Jacek Sokołowski

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.

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.

Intraoperative Monitoring of Hearing Improvement during Ossiculoplasty by Laser-Doppler Vibrometry, Auditory Brainstem Responses, and Electrocochleography.

Intraoperative Monitoring of Hearing Improvement during Ossiculoplasty by Laser-Doppler Vibrometry, Auditory Brainstem Responses, and Electrocochleography Otolaryngology– Head and Neck Surgery 2014, Vol. 150(6) 1043–1047 American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814524365 http://otojournal.org

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

Sinusitis in patients undergoing allogeneic bone marrow transplantation – a review

INTRODUCTION Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation. OBJECTIVE The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation. METHODS An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications. RESULTS Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31-955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis. CONCLUSION Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT) prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT), preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation.

Metodologia pomiarów ruchomości elementów ucha środkowego za pomocą laserowej wibrometrii dopplerowskiej

Summary Introduction Laser Doppler vibrometry can potentially be applied in the measurement of the acoustic conductivity of the middle ear during tympanoplasty. Its usefulness in estimating the accuracy of ossiculoplasty requires experimentally verified. Aim The article presents the test procedure developed at the Department of Otolaryngology, Medical University of Warsaw for the displacement measurement of the conductive elements of the middle ear. Materials and method In the study were used 14 fresh-frozen temporal bones. In the initial stage was performed antrotomy with posterior tympanotomy. During the measurements, ER-2 speakers generated a signal with a frequency of 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. Acoustic conductivity of the middle ear was measured on the back branch of the stapes, round window. Laser Doppler Vibrometer was used to measure velocity of each selected elements of the ear. In four experiments were assessed the intraoperative availability of measurement points, the impact of laser beam angle changes and the presence of reflective tape on the amplitude of vibration measured point, intra- and interindividual variability of the method. Results For all measured frequencies intra-individual differences were no statistically significant. There were observed large differences between the velocity values in various temporal bones. Changing the angle of the laser beam does not significantly affect the results. Mucosal surface of the tympanic cavity does not reflect the laser beam. Conclusion Laser Doppler vibrometry can be used to measure motion of the middle ear sound conductivity with very good repeatability of measurements. Changing the angle of the laser beam should not vary amplitude of measurement during surgery. To maintain the sensitivity of response, it is necessary to use part of reflective tape.

Methodology for Intraoperative Laser Doppler Vibrometry Measurements of Ossicular Chain Reconstruction

Objectives Despite the increasing number of research concerning the applications of the Laser Doppler Vibrometry (LDV) in medicine, its usefulness is still under discussion. The aim of this study is to present a methodology developed in our Department for the LDV intraoperative assessment of ossicular chain reconstruction. Methods Ten patients who underwent “second look” tympanoplasty were involved in the study. The measurements of the acoustic conductivity of the middle ear were performed using the LDV system. Tone bursts with carrier frequencies of 500, 1,000, 2,000, and 4,000 Hz set in motion the ossicular chain. The study was divided into four experiments that examined the intra- and interindividual reproducibility, the utility of the posterior tympanotomy, the impact of changes in the laser beam angle, and the influence of reflective tape presence on measurements. Results There were no statistically significant differences between the two measurements performed in the same patient. However, interindividual differences were significant. In all cases, posterior tympanotomy proved to be useful for LDV measurements of the ossicular prosthesis vibrations. In most cases, changing the laser beam angle decreased signal amplitude about 1.5% (not significant change). The reflective tape was necessary to achieve adequate reflection of the laser beam. Conclusion LDV showed to be a valuable noncontact intraoperative tool for measurements of the middle ear conductive system mobility with a very good intraindividual repeatability. Neither a small change in the angle of the laser beam nor performing the measurements through posterior tympanotomy showed a significant influence on the results. Reflective tape was necessary to obtain good quality responses in LDV measurements.

