Grażyna Greczka

Hearing impairment in Polish infants.

To the Editor: Hearing impairment has been reported as occurring in 1 to 2 per 1000 neonates.1,2 However, hearing loss is a highly heterogeneous condition, with varying severity (mild, moderate, severe, and profound) and type (conductive, sensorineural, and mixed). Hearing loss can be unilateral or bilateral, stable or progressive, and temporary or permanent. Hearing “loss” or impairment typically refers to a hearing limit of 40 dB for the better ear.1 With wider inclusion criteria for hearing impairment (a limit of 25 dB in the worse ear), the prevalence of hearing impairment in infants has been reported as 2 to 3 per 1,000.2 Profound hearing loss defined as a bilateral sensorineural hearing limit of ≥ 70 dB has been reported in 4 to 10 per 10,000.3 Thus, population levels of hearing loss are highly dependent on definition. We present a detailed description of hearing impairment in Polish children up to 1 year of age. This population is relatively homogenous with respect to ethnic background, socioeconomic conditions, and health status. Data were obtained through the Polish Universal Neonatal Hearing Screening Program, organized and run by the charity foundation Great Orchestra of Christmas Charity (www.wosp.org.pl/eng). The program started in 2002, and since January 2003 has tested all newborns in Poland,4 >3.5 million babies. On the basis of data from the Polish Central Statistical Office, we estimate that 96% of the newborn population in Poland are screened in this program. Our results are based on infants registered in the program database between 2003 and 2011 (3,322,349 babies). Of these screened children, 9% (n = 292,375) were referred for further hearing evaluation. Among these, 9872 children (2.97 per 1000 infants) were diagnosed as having a hearing problem (defined as any hearing impairment with a threshold >20 dB). However, this evaluation did not originally specify diagnosis type or severity. More thorough evaluation was initiated after the start of the program and covered 5443 of the 9872 children. Assuming that the children who received thorough screening are representative of all children with hearing impairments, we have estimated the following population prevalence. Permanent (sensorineural) bilateral hearing impairment was found in 1.38 per 1000 children (Table). Of these, 40% had severe-to-profound bilateral hearing loss (the most devastating) (0.55 per 1,000). Of the two other types of bilateral hearing impairment, conductive loss was found in 0.47 per 1,000 and mixed hearing loss in 0.24 per 1,000, with a total of 2.09 per 1,000 having bilateral hearing loss. Including those with unilateral hearing loss, serious hearing loss was present among 3.0 per 1000 children. Considering only those with hearing loss >40 dB, prevalence was 2.0 per 1000—consistent with the prevalence estimates in other populations. We infer from these results that our extrapolation from the subset of children with complete examinations was sound. The more specific categorizations by severity and type of hearing loss shown in the Table provide a level of detail not usually available on a population level.

The risk factor profile of children covered by the Polish universal neonatal hearing screening program and its impact on hearing loss incidence

OBJECTIVE The high frequency of risk factors detected within the newborn population increases the total number of children that should receive regular follow-ups. However, in some circumstances, this could be beyond the capacity of the health system. Therefore, careful interpretation and selection of risk factors, and in particular of those factors not strictly defined, should be carried out during screening. The aim of the study was to analyse the risk factor profile of children covered by the national universal neonatal hearing screening program and to correlate it with hearing loss incidence. PATIENTS AND METHODS The analysis of records in the program database collected from 472 neonatal and well-baby units over a period of 10 years (2002-2012), focused on children with at least one risk factor. The analysis was subdivided into distribution of risk factors as well as to risk factors and hearing loss correlation. RESULTS In the studied cohort of n=137,432 children (4% of the total number of screened children) single risk factors were most frequently detected, accounting for 71% of records. The association of two or more risk factors appeared in 659 configurations (29%), with a mean of 3.1 coexisting risk factors and a maximum of 9. Hearing loss was dependent on the number of risk factors in a child, but reached its maximum with the association of 6 factors. CONCLUSIONS The detection of postnatal hearing loss should be continued in order to increase our understanding of hearing incidence and the role of environmental factors. To optimize screening, discussions between specialists (mostly related to the issue of risk factors detected and registered in the earliest stage of screening programs) would be beneficial.

Hearing impairment in premature newborns-Analysis based on the national hearing screening database in Poland.

