Antoni Bruzgielewicz

Tuberculosis of the head and neck - epidemiological and clinical presentation.

Introduction The aim of our retrospective study was to review the clinical and epidemiological presentation of head and neck tuberculosis. Material and methods We analyzed the history of 73 patients with head and neck tuberculosis hospitalized in the Department of Otolaryngology, Medical University of Warsaw, between 1983 and 2009. Results We found that 26 (35.6%) patients presented with lymph node tuberculosis, 20 (27.4%) with laryngeal tuberculosis, 10 (13.7%) with oropharyngeal tuberculosis, 9 (12.3%) with salivary gland tuberculosis, 3 (4.1%) with tuberculosis of paranasal sinuses, 3 (4.1%) with aural tuberculosis, and 2 (2.7%) with skin tuberculosis in the head and neck region. Within the group of patients with lymph node tuberculosis in 15 cases there were infected lymph nodes of the 2nd and 3rd cervical region and in 11 infected lymph nodes of the 1st cervical region. In 5 cases of laryngeal tuberculosis there was detected coexistence of cancer. Oropharyngeal tuberculosis in 7 cases was localized in tonsils, where in 1 case coexisting cancer was diagnosed. Chest X-ray was performed in all cases and pulmonary tuberculosis was identified in 26 (35.6%) cases. Conclusions We conclude that tuberculosis still remains a problem and must be taken into consideration in the diagnostic process. The coincidence of tuberculosis and cancer is remarkable in the head and neck region.

Association of Polymorphic Variants of miRNA Processing Genes with Larynx Cancer Risk in a Polish Population

Laryngeal cancer (LC) is one of the most prevalent types of head and neck cancer. An increasing interest has been focused on the role of microRNA (miRNAs) in LC development. The study group consisted of 135 larynx cancer patients and 170 cancer-free individuals. Nine polymorphisms of pre-miRNA processing genes, DROSHA (rs6877842), DGCR8 (rs3757, rs417309, and rs1640299), RAN (rs14035), XPO5 (rs11077), DICER1 (rs13078 and rs3742330) and TARBP2 (rs784567), were performed by TaqMan SNP Genotyping Assay. It was found that the frequency of the GT and the TT polymorphic variants of XPO5 gene were higher in LC patients than in controls (p < 0.0001 and p = 0.000183, resp.). In turn, the frequency of the CT genotype of RAN gene was higher in controls than in LC patients (p < 0.0001). The TT and the AG of DICER1 gene (p = 0.034697 for rs13078 and p = 0.0004 for rs3742330) as well as the AG and the GG genotypes of TARBP2 gene (p = 0.008335 and p < 0.0001, resp.) were associated with higher risk of LC occurrence. Our data suggested that polymorphisms of miRNA processing genes might be useful as predictive factors for the LC development.