Martwica popromienna kości skroniowej

Summary Introduction Radiotherapy is an effective, modern method of treating malignant neoplasms of head and neck and also intracranial tumours. Technological development and computerization of equipment used in radiotherapy enabled introduction of modern methods of treatment allowing decrease the risk of postradiation complications but not eliminating them completely. Postradiant necrosis of temporal bone that is osteoradionecrosis (ORN) is a quite well known complication of radiotherapy of head and neck tumours. Secretory otitis media, conductive deafness, excretion of sequesters through external auditory canal, inflammation and atresia of external auditory canal are common findings during examination. Cases of disseminated osteoradionecrosis need to be qualified for operation due to potential intratemporal and intracranial complications. Radical excision of necrotic tissue gives possibility of parallel cochlear implantation among patients with total bilateral deafness, which is a consequence of radiotherapy. Aims Aim of this study was clinical and epidemiological analysis of consequences and complications inside temporal bone which occurred after radiotherapy in the head and neck area. Conservative and surgical treatment possibilities according to progression of postradiant changes and severity of ailments were analyzed. Circumstances of conducting lateral petrosectomy with parallel cochlear implantation in case of osteoradionecrosis proceeding with total bilateral deafness were highlighted. Material and methods Retrospective analysis of 12 patients treated in the Department of Otolaryngology at the Medical University of Warsaw in 2000–2010 for postradiant consequences and complications inside the temporal bone was performed. The diagnosis of osteoradionecrosis was based on clinical ENT examination including meticulous microscopic examination, audiologic evaluation and CT scans of temporal bone. Results The group consisted of 5 men and 7 women. In 8 patients changes were unilateral and in 4 – bilateral. In total, 16 cases (ears) of osteoradionecrosis in the area of temporal bone were analyzed. Patients were mainly complaining about hearing loss or deafness, tinnitus, otalgia, otorhoea, feeling of fullness and distension in the ear. Presence of effusion in the middle ear was an indication for ventilation tube insertion. Cases of ORN potentially endangered by further complications needed surgical treatment, therein lateral petrosectomy. Case of osteoradionecrosis proceeding with total bilateral deafness needed a concurrent cochlear implantation. Only the patients with diffuse osteoradionecrosis confirmed by CT scans ere qualified for surgery. Conclusions Radiotherapy of head and neck tumours is charged with risk of complications, both early and appearing later after therapy. Osteoradionecrosis is found many years after radiation and the course of illness is repeatedly tricky and potentially life-threatening. In the face of complications resulting from the essence of illness surgical treatment, therein lateral petrosectomy is necessary. Complications of radiotherapy cannot eliminate it as a method of independent treatment nor combined with other methods.INTRODUCTION Radiotherapy is an effective, modern method of treating malignant neoplasms of head and neck and also intracranial tumours. Technological development and computerization of equipment used in radiotherapy enabled introduction of modern methods of treatment allowing decrease the risk of postradiation complications but not eliminating them completely. Postradiant necrosis of temporal bone that is osteoradionecrosis (ORN) is a quite well known complication of radiotherapy of head and neck tumours. Secretory otitis media, conductive deafness, excretion of sequesters through external auditory canal, inflammation and atresia of external auditory canal are common findings during examination. Cases of disseminated osteoradionecrosis need to be qualified for operation due to potential intratemporal and intracranial complications. Radical excision of necrotic tissue gives possibility of parallel cochlear implantation among patients with total bilateral deafness, which is a consequence of radiotherapy. AIMS Aim of this study was clinical and epidemiological analysis of consequences and complications inside temporal bone which occurred after radiotherapy in the head and neck area. Conservative and surgical treatment possibilities according to progression of postradiant changes and severity of ailments were analyzed. Circumstances of conducting lateral petrosectomy with parallel cochlear implantation in case of osteoradionecrosis proceeding with total bilateral deafness were highlighted. MATERIAL AND METHODS Retrospective analysis of 12 patients treated in the Department of Otolaryngology at the Medical University of Warsaw in 2000-2010 for postradiant consequences and complications inside the temporal bone was performed. The diagnosis of osteoradionecrosis was based on clinical ENT examination including meticulous microscopic examination, audiologic evaluation and CT scans of temporal bone. RESULTS The group consisted of 5 men and 7 women. In 8 patients changes were unilateral and in 4 - bilateral. In total, 16 cases (ears) of osteoradionecrosis in the area of temporal bone were analyzed. Patients were mainly complaining about hearing loss or deafness, tinnitus, otalgia, otorhoea, feeling of fullness and distension in the ear. Presence of effusion in the middle ear was an indication for ventilation tube insertion. Cases of ORN potentially endangered by further complications needed surgical treatment, therein lateral petrosectomy. Case of osteoradionecrosis proceeding with total bilateral deafness needed a concurrent cochlear implantation. Only the patients with diffuse osteoradionecrosis confirmed by CT scans ere qualified for surgery. CONCLUSIONS Radiotherapy of head and neck tumours is charged with risk of complications, both early and appearing later after therapy. Osteoradionecrosis is found many years after radiation and the course of illness is repeatedly tricky and potentially life-threatening. In the face of complications resulting from the essence of illness surgical treatment, therein lateral petrosectomy is necessary. Complications of radiotherapy cannot eliminate it as a method of independent treatment nor combined with other methods.