Objectives The incidence of sensorineural hearing loss is between 1 and 3 per 1000 in healthy neonates and 2–4 per 100 in high-risk infants. The national universal neonatal hearing screening carried out in Poland since 2002 enables selection of infants with suspicion and/or risk factors of hearing loss. In this study, we assessed the incidence and risk factors of hearing impairment in infants ≤33 weeks’ gestational age (wga). Methods We analyzed the database of the Polish Universal Newborns Hearing Screening Program from 2010 to 2013. The study group involved 11438 infants born before 33 wga, the control group—1487730 infants. Screening was performed by means of transient evoked otoacoustic emissions. The risk factors of hearing loss were recorded. Infants who failed the screening test and/or had risk factors were referred for further audiological evaluation. Results Hearing deficit was diagnosed in 11% of infants ≤25 wga, 5% at 26–27 wga, 3.46% at 28 wga and 2–3% at 29–32 wga. In the control group the incidence of hearing deficit was 0.2% (2.87% with risk factors). The most important risk factors were craniofacial malformations, very low birth weight, low Apgar score and mechanical ventilation. Hearing screening was positive in 22.42% newborns ≤28 wga and 10% at 29–32 wga and in the control group. Conclusions Hearing impairment is a severe consequence of prematurity. Its prevalence is inversely related to the maturity of the baby. Premature infants have many concomitant risk factors which influence the occurrence of hearing deficit.

Universal Neonatal Hearing Screening Program in Poland--10-year summary.

INTRODUCTION The analysis was aimed to summarize the outcomes of Polish Universal Neonatal Hearing Screening Program (PUNHSP). MATERIALS AND METHODS The analysis comprised the population of children registered in the PUNHSP database between 2003 and 2013. The evaluated parameters included: the program coverage (percentage of children covered by the Program in relation to the number of births), results of screening tests at different levels of the Program and hearing loss incidence. RESULTS The average screened population was 96,0% with respect to total number of live births in Poland. Children requiring further evaluation represent annual average 8.5% of the study population. Among them, on average 55.8% were consulted in audiological centers. Hearing loss incidence was estimated to be 0,3%. The highest hearing loss incidence was detected in children which failed the OAE test with concomitant risk factors. 58.2% of children were fitted with hearing aids, 34.0% were referred for surgical treatment, and 7.8% for further rehabilitation. CONCLUSIONS The results of the program evaluation confirmed its good efficiency. The coverage and hearing tests results are comparable to those from other countries conducting similar national hearing screening programs.

The report on the Universal Neonatal Hearing Screening Program in Poland between 2003 and 2015.

The Universal Neonatal Hearing Screening Program (UNHSP) has been operating in the whole Poland since 2003. Its main goals are to perform a screening hearing in the 2-3 day of life in every newborn baby in Poland and to gather information on risk factors of hearing loss. In total, 505 centers participate in the UNHSP on three reference levels. As of January 19th 2016, the central data base (CDB) of the UNHSP has records of 4,845,036 children, which comprises 96% of all children born in Poland. Hearing loss was diagnosed in 12,974 children, i.e. in 3 out of 1000 children. Here, we present the most important results and conclusions of the UNHSP.

The report of the Polish Universal Neonatal Hearing Screening Program in 2016

The Polish Universal Neonatal Hearing Screening Program (PUNHSP) has been carried out in Poland for 14 years. The main aim of this Program is to organize hearing screening tests and to gather the information about risk factors of hearing loss in almost all newborns in Poland. It consists of 496 centers at 3 referral levels. A total of 5 458 114 children had been registered in the Central Database (CDB) of PUNHSP by the 22nd of August 2017. Bilateral sensorineural hearing loss was the most frequently appearing hearing impairment in children. It was diagnosed in 260 cases in 2016. This report presents the most important results and conclusions concerning the running of the PUNHSP in 2016.

Primary and salvage laser surgery of 341 glottic cancers-Comparison of treatment outcomes between University Head Neck Tertiary Referral Center and Local Head Neck Department: PRIMARY AND SALVAGE LASER SURGERY OF 341 GLOTTIC CANCERS

The main goal was to compare the clinical data of patients with T1 and T2 glottic cancer treated with CO2 transoral laser microlaryngoscopy (TLM) in the Tertiary Referral University Department of Otolaryngology, Head Neck Surgery, Poznan and the local Department of Otolaryngology, Oncology and Maxillofacial Surgery, Bydgoszcz.

