Karolina Hydzik-Sobocińska

Endoskopowe leczenie chorych z izolowanymi stanami patologicznymi zatoki klinowej

Summary Introduction Cases of isolated lesions of the sphenoid sinus are rare. For descriptive purposes, clinicians divide them into inflammatory and non-inflammatory with prevalence of the former. Symptoms of the sphenoid sinus disease are difficult to characterise, the most common of them being vague headache and visual disturbances. Thorough preoperative evaluation of the lesion is essential – nasal endoscopy must be performed and computerised tomography or magnetic resonance imaging results analysed. The purpose of the study is to present the assessment of endoscopic surgery outcome in the own group of patients with isolated sphenoid disease. Material and methods Clinical data of 22 subjects were analysed retrospectively. There were 5 patients with bacterial sinusitis, 6 with fungal sinusitis, 4 with allergic thickening of the mucous membrane with no evidence of bacterial or fungal infection, 2 with mucocele, 1 with sphenoid osteoma, 1 with inverted papilloma, 1 with a foreign body and 2 with cerebral fluid fistula. Each patient had preoperative nasal endoscopy and CT/MRI imaging performed. Then they underwent endoscopic transnasal sphenoethmoidectomy with removal of the lesion or closure of the fistula. The sphenoid sinus was approached through its front wall. Results The patients’ postoperative course was uneventful. They noted improvement in all preoperative symptoms, except for bilateral oculomotor nerve paralysis in one individual, and were asymptomatic to ophthalmological examination. Conclusions Isolated lesions of the sphenoid sinus, even very rare tumours like those presented here, can be in most cases safely approached and removed endoscopically. All risks of the method must be considered prior to the operation. High frequency of fungal sinusitis should be noted.

Reoperacje w przebiegu otitis media chronica cholesteatomatosa

Summary Introduction Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. Aim This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. Material and methods Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004–2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. Results 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Stahylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. Conclusions The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.INTRODUCTION Chronic cholesteatoma otitis media, apart from destruction of bones and possibility of otogenous complications, is characterized by possibility of recurrence of the disease after non radical treatment or presence of risk factors. AIM This paper intends to analyze changes typical for cholesteatoma, observed during otosurgery including the results of bacteriological investigations. MATERIAL AND METHODS Nearly 450 otosurgeries were performed in Department of Otolaryngology at Jagiellonian University 2004-2007. Analysis refers to patients reoperated on chronic cholesteatoma otitis media. RESULTS 47 reoperations in the course of chronic choleateatoma otitis media were performed. Bacteriological analysis was provided in 21 cases. The most common bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were not observed in specimens. CONCLUSIONS The recurrence of the process should be expected in patients with cholesteatoma. They require regular, periodical follow-up examination.

Endoskopowe leczenie chorych z kostniakami zatok przynosowych – doświadczenie własne ☆

Summary Osteomas are relatively common, benign, slow-growing, often asymptomatic neoplasms of the paranasal sinuses, occurring mainly in frontal and ethmoid sinuses. Surgical removal is done if they extend beyond the boundaries of the sinus, keep enlarging, are localised in the region adjacent to the nasofrontal duct, or if signs of chronic sinusitis are present and, irrespective of their size, in symptomatic tumours. Progressive headaches and chronic inflammation of the adjacent mucous membrane are most common symptoms. Endoscopic surgery plays an important role in management of ethmoid, sphenoid and frontal osteomas. Aim The aim of the paper was to report own experience in endoscopic treatment of patients with osteomas of the paranasal sinuses. Material and methods 6 patients with osteomas of paranasal sinuses were included in the group, mean age 36 years (range 15–52). Most common involvement was ethmoid cells (3). There were also patients with frontal, maxillary and sphenoid osteoma. All tumours were removed under endoscopic giudance. Frontoethmoidectomy was performed to remove ethmoid and frontal osteomas. Antrotomy was used in case of maxillary involvement and sphenoethmoidectomy in the patient with sphenoid sinus osteoma. Sphenoid sinus was approached through its anterior wall with a Stammberger punch. All the tumours were removed using fine forceps. Results No post-operative complications were observed. No recurrences were noted. All patients remain asymptomatic. Conclusions Resection of small and medium size osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques. It allows their radical resection and very good cosmetic effects.

