Hanna Zielińska-Bliźniewska

Electronystagmography versus videonystagmography in diagnosis of vertigo

ObjectivesVertigo is a very common symptom mainly caused by the lesion of vestibular system (peripheral or central) and often accompanied by some work-related diseases and occupational intoxications. The aim of this study was to assess the value of electronystagmography (ENG) and videonystagmography (VNG) for diagnosing vertigo of various origin.Materials and MethodsThe study included four groups, 25 subjects each, of patients suffering from vestibular disorders of peripheral, central and mixed origin versus healthy controls. All were examined by means of ENG and VNG, using the bithermal caloric test with 30°C and 44°C air irrigations of the ears. The findings (frequency of induced nystagmus FRQ, its slow phase velocity SPV, canal paresis CP, directional preponderance DP, vestibular excitability VE) were analysed and compared.ResultsIn all patients with vertigo due to vestibular neuritis, barotrauma and kinetosis, significant CP, the important sign of peripheral site of vestibular lesion was identified both in ENG and VNG. None of the patients with central origin disorders showed CP in VNG; in the majority of cases DP was observed. However, in ENG we found CP in 5 patients with central origin disorders. There were no essential differences between ENG and VNG in measurements of FRQ and SPV except for higher values in VNG in controls and patients with mixed vertigo.ConclusionsThe results suggest that the VNG should be recommended in preference as the valuable method to assess vertigo and to discriminate between the peripheral and the central vestibular lesions.

Analiza oceny histopatologicznej zmian patologicznych usuniętych w endoskopowych operacjach nosa i zatok przynosowych w materiale własnym

Summary Introduction The work aimed at evaluating results of histopathological examination of postoperative material in endoscopic paranasal sinus surgery in the own material. Material and methods The analysis covered 3,896 results of histopathological examination of routine postoperative material from the Department of Clinical Pathomorphology and Cytopathology Military Medical Academy University Clinical Hospital in Lodz. The study was conducted in hematoxylin and eosin staining according to the principles of this method. The postoperative material included pathological lesions removed by endoscopic surgery of the nose and paranasal sinuses in patients who were treated at Department of Otolaryngology and Laryngological Oncology between 2006 and 2010. The treatment included 1,118 patients, 509 women at the age of 15–79 and 609 men aged 17–77. The material for histopathological examination was sent from merely 1,176 operations because 57 patients were operated twice and one patient was operated three times. Results Polyps within the nose and paranasal sinuses were confirmed by histopathological examination in 705 patients, including 289 women and 416 men. Hypertrophic changes were diagnosed in 404 patients, including 218 women and 186 men. Inverted papilloma was recognised in histopathological examination in 9 patients, including 2 women and 7 men. Hypertrophies were slightly more common in women than in men. Both in men and women unilateral hypertrophic changes within the ostiomeatal complex were predominant, 42.66% in women and 40.86% in men. Conclusion Histopathological examination of postoperative material in patients under endoscopic treatment due to paranasal sinusitis is considerably important for complex evaluation of inflammation type and confirmation of indications for appropriate anti-inflammatory therapy.

The ability of selected plant essential oils to enhance the action of recommended antibiotics against pathogenic wound bacteria

The aim of this work was to characterize the ability of essential oils to support antibiotics against pathogenic bacteria in wounds. Gram-positive and Gram-negative bacteria obtained from wound infections were identified according to standard microbiological methods. Essential oils were analysed by GC-FID-MS. The susceptibility of bacteria to antibiotics, essential oils and their combination was assessed using the disc-diffusion method. The Minimal Inhibitory Concentration and Minimum Bactericidal Concentration of the essential oils were established by the micro-dilution broth method. Although cinnamon, clove, thyme and lavender essential oils were found to have the greatest antibacterial activity when used alone, the greatest additive and synergistic effects against pathogenic wound bacteria in combination with recommended antibiotics were demonstrated by basil, clary sage and rosemary oils.