The supreme turbinate and the drainage of the posterior ethmoids: a computed tomographic study

BACKGROUND It is generally acknowledged that the posterior ethmoidal cells drain under the superior nasal turbinate (SorNT) or, rarely, under the supreme nasal turbinate (SmeNT), and the sphenoid ostium (SO) opens to the sphenoethmoidal recess. However, detailed relations between these structures are variable, complex and still not clear. There is no reliable data on the prevalence of SmeNT and drainage of the posterior ethmoidal cells under this structure. The aim of this study was to re-evaluate the anatomy of the aforementioned region. MATERIALS AND METHODS Multiplanar and three-dimensional reconstruction analysis of 100 thin slice paranasal sinus computed tomography scans. RESULTS SmeNT was identified in 77 subjects (136 sides). It formed the ostium to the posterior ethmoidal cell adjacent to the skull base or orbit in 58 subjects (91 sides). This cell drained independently from the remaining posterior ethmoidal cells. The sphenoethmoidal (Onodi) cell drained to supreme meatus in 41 subjects (54 sides), and to superior meatus in 37 subjects (49 sides). SO was always located medial to the posteroinferior attachment of SmeNT, or SorNT (in absence of SmeNT). CONCLUSIONS Patients with divergent drainage of the posterior ethmoids (with posterior ethmoidal cell draining to the supreme meatus) may require more extensive surgery to avoid persistence or recurrence of inflammatory disease. SmeNT is more common than thought, but due to its posterior and superior location to SorNT, it is rarely seen intraoperatively. If SmeNT is present, SO is always located medial to its posteroinferior attachment. (Folia Morphol 2018; 77, 1: 110-115).

Intraoperative Monitoring of Hearing Improvement during Ossiculoplasty by LDV-ABR-ECochG Technique

Objectives: Assess utility of combined electrophysiological and laser-Doppler Vibrometry (LDV) technique for intraoperative monitoring (IM) of hearing threshold (HT) improvement during ossiculoplasty. Methods: Study Design: A prospective, feasibility study. Setting: Academic, tertiary referral center. Ten patients underwent two-stage canal wall-up tympanoplasty due to chronic otitis media with cholestaetoma. During the second look surgery performed 6 to 9 months later, ossiculoplasty was monitored intraoperatively by LDV to assess prosthesis movability and by electrocochleography from the round window (RW-ECochG), and by auditory brainstem responses (ABR) to evaluate HT improvement. The ear was stimulated acoustically by tone-bursts: 0.5kHz, 1.0kHz, 2.0kHz, and 4.0kHz. Intraoperative HT, defined as the last intensity for which RW-ECochG and ABR wave V was present, were tested for various configurations of prosthesis placement. Simultaneously for the same stimulation, LDV measured prosthesis moveability. In all subjects, pre- and postoperative pure tone audiometry was performed to evaluate postoperative air-bone gap closure (ABG-C). Results: Postoperative ABG-C ranged between 10 and 45 dB. HT improvement evaluated intraoperatively correlated with postoperative ABG-C. Various prosthesis configurations and placements resulted in measurable changes mostly in the RW-ECochG thresholds. LDV appeared sensitive mostly to prosthesis position changes manifesting by movability improvement at 0.5 and 1.0kHz. Conclusions: RW-ECochG was found to be better than ABR for IM of HT improvement, showing the best correlations with postoperative ABG-C. RW-ECochG and LDV showed their usefulness to control prosthesis position changes by confirming better acoustic energy transfer through the reconstructed ossicular chain.