Zastosowanie petrosektomii bocznej w patologii ucha i kości skroniowej

Summary Introduction Certain problems in ear surgery are caused by temporal bone cholestetoma and chronic otitis media complicated by deafness, facial nerve dysfunction, vertigo or meningcephalocele. Lateral petrosectomy offers possibility of radical treatment and prevention of temporal bone destruction and following complications. Aim of study It is an analysis of indications for lateral petrosectomy and its results as a treatment of otitis media and temporal bone cholesteatoma. The possibility of synchronous cochlear implantation is noted. Material Retrospective analysis of 62 patients after lateral petrosectomy, operated in the Department of Otolaryngology at the Medical University of Warsaw in 2001–2009. The group consisted of thirty one men and thirty one women. Results Thirty two patients suffered from chronic granuloma or chronic choleateatoma otitis media or temporal bone cholesteatoma. Seventeen patients suffered from deafness prior surgery. Cochlear implantation was possible in five patients: two of them after cranium fracture, two with deafness caused by chronic otitis media and one with deafness caused by osteoradionecrosis. Intraoperative CSF leak was observed of eight patients. In one case lateral perosectomy was used as a treatment of CSF leak after removal of cerebellopontine tumor. There was no evidence of CSF leak after surgery. Facial nerve dysfunction was observed in fifteen cases. Conclusions Lateral petrosectomy offers possibility of radical treatment in same patients with chronic otorrhea. The total removal of cholesteatoma prevents intracranial and intratemporal complications in case of chronic otitis media. Patients after lateral petrosectomy require systematic ENT and radiological (CT, NMR) examination.INTRODUCTION Certain problems in ear surgery are caused by temporal bone cholestetoma and chronic otitis media complicated by deafness, facial nerve dysfunction, vertigo or meningcephalocele. Lateral petrosectomy offers possibility of radical treatment and prevention of temporal bone destruction and following complications. AIM OF STUDY It is an analysis of indications for lateral petrosectomy and its results as a treatment of otitis media and temporal bone cholesteatoma. The possibility of synchronous cochlear implantation is noted. MATERIAL Retrospective analysis of 62 patients after lateral petrosectomy, operated in the Department of Otolaryngology at the Medical University of Warsaw in 2001-2009. The group consisted of thirty one men and thirty one women. RESULTS Thirty two patients suffered from chronic granuloma or chronic choleateatoma otitis media or temporal bone cholesteatoma. Seventeen patients suffered from deafness prior surgery. Cochlear implantation was possible in five patients: two of them after cranium fracture, two with deafness caused by chronic otitis media and one with deafness caused by osteoradionecrosis. Intraoperative CSF leak was observed of eight patients. In one case lateral perosectomy was used as a treatment of CSF leak after removal of cerebellopontine tumor. There was no evidence of CSF leak after surgery. Facial nerve dysfunction was observed in fifteen cases. CONCLUSIONS Lateral petrosectomy offers possibility of radical treatment in same patients with chronic otorrhea. The total removal of cholesteatoma prevents intracranial and intratemporal complications in case of chronic otitis media. Patients after lateral petrosectomy require systematic ENT and radiological (CT, NMR) examination.

Rak gruczołowato-torbielowaty głowy i szyi – doświadczenie 10 lat

Summary Introduction Adenoid cystic carcinoma (ACC) was first described in 1853 and 1854 by three french scientists, Robin, Lorain and Laboulbene. ACC is a rare cancer of the head and neck (about 1%) and it comprises from 6% to 10% of all malignant tumors of the salivary glands. 15%–30% of these tumors are located in submandibular gland, 30% occur in small salivary glands (in the palate, tongue, mouth, nose, sinuses, mucous membrane of the cheeks) and about 6% in parotid gland. Because of its specificity ACC is a challenge for the doctor – it is usually recognized at an advanced stage, spreads along the nerves, it has a high propensity for recurrence, often gives distant metastases, 10-year survival are very small. Aims Aim of this study is the epidemiological and clinical analysis of patients with adenoid cystic carcinoma. Material and methods Includes a retrospective analysis of 21 cases of patients with ACC of the head and neck were hospitalized at the ENT Clinic of the Warsaw Medical University between 2001 and 2011. Data from medical records contain information about the location of the tumor, symptoms and clinical signs, diagnostic methods, method of treatment and local recurrences and distant metastases. Results most cases ACC occurred in the large salivary glands (14 cases), in 5 cases in the nasal cavity and maxillofacial region, in 2 cases in the tongue. In order to accurately determine the extent of the tumor, its relationship to adjacent structures was performed computed tomography and magnetic resonance imaging. Most of patients before treatment have been made biopsy of the tumor or download tissues by forceps for histopathological examination. Reported symptoms depend on the location of the tumor. In 20 cases the patients were treated by surgical therapy and followed by radiotherapy, in one case because of the extent of the tumor was sent to radiotherapy. Conclusions Surgical treatment of ACC requires a wide margin of healthy tissues; For the risk of local recurrences affected positive surgical margins, scull base locations of primary tumor and perineural invasion; Because of unpredictable nature of the tumor (local recurrences, distant metastasis), observation of patients after treatment should be carried out permanently, along with periodic imaging studies.

Postępowanie w przypadkach wznowy brodawczaka odwróconego nosa i zatok przynosowych po leczeniu operacyjnym w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego

Summary Introduction Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5–4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach. The aim of study was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009. Material The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years. Results Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell-Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy. Conclusions 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualification for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.

Metoda oceny ruchomości kosteczek słuchowych. Badanie eksperymentalne i możliwe zastosowanie kliniczne

Summary Aim of study Evaluation of usefulness new non-contact method- Laser Doppler vibrometry (LDV) in measurements of movability of ossicular chain during second look operation was aim of the study. We would like answer to questions: 1. Is LDV helpful in intraoperative conditions? 2. Which measurements points have the largest practical value? 3. Which measured parameters could be used to determination of effectiveness ossicular chain reconstruction? Methods and materials In experiment there were taken 3 fresh temporal bones kept in 0,9% NaCl. In first stage were executed: antromastoidectomy with wide tympanotomy. The ossicular chain movability investigation was conducted on: back branch of stapes, front branch of stapes, round window, umbo of eardrum. Laser Doppler Vibrometer was used to measurement ossicular chains movability. ER-2 loudspeakers were generated wave: 1000 Hz, 2000 Hz, 4000Hz. In second stage were executed: Malleus-Stapes Assembly (MSA) ossicular chains reconstruction and repeated investigation in measured points. Results The most convenient points to measurement were respectively: back branch of stapes, front branch of stapes, umbo of eardrum. In two cases round window was placed in deep niche and was partly covered by facial nerve. MSA performance didn’t influence accessibility of measuring points. Theresholds of measured points movability was useful to evaluation of reconstruction. Conclusions Back branch of stapes, front branch of stapes and umbo of eardrum are useful to intraoperatve measurements ossicular chain movability. Delimitation thresholds of ossicular chain movability can help in reconstructions evaluation. After next experiments LDV can be use in practice-intraoperative.

First bilateral simultaneous implantation with fully implantable middle ear hearing device

The majority of moderate to severe sensorineural hearing loss individuals must rely on amplification of the acoustic signal to improve communication skills. This aim is generally accomplished with conventional air conduction hearing aids [1]. In some cases, hearing aid wearers report difficulties and limited adoption of hearing aids due to ear canal occlusion, pain or irritation of the skin in the ear canal, social stigma, and cosmetic issues [2]. The fully implantable middle ear hearing device is now an alternative solution for those patients. It resides completely underneath the skin behind the ear, with nothing in the external ear canal. The Otologics Carina implant is composed of an electronic capsule, microphone, and electromagnetic transducer. The battery, magnet, digital signal processor, coil, and connector make up the electronic capsule [1, 2]. The sensitive subcutaneous microphone picks up the acoustic signal, which is then translated into a digital signal, amplified according to the wearers needs, and converted into the electrical signal. This electrical signal is sent to the electromagnetic transducer, which translates it into a mechanical motion that directly stimulates the ossicles. The tip of the transducer touches the middle ear ossicular chain, round or oval window and in this way bypasses the external ear canal [1–5].

Przydatność badania ruchomości okienka okrągłego za pomocą Laser Doppler Vibrometer w ocenie rekonstrukcji łańcucha kosteczek słuchowych w tympanoplastykach typu zamkniętego