Porównanie wpływu różnych rodzajów znieczulenia na kontrolę krwawienia śródoperacyjnego w operacjach endoskopowych zatok przynosowych

Summary Introduction The study aimed at evaluating the influence of targeted hypotension with three types of anaesthetics on the amount of blood loss in extensive endoscopic operations of polyps of the nose and paranasal sinuses. Material and methods Ninety patients, including 30 women aged 31–73 and 60 men aged 21–79, who were operated within the period of 2008–2010 at Department of Otolaryngology and Laryngological Oncology Military Medical Academy University Clinical Hospital in Lodz, were qualified for the study. The bilateral removal of nasal polyps, bilateral ethmoidectomy, and surgery or revision of the maxillary, sphenoid and temporal sinuses in endoscopy were conducted in each patient. Due to the type of general anaesthesia the patients were divided into three groups, 30 patients each: I – sevoflurane inhalation (sedation) and fentanyl I.V., II – sevoflurane inhalation (sedation) and remifentanil I.V. (analgesia), III – TIVA, propofol sedation and remifentanil analgesia. The drugs were administered via the infusion pomp TCI. Results In group I the mean anaesthesia time was 108.67±20.80 min., group II – 112.63±22.17 min., group III – 103.67±17.47 min. The surgery time in the studied groups was as follows: I – 71.33±16.71 min, II – 78.83±24.24 min, III – 66.5±15.49 min. During the operation the mean blood loss was: group I – 365±176.2 ml, group II – 340±150.5 ml, group III – 225±91.7 ml. During the operation the mean rate of blood loss was: group I – 5.118±2.38 ml/min, II – 4.507±2.215 ml/min, group III – 3.416±1.059 ml/min. Conclusions In TIVA the advanced technologically control of a drug dose allows for a better control of hypotension, which, finally, results in lower haemorrhage within the operation area, a favourable condition for both a patient and a physician. Perioperative bleeding was independent on sex in every type of anaesthesia.INTRODUCTION The study aimed at evaluating the influence of targeted hypotension with three types of anaesthetics on the amount of blood loss in extensive endoscopic operations of polyps of the nose and paranasal sinuses. MATERIAL AND METHODS Ninety patients, including 30 women aged 31-73 and 60 men aged 21-79, who were operated within the period of 2008-2010 at Department of Otolaryngology and Laryngological Oncology Military Medical Academy University Clinical Hospital in Lodz, were qualified for the study. The bilateral removal of nasal polyps, bilateral ethmoidectomy, and surgery or revision of the maxillary, sphenoid and temporal sinuses in endoscopy were conducted in each patient. Due to the type of general anaesthesia the patients were divided into three groups, 30 patients each: I – sevoflurane inhalation (sedation) and fentanyl I.V., II – sevoflurane inhalation (sedation) and remifentanil I.V. (analgesia), III – TIVA, propofol sedation and remifentanil analgesia. The drugs were administered via the infusion pomp TCI. RESULTS In group I the mean anaesthesia time was 108.67±20.80 min., group II – 112.63±22.17 min., group III – 103.67±17.47 min. The surgery time in the studied groups was as follows: I – 71.33±16.71 min, II – 78.83±24.24 min, III – 66.5±15.49 min. During the operation the mean blood loss was: group I – 365±176.2 ml, group II – 340±150.5 ml, group III – 225±91.7 ml. During the operation the mean rate of blood loss was: group I – 5.118±2.38 ml/min, II – 4.507±2.215 ml/min, group III – 3.416±1.059 ml/min. CONCLUSIONS In TIVA the advanced technologically control of a drug dose allows for a better control of hypotension, which, finally, results in lower haemorrhage within the operation area, a favourable condition for both a patient and a physician. Perioperative bleeding was independent on sex in every type of anaesthesia.

Znaczenie polimorfizmu -765G/C genu COX-2 dla patogenezy przewlekłego zapalenia zatok przynosowych z polipami nosa w populacji polskiej

Summary Introduction It is believed that local factors within the nasal cavities contribute to the formation of nasal polyps. The disruption of local homeostasis mechanisms in a chronic inflammatory process is one of those factors. Cyclooxygenase (COX)-2 expression is activated in the course of the immune response to extracellular and intracellular stimuli. Also, an increase of the gene expression can be associated with the development of nasal polyps in patients with chronic sinusitis. The aim of the study The aim of this study was an evaluation of the role of the -765G/C COX-2 polymorphism in sinusitis pathogenesis in patients with nasal polyps. Materials and methods The study group consisted of 100 patients, aged 35–65, with chronic sinusitis and nasal polyps and 150 people in the age, sex-, age- and ethnicity-matched control group. The study material included DNA isolated from peripheral blood lymphocytes of the patients and the controls. PCR-RFLP method was used in genotyping polymorphic variants of COX-2. Results In comparison to the control group, the group of the patients with chronic sinusitis and nasal polyps showed a statistically significant increase in the occurrence frequency of the -765G/C polymorphic variant of COX-2 gene (OR 4.04; 95% CI 2.32–7.03; p > 0.001) and C allele (OR 3.68; 95% CI 2.38–5.68; p Conclusions The -765G/C genotype of COX-2 can be associated with an increased risk of the occurrence of chronic sinusitis with nasal polyps in the Polish population Hasla indeksowe COX-2, polimorfizm genow, stany zapalne nosa i zatok, polipy nosa

Sensitivity evaluation in air and water caloric stimulation of the vestibular organs using videonystagmography.

