltration of the frontal skull base. This strategy, however, requires frequent follow-up visits.

[Bezold's abscess: a rare complication of otitis media]. / Ropien Bezolda--rzadkie usznopochodne powiklanie.

The authors present the case of a 21-year-old female in who, during the course of cholesteatoma, extracranial complications occurred twice in the form of Bezold's abscess. This type of the complication of otitis media occurs extremely rare. Medical literature has recorded about 20 cases of such complications. Due to commonly applied antibiotic therapies, extracranial and intracranial complications are rarely recorded in the course of otitis media, their mortality rate, however, amounts to a dozen or so per cent. The paper presents the way in witch the infection of otitis media spreads towards the neck. The authors stress the significance of computer tomography in diagnostic. Radical mastoidectomy and exploration of the neck were performed on the patient. Antibiotic regimens were based on antimicrobial sensitivity patterns. Presently, the patients is under constant laryngologist observation.