Jerzy Tomik

Artificial neural network modelling of the results of tympanoplasty in chronic suppurative otitis media patients

The application of computer modelling for medical purposes, although challenging, is a promising pathway for further development in the medical sciences. We present predictive neural and k-nearest neighbour (k-NN) models for hearing improvements after middle ear surgery for chronic otitis media. The studied data set comprised 150 patients characterised by the set of input variables: age, gender, preoperative audiometric results, ear pathology and details of the surgical procedure. The predicted (output) variable was the postoperative hearing threshold. The best neural models developed in this study achieved 84% correct predictions for the test data set while the k-NN model produced only 75.8% correct predictions.

Przewlekłe zapalenie ucha środkowego jako wstęp do usznopochodnych powikłań wewnątrzczaszkowych

INTRODUCTION Otogenic intracranial complications are rare. Misdiagnosed and untreated can be dangerous for health and life. They should be always kept in mind. AIM We discuss patients in whom defects of skull base were observed during operation. These defects can lead to serious intracranial complications. MATERIAL AND METHODS We analyse patients with chronic otitis media operated in our department between 2004-2006. 250 operations on ears were performed in that period of time. We discuss patients with intracranial otogenic complications and patients in whom defects of skull base were noticed by chance during operations. RESULTS Defects of skull base were observed in 24 cases. Intracranial complications were in 3 patients. 1 patiens died because of abscess of cerebellum, others were treated with good distant effect. Used methods of reconstruction were effective, we observed no discharge of cerebro-spinal fluid and no other intracranial complications. CONCLUSIONS It exists group of patients with chronic otitis media that have asymptomastic defects of cranial fossa. These defects can be responsible for intracranial complications. MRI and TC are very important in preoperative diagnostics.Summary Introduction Otogenic intracranial complications are rare. Misdiagnosed and untreated can be dangerous for health and life. They should be always kept in mind. Aim We discuss patients in whom defects of skull base were observed during operation. These defects can lead to serious intracranial complications. Material and methods We analyse patients with chronic otitis media operated in our department between 2004–2006. 250 operations on ears were performed in that period of time. We discuss patients with intracranial otogenic complications and patients in whom defects of skull base were noticed by chance during operations. Results Defects of skull base were observed in 24 cases. Intracranial complications were in 3 patients. 1 patiens died because of abscess of cerebellum, others were treated with good distant effect. Used methods of reconstruction were effective, we observed no discharge of cerebro-spinal fluid and no other intracranial complications. Conclusions There is a group of patients with chronic otitis media that have asymptomastic defects of cranial fossa. These defects can be responsible for intracranial complications. MRI and TC are very important in preoperative diagnostics.

The Balloon-Based Manometry Evaluation of Swallowing in Patients with Amyotrophic Lateral Sclerosis

The aim of the study was to analyse the disturbances of the oro-pharyngeal swallowing phase of dysphagia in amyotrophic lateral sclerosis (ALS) patients with the use of specific manometric measurements and to evaluate their plausible association with the duration of the disease. Seventeen patients with ALS were evaluated with manometric examinations of the oral and pharyngeal part of the gastrointestinal tract. Tests were carried out by using the oesophageal balloon-based method with four balloon transducers located 5 cm away from each other. The following manometric parameters were analysed: the base of tongue contraction (BTC) and the upper oesophageal sphincter pressure (UESP), and the hypopharyngeal suction pump (HSP) as well as the oro-pharyngeal, pharyngeal and hypopharyngeal transit time and average pharyngeal bolus velocity (oropharyngeal transit time (OTT), pharyngeal transit time (PTT), hypopharyngeal transit time (HTT) and average pharyngeal bolus velocity (APBV), respectively). Manomatric examinations during swallowing in patients with ALS showed significant weakness of BTC, a decrease of HSP and a decrease of the velocity of bolus transit inside the pharynx which were particularly marked between the first and the third examination. Manometric examinations of the oro-pharyngeal part of the gastrointestinal tract are useful and supportive methods in the analysis of swallowing disturbances in ALS patients.

Przypadek neurothekeoma oczodołu

Summary 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 Kronlein 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.

Endoskopowe leczenie olbrzymich kostniaków podstawy czaszki

Summary Introduction Osteomas are relatively common, benign, slow-growing neoplasms. Mainly occurring in frontal and ethmoid sinuses. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim We discuss our experiences in endoscopic treatment of giant osteomas. Results In giant osteomas Draf III or Lothrop approaches are prefered. Periostium of the orbit was intact in all cases. Discharge of cerebrospinal liquid was not observed. Conclusions Size of tumor determines type of surgical aprroach. Endoscopic surgery is more and more popular way in surgical treatment of giant osteomas.

The Evaluation of Abnormal Voice Qualities in Patients with Amyotrophic Lateral Sclerosis

Objective: Voice abnormalities are among the symptoms occurring in patients with amyotrophic lateral sclerosis (ALS). They are divergent and range from hoarseness, through the excessive adduction of false folds, up to the weakness of the vocal folds. The aim of the study was to analyze the phonatory function of the larynx in ALS patients. Methods: Seventeen patients with ALS were evaluated with subjective perceptual voice assessment (including the GRBAS scale), videolaryngostroboscopy including voice range and maximum phonation time (MPT), and objective acoustic voice analysis with IRIS software (including evaluation of jitter, shimmer, mean fundamental frequency, and noise-to-harmonics ratio (NHR)). Examinations were performed three times at 6-month intervals. Results: Hoarseness, roughness, and breathiness of voice were all found more frequently in the majority of these patients. Voice range, amplitude of vibration, mucosal wave, and glottal closure showed significant abnormalities with repeated examinations. MPT was shortened especially among women with ALS. Acoustic analysis of voice among men showed increased jitter value in the first examination only, while jitter, shimmer, and NHR in women with ALS were increased in all examinations. Conclusions: Analysis of voice qualities among patients with ALS allows for the detection of various abnormalities associated with the natural progression of the disease.

Endoskopowe resekcje guzów złośliwych nosa i zatok przynosowych

Summary Malignant neoplasms of the nose and paranasal sinuses constitute about 3% of head and neck tumors. They are more often observed in males. We discuss clinical appearance and treatment performed in 6 individuals with malignant tumors in the nose and paranasal sinuses that were removed with endoscopic surgery. Successful result in endoscopic treatment patients with malignant tumors in the nose and paranasal sinuses depends on right indications of individuals to this procedure. In some situations it could be alternative to surgery with external approach.

Rozległe urazy szyi w materiale Kliniki Otolaryngologii CM UJ w Krakowie w latach 2009–2012

Isolated laryngeal fractures quite rarely can occur following trauma to the neck region, but because of the variety and dynamic growth of symptoms or possible injury of the main structures on the neck may be life-threatening. The appropriate treatment of these patients is quick surgical intervention proceeded by imaging techniques. Here we report the cases of three patients treated in our Department between 2009 and 2012: two of them with penetrating injury and one with blunt trauma. The appropriate treatment of these patients requires that airway patency be the first priority and if possible quick reconstruction. These cases illustrate the individualized treatment and multidisciplinary approach in managing such cases.

Artykuł oryginalny/Original research articleZmiana odpowiedzi ucha wewnętrznego obserwowana po operacjach na uchu środkowymResponse changes of inner ear observed after middle ear surgery

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).

Zmiana odpowiedzi ucha wewnętrznego obserwowana po operacjach na uchu środkowym

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).