INTRODUCTION The aim of the study was to compare air and water caloric stimulation of the vestibular organs using videonystagmography (VNG). MATERIAL AND METHODS The study covered 18 women aged 21-63 and 11 men aged 21-74 years hospitalized at the ENT, without complaints for vertigo and/or balance disorders. The alternate binaural bithermal caloric test with cool 30°C and warm 44°C air or water irrigations (after 2h interval for the recordings) with the use of VNG was done. RESULTS All parameters of air and water vestibular caloric stimulations, assessed in the VNG, differed significantly but were within the normal range. The research showed a statistically significant difference between canal paresis but only for the left ear at 30°C and 44°C. Absolute directional preponderance, relative directional preponderance, vestibular excitability, slow component velocity, frequency were different statistically for both ears at both temperatures. CONCLUSIONS Our study showed that both air and water caloric stimulations were able to distinguish physiological and impaired vestibular function. The obtained results showed statistically higher response for water than air stimulation.

Ocena skuteczności leczenia chorych z zawrotami głowy typu mieszanego za pomocą rehabilitacji ruchowej

INTRODUCTION The aim of this work was to evaluate the efficiency of kinesitherapy in the patients with mixed-type vertigo. MATERIAL AND METHODS The study was conducted on a randomized group of 35 patients, 21 women and 14 men aged 24-75 years (mean age 42.5 years), who were treated at the Department of Otolaryngology and Laryngological Oncology Medical University Teaching Hospital in Lodz for mixed-type vertigo. The inclusion criteria were an interview, physical and otorhinolaryngological examinations, laboratory investigations, complete audiological and otoneurological examinations, including BERA and VNG, USG examination of the blood vessels to the cranium, and CT of the cervical spine. Each patient underwent an individually selected set of habituation exercises, corrective exercises for posture and its orientation in space through 2 months. The efficiency of the implemented therapy was evaluated after two weeks, one month and two months with the use of the complete videonystagmographic test and Silvoniemis criteria. RESULTS The mean excitability of the labyrinths was 25.38 degrees/s before rehabilitation and 22.26 degrees/s after rehabilitation, absolute directional preponderance was 7.62 degrees/s and 1.92 degrees/s respectively, relative directional preponderance was 31.36 degrees/s and 12.57 degrees/s, and unilateral deficit 32.12 degrees/s and 14.34 degrees/s. The subjective evaluation of the vertigo intensification based on the 5 stages of Silvoniemis scale indicates that the mean point-based evaluation reported by the patients at the beginning of the therapy was 3.85 points, whereas after the therapy was 2.91 points after two weeks, 2.35 points after one month, and 1.2 points after two months. CONCLUSIONS Kinesitherapy is an alternative and very effective method for treating mixed-type vertigo.

Evaluation of vocal acoustic and efficiency analysis parameters in medical students and academic teachers with use of iris and diagnoscope specialist software

ObjectivesThe aim of this study was to compare the parameters of vocal acoustic and vocal efficiency analyses in medical students and academic teachers with use of the IRIS and DiagnoScope Specialist software and to evaluate their usefulness in prevention and certification of occupational disease.Material and MethodsThe study group comprised 40 women, including students and employees of the Military Medical Faculty, Medical University of Łodź. After informed consent had been obtained from the participant women, the primary medical history was taken, videolaryngoscopic and stroboscopic examinations were performed and diagnostic vocal acoustic analysis was carried out with the use of the IRIS and Diagno-Scope Specialist software.ResultsBased on the results of the performed measurements, the statistical analysis evidenced the compatibility between two software programs, IRIS and DiagnoScope Specialist, with the only exception of the F4 formant. The mean values of vocal acoustic parameters in medical students and academic teachers, obtained by means of the IRIS software, can be used as standards for the female population not yet developed by the producer. When using the DiagnoScope Specialist software, some mean values were higher and some lower than the standards specified by the producer.ConclusionsThe study evidenced the compatibility between two measurement software programs, IRIS and DiagnoScope Specialist, except for the F4 formant. It should be noted that the later has advantage over the former since the standard values of vocal acoustic parameters have been worked out by the producer. Moreover, they only slightly departed from the values obtained in our study and may be useful in diagnostics of occupational voice disorders.