Endoskopowe leczenie chorych z wewnątrzczaszkowymi powikłaniami zapalenia zatok

Summary Introduction Intracranial complications of sinusitis (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and current topic. Although they are nowadays relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. Infection may spread hematogenously or by direct extension. Patients with complications require surgery to remove the focus of infection from the sinuses and drain the abscess. Recently, endoscopic frontal and sphenoid sinus surgery has emerged as the preferred technique for the treatment of the most advanced and complicated chronic sinusitis. Material and methods Records of 7 patients aged from 13 to 65 (mean 30.6) years treated in our department for intracranial complications between January 2002 and September 2006 were analysed retrospectively. The diagnosis of meningitis was established in 2 patients, in one case with accompanying bilateral oculomotor nerve palsy. Cavernous sinus thrombosis, frontal abscess with hemiplegia, cerebral oedema, bilateral oculomotor nerve palsy and retrobulbar optic nerve neuritis with blindness was diagnosed each in one individual. 5 endoscopic bilateral frontosphenoethmoidectomies and 2 endoscopic sphenoethmoidectomies were performed. In one case a frontosphenoethmoidectomy was combined with craniotomy. Results All preoperative symptoms subsided in 4 operated individuals. Vision improved in the patient with bilateral retrobulbar optic nerve neuritis. In patients with hemiplegia and bilateral oculomotor nerve palsy the symptoms persisted. No complications of the surgery were observed. Conclusions Surgical treatment of the focus of infection in the sinuses can be accomplished endoscopically via an intranasal approach with less morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic effects.

Czynniki prognostyczne u chorych leczonych operacyjnie z powodu perforacji błony bębenkowej przy nieuszkodzonym łańcuchu kosteczek słuchowych

Summary Background Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. Aim This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. Material and methods Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. Results 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. Conclusions The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operators preferences, as well as the availability of given material for transplanting.BACKGROUND Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. AIM This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. MATERIAL AND METHODS Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. RESULTS 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. CONCLUSIONS The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operators preferences, as well as the availability of given material for transplanting.

Endoskopowe leczenie płynotoku nosowego

Summary Introduction The frequency of different factors causing cerebrospinal fluid rhinorrhea (CFR) has lately changed. The incidence of iatrogenic CFR has reached 10% of all cases of CFR, due to an increasing number of endoscopic operations of the sinuses and skull base, while idiopathic CFR is nowadays very rare. The current treatment method for CFR is surgical repair of the fistula. Endoscopic surgery of the anterior skull base has become the standard procedure for the repair of cerebrospinal fluid (CSF) leaks of various origins. The aim of this study was to analyse results of endoscopic surgical technique used in our department for the treatment of CFR. Material and methods Records of 5 patients aged from 46 to 69 (mean 58.2) years treated in the department between April 2004 and March 2006 were analysed retrospectively. 4 individuals had underwent endoscopic sinus surgery for sinus problems which resulted in iatrogenic CSF leak. One patient had idiopathic CFR. 3 fistulas localised in the neighbourhood of the cribriform plate were closed using an „underlay” technique with synthetic dura, and covered with free mucosal grafts from the nasal septum, kept in place by fibrin glue. The fistula in the neighbourhood of the sphenoid sinus posterior wall was closed using an „overlay” technique with surgical, covered with synthetic dura. Results In the 3 patients with cribriform plate fistulas the closure was successful and CFR did not recur during 6 to 9 months follow-up. In the patient with sphenoid sinus fistula CFR recurred on exertion after 4 months. In one patient with cribriform plate fistula, CFR resolved spontaneously during preparation to surgery. Conclusions Endoscopic closure of the skull base fistula represents a minimally invasive and highly successful procedure. Our experience suggests thet the optimal surgical technique in the region of cribriform plate consists in performing an „underlay” procedure with synthetic dura and covering the graft with free mucosal grafts from the nasal septum.

Czynniki prognostyczne u chorych leczonych operacyjnie z powodu perforacji błony bębenkowej przy nieuszkodzonym łańcuchu kosteczek słuchowychPrognostic factors in patients operated on eardrum perforation with intact ossicular chain

Summary Background Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. Aim This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. Material and methods Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. Results 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. Conclusions The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operators preferences, as well as the availability of given material for transplanting.BACKGROUND Ear drum perforation is a typical feature in chronic otitis media. It can have posttraumatic etiology or it is observed in acute otitis media too. AIM This paper is intended to evaluate effectiveness of tympanic membrane reconstruction and indicate factors which have an influence on hearing improvement after myringoplasty. MATERIAL AND METHODS Analysis involves ca. 500 individuals operated on ear in Department of Otolaryngology at the Jagiellonian University between 2004 and 2009. RESULTS 120 individuals were operated on for the first time due to chronic otitis media with intact ossicular chain. Statistically significant heating improvement was observed in patients with discharge, without discharge and in group with scars. CONCLUSIONS The presence of granulation changes is an unfavorable prognostic condition in the patients with ear drum perforation. In clinical practice, the criterion which often determines the application of either of the materials in myringoplasty are operators preferences, as well as the availability of given material for transplanting.