Analysis of follow-up at the diagnostic level in the Polish Universal Neonatal Hearing Screening Programme

Objectives Routine analysis showed that between 1 June and 30 November 2014, only 47.6% of expected follow-up visits at the diagnostic level were registered in the Polish Universal Neonatal Hearing Screening Programme central database. We attempted to detect and analyse the reasons for this low percentage. Methods A telephone survey questionnaire was developed for parents whose children had not registered for consultation at the diagnostic level, or had not received a final diagnosis according to the programme database. Questions aimed to verify the database records and compare these with information received from and given to parents. From the 7888 children not registered at the diagnostic level, 3239 records were randomly selected, i.e. 52.4% of those who had been expected to attend. Results Questions were answered by 1950 parents (60.2% of the selected group). Of these, 52.1% (n = 734) had attended for diagnostic tests, but this was not recorded in the database. The most common reasons for not attending were the long waiting time for the visit (36.09%), lack of referral to a visit (25.9%) and conscious parent decision (16.35%). Conclusion The telephone survey disclosed omissions in database registration, and that in fact 83.6% of children had attended at the diagnostic level.

The analysis of expression of p16 protein in group of 53 patients treated for sinonasal inverted papilloma

INTRODUCTION Sinonasal inverted papilloma constitute relevant therapeutic problem due to destructive character of growth, tendency to recur and the possibility of malignant transformation. Therefore, many attempts to identify risk factors for inverted papilloma occurrence have been undertaken, as well as research to find markers that would allow for the earlier detection of tumors and the application of adequate therapy. A widely known risk factor of inverted papilloma is HPV infection. One of the markers of HPV infection and the ongoing effect of this change (although arousing some controversy) is the expression of the p16 protein. OBJECTIVE The aim of the study was to analyze the correlation between the expression of p16 as a surrogate of HPV infection in analyzed histopathological material and epidemiological variables, recurrences or malignant transformation. METHODS The retrospective study includes a group of 53 patients (18 women and 35 men) undergoing treatment for sinonasal inverted papilloma in the period of 2002-2012. The intensity of the p16 protein in histopathological material was scored as: 0 - no expression, 1 - diffuse expression (borderline) and 2 - positive expression; or 0 - no expression/diffuse expression (borderline); 1 - positive expression. The Ethics Committee agreement was obtained (1089/12; 245/13). RESULTS AND CONCLUSION There was no statistically significant relationship between the expression of p16 and the age of patients, cigarette smoking, tumor location, tumor staging according to the Krouse and Cannady classification, the presence of dysplasia or the occurrence of relapse.

Wzrost częstości występowania brodawczaków odwróconych masywu szczękowo-sitowego – analiza epidemiologiczna

In recent years, the incidence of sinonasal inverted papilloma (IP) in a stable population has increased significantly. The aim of the study was to analyze the occurrence of IP between the years 2002-2012 in relation to epidemiological factors in an unalterable area. Moreover, we wanted to start a discussion about the difficulties in determining the inci¬dence of benign lesions that are not included in registers. This retrospective study included a group of 69 patients who were treated in the Department of Otolaryngology, ENT Oncology, Poznań University of Medical Sciences. In 2006, we noticed a sudden change in referrals. We compared two groups of patients who were referred during two differ¬ent time periods: 11 patients (2002-2006) and 58 patients (2007-2012). Despite a marked difference in the number of patients, there were no differences between the groups in tumor location (p>0.05), stage (p=0.16), duration of symp¬toms (p=0.39), place of residence, and smoking (p=0.41). The patient`s age was the only variable that differed significantly between the groups (48.45 vs. 56.93 years; p=0.043569, respectively).In recent years, the incidence of sinonasal inverted papilloma (IP) in a stable population has increased significantly. The aim of the study was to analyze the occurrence of IP between the years 2002-2012 in relation to epidemiological factors in an unalterable area. Moreover, we wanted to start a discussion about the difficulties in determining the inci¬dence of benign lesions that are not included in registers. This retrospective study included a group of 69 patients who were treated in the Department of Otolaryngology, ENT Oncology, Poznan University of Medical Sciences. In 2006, we noticed a sudden change in referrals. We compared two groups of patients who were referred during two differ¬ent time periods: 11 patients (2002-2006) and 58 patients (2007-2012). Despite a marked difference in the number of patients, there were no differences between the groups in tumor location (p>0.05), stage (p=0.16), duration of symp¬toms (p=0.39), place of residence, and smoking (p=0.41). The patient`s age was the only variable that differed significantly between the groups (48.45 vs. 56.93 years; p=0.043569, respectively).