Szumy uszne a depresja

INTRODUCTION The aim of the study was to assess the frequency of depression and its intensity in patients with diagnosed tinnitus and their correlation with selected audiological parameters. MATERIAL AND METHODS 80 patients underwent the study, including 46 females (57.5%) and 34 males (42.5%) aged 20-84 suffering from tinnitus. The study methodology included: an interview, otorhinolaryngological examination, full audiological diagnostics and imaging test (CT or MR). Patients who qualified for the study completed a modified questionnaire according to the Beck Depression Inventory (BDI). THE STUDY RESULTS: The study found the depression level higher than the one in the general population and amounting to 45%, with 41.2% of the patients suffering from masked depression (a mean rating scale of 14-16), and 3.7% of the patients showing symptoms of moderate depression (27 points according to the rating scale). The own studies showed no statistically meaningful relation between intensification of depression in the studied patients and their age and sex as well as acoustic parameters such as frequency, tinnitus localization. However, a statistically variable relation was noted showing that the longer a patient suffered from tinnitus the more often depression occurred. CONCLUSIONS The occurrence of depression among the studied patients with tinnitus is higher than in the Polish population. In the conducted studies dominated depression of mild intensity. It was affirmed that depression occurred more often in patients with tinnitus lasting longer than 5 years.Summary Introduction The aim of the study was to assess the frequency of depression and its intensity in patients with diagnosed tinnitus and their correlation with selected audiological parameters. Material and methods 80 patients underwent the study, including 46 females (57,5%) and 34 males (42,5%) aged 20–84 suffering from tinnitus. The study methodology included: an interview, otorhinolaryngological examination, full audiological diagnostics and imaging test (CT or MR). Patients who qualified for the study completed a modified questionnaire according to the Beck Depression Inventory (BDI). The study results The study found the depression level higher than the one in the general population and amounting to 45%, with 41,2% of the patients suffering from masked depression (a mean rating scale of 14–16), and 3,7% of the patients showing symptoms of moderate depression (27 points according to the rating scale).The own studies showed no statistically meaningful relation between intensification of depression in the studied patients and their age and sex as well as acoustic parameters such as frequency, tinnitus localization. However, a statistically variable relation was noted showing that the longer a patient suffered from tinnitus the more often depression occurred. Conclusions The occurrence of depression among the studied patients with tinnitus is higher than in the Polish population. In the conducted studies dominated depression of mild intensity. It was affirmed that depression occurred more often in patients with tinnitus lasting longer than 5 years.

Acoustic and capacity analysis of voice academic teachers with diagnosed hyperfunctional dysphonia by using DiagnoScope Specialist software.

OBJECTIVES The aim of the study was to assess the acoustic and capacity analyses of voice in academic teachers with hyperfunctional dysphonia using DiagnoScope Specialist software. MATERIAL AND METHODS The study covered 46 female academic teachers aged 34-48 years. The women were diagnosed with hyperfunctional dysphonia (with absence of organic pathologies). Having obtained the informed consent, a primary medical history was taken, videolaryngoscopic and stroboscopic examinations were performed and diagnostic voice acoustic and capacity analyses were carried out using DiagnoScope Specialist software. RESULTS The acoustic analysis carried out of academic teachers with diagnosed hyperfunctional dysphonia showed enhancement in the following parameters: fundamental frequency (FO) by 1.2%; relative average perturbation (Jitter by 100.0% and RAP by 81.8%); relative amplitude perturbation quotient (APQ) by 2.9%; non-harmonic to harmonic ratio (U2H) by 16.0%; and noise to harmonic ratio (NHR) by 13.4%. A decrease of 2.5% from normal values was noted in relative amplitude perturbation (Shimmer). Formant frequencies also showed reduction (F1 by 10.7%, F2 by 5.1%, F3 by 2.2%, and F4 by 3.5%). The harmonic perturbation quotient (HPQ) was 0.8% lower and the residual harmonic perturbation quotient (RHPQ) 16.8% lower, with the residual to harmonic (R2H) decreasing by 35.1 per cent; the sub-harmonic to harmonic (S2H) by 2.4%; and the Yanagihara coefficient by 20.2%. CONCLUSIONS The capacity analysis with the DiagnoScope Specialist software showed figures significantly lower than normal values of the following parameters: phonation time, true phonation time, phonation break coefficients, vocal capacity coefficient and mean vocal capacity.