Biofilm w przebiegu przewlekłego zapalenia zatok przynosowych. Badania morfologiczne w SEMBiofilm from patients with chronic rhinosinusitis. Morphological SEM studies

INTRODUCTION Bacterial biofilm is a three-dimensional structure made of aggregates of bacterial cells (microcolonies) and the extra cellular matrix released by them, adhering to organic and inorganic surfaces. It is estimated that 99% of all bacteria exist in biofilms, and only 1% live in a free-floating or planktonic state at any given time. The aim of the study was to demonstrate biofilms in mucosal specimens of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and co-occurrence of such illnesses as nasal polyps, bronchial asthma, NSAIDs allergy, and aspirin-induced asthma. MATERIAL AND METHODS A prospective study of 25 patients suffering from chronic rhinosinusitis. All patients underwent completed a otolaryngological examination and paranasal sinus CT scans. Endoscopic surgery of nasal sinuses (ESS) was performed in all patients. The mucous membrane samples were taken from the inside of the sinus and concha bullosa. They were prepared and examined with a scanning electron microscope (SEM). The images were then compared with the available database of the biofilm images. RESULTS Using SEM morphologic criteria, the biofilms were identified in the studied material in nineteen patients (83%). In four patients with chronic rhinosinusitis, no biofilms were found on the samples taken. A bacteriological examination of smears from inside of the sinus, revealed the presence of various types of bacteria. In two patients no bacteria was found in the smears. CONCLUSIONS It is supposed that bacterial biofilms perform an essential role in the pathogenesis of chronic sinusitis. One may speculate that, the presence of biofilms in patients with chronic rhinosinusitis could induce the co-occurrence of such illnesses as nasal polyps, bronchial asthma, aspirin-induced asthma or a NSAIDs allergy. In order to evaluate better the role of biofilms in chronic rhinosinusitis, it seems justified to extend the research to a larger group of patients and a control group.Summary Introduction Bacterial biofilm is a three-dimensional structure made of aggregates of bacterial cells (microcolonies) and the extra cellular matrix released by them, adhering to organic and inorganic surfaces. It is estimated that 99% of all bacteria exist in biofilms, and only 1% live in a free-floating or planktonic state at any given time. The aim of the study was to demonstrate biofilms in mucosal specimens of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and co-occurrence of such illnesses as nasal polyps, bronchial asthma, NSAIDs allergy, and aspirin-induced asthma. Material and methods A prospective study of 25 patients suffering from chronic rhinosinusitis. All patients underwent completed a otolaryngological examination and paranasal sinus CT scans. Endoscopic surgery of nasal sinuses (ESS) was performed in all patients. The mucous membrane samples were taken from the inside of the sinus and concha bullosa. They were prepared and examined with a scanning electron microscope (SEM). The images were then compared with the available database of the biofilm images. Results Using SEM morphologic criteria, the biofilms were identified in the studied material in nineteen patients (83%). In four patients with chronic rhinosinusitis, no biofilms were found on the samples taken. A bacteriological examination of smears from inside of the sinus, revealed the presence of various types of bacteria. In two patients no bacteria was found in the smears. Conclusions It is supposed that bacterial biofilms perform an essential role in the pathogenesis of chronic sinusitis. One may speculate that, the presence of biofilms in patients with chronic rhinosinusitis could induce the co-occurrence of such illnesses as nasal polyps, bronchial asthma, aspirin-induced asthma or a NSAIDs allergy. In order to evaluate better the role of biofilms in chronic rhinosinusitis, it seems justified to extend the research to a larger group of patients and a control group.

Biofilm w przebiegu przewlekłego zapalenia zatok przynosowych. Badania morfologiczne w SEM

INTRODUCTION Bacterial biofilm is a three-dimensional structure made of aggregates of bacterial cells (microcolonies) and the extra cellular matrix released by them, adhering to organic and inorganic surfaces. It is estimated that 99% of all bacteria exist in biofilms, and only 1% live in a free-floating or planktonic state at any given time. The aim of the study was to demonstrate biofilms in mucosal specimens of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and co-occurrence of such illnesses as nasal polyps, bronchial asthma, NSAIDs allergy, and aspirin-induced asthma. MATERIAL AND METHODS A prospective study of 25 patients suffering from chronic rhinosinusitis. All patients underwent completed a otolaryngological examination and paranasal sinus CT scans. Endoscopic surgery of nasal sinuses (ESS) was performed in all patients. The mucous membrane samples were taken from the inside of the sinus and concha bullosa. They were prepared and examined with a scanning electron microscope (SEM). The