Summary Round windows movability measurements with helping of LDV in evaluation of ossicular chain functioning. Aim of study Quantitive evaluation of round window movability in normal conditions and after malleus stapes assembly reconstruction were aims of the study. Methods and materials In the experiment there were taken 10 non-frozen temporal bones harvested within 48 hours.Temporal bones specimens were prepared like in closed technique with antromastoidectomy and large posterior tympanotomy. Hearing system before and after MSA reconstruction were evaluated by measurement of round window movement. Measurements were performed at four frequencies: 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. Results In the normal ossicular chain the biggest movability were stated at frequency of 1 kHz. After reconstruction at all frequencies measurements were significantly worse. In reconstructed ears the highest movabilities were stated at frequencies 2000 Hz and 4000 Hz. Conclusions Round window movability could be measured by Laser Doppler Vibrometry in posterior tympanotomy approach. Before reconstruction the biggest movability were evaluated at 1000 Hz and after MSA at 2000 Hz.UNLABELLED Round windows movability measurements with helping of LDV in evaluation of ossicular chain functioning. AIM OF STUDY Quantitive evaluation of round window movability in normal conditions and after malleus stapes assembly reconstruction were aims of the study. METHODS AND MATERIALS In the experiment there were taken 10 non-frozen temporal bones harvested within 48 hours. Temporal bones specimens were prepared like in closed technique with antromastoidectomy and large posterior tympanotomy. Hearing system before and after MSA reconstruction were evaluated by measurement of round window movement. Measurements were performed at four frequencies: 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. RESULTS In the normal ossicular chain the biggest movability were stated at frequency of 1 kHz. After reconstruction at all frequencies measurements were significantly worse. In reconstructed ears the highest movabilities were stated at frequencies 2000 Hz and 4000 Hz. CONCLUSIONS Round window movability could be measured by Laser Doppler Vibrometry in posterior tympanotomy approach. Before reconstruction the biggest movability were evaluated at 1000 Hz and after MSA at 2000 Hz

Videolaryngoscopic and videostroboscopic evaluation following laser CO2 and conventional cordectomy of Tis and T1 glottic carcinoma

Introduction This paper is an analysis of long-term functional results, observed on videolaryngoscopic and videostroboscopic examination, of two different types of surgical intervention for Tis and T1 glottic carcinoma: laryngofissure conventional cordectomy and endoscopic laser CO2 cordectomy, with or without additional radiation therapy (using 60Co). Material and methods A total of 46 patients with Tis and T1 glottic carcinoma, 43 men (93.48%) and 3 women (6.52%), served as subjects. All were treated surgically with laryngofissure conventional cordectomy (15 patients, 32.61%) or endoscopic laser CO2 cordectomy (31 patients, 67.39%). The procedures were performed in the Department of Otolaryngology at the Medical University of Warsaw between November 1990 and February 2004. Videolaryngoscopic and videostroboscopic examinations were conducted a minimum of 3 years after the surgery, between January 2006 and February 2007. The appearance of the neocord (the scar after cordectomy), scar or synechia formation in the anterior commissure, movements of the vocal folds on respiration and phonation, difference in level between the neocord and the normal vocal fold, glottic closure, phonation type, and ventricular folds hyperfunction were examined. The symmetry of vocal fold vibrations, regularity of vibrations, glottic closure, amplitude of vibrations, and mucosal wave were also evaluated. Results In our study, the videolaryngoscopic and videolaryngostroboscopic examination showed a significantly higher occurrence of the following findings in patients after endoscopic laser cordectomy: phonation at the glottic level, complete glottic closure, and a tendency to vibration of the neocord on phonation. Conclusions Ventricular hyperfunction on phonation and scar or synechia formation in the anterior commissure were observed statistically more frequently in patients after laryngofissure conventional cordectomy.

Evaluation of polymorphisms in microRNA biosynthesis genes and risk of laryngeal cancer in the Polish population

MicroRNAs are the largest group of short regulatory RNAs. They regulate genes participating in many physiological and pathological processes. The role of micro RNAs in cancer development is also considerable. Therefore, the aim of this study was to evaluate the relationship between DROSHA (rs6877842) and DGCR8 (rs417309, rs1640299) gene polymorphisms with risk of occurrence of laryngeal cancer. The study included 100 patients and 100 healthy subjects. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissues. Analysis of the gene polymorphisms was performed using TaqMan SNP Genotyping Assay. The rs417309 AA genotype was found to be correlated with increased risk of larynx cancer. The rs1640299 TG and rs6877842 CG heterozygotes were significantly inversely associated with the presence of larynx cancer. Additionally, rs417309 AA genotype increased the risk of larynx cancer in the T1 stage, and the rs1640299 TG heterozygote occurred more frequently in the control group than those in the T3 and T4 stage. The rs417309 and rs1640299 polymorphisms of the DGCR8 gene as well as rs6877842 of the DROSHA gene might be associated with a risk of laryngeal cancer occurrence in the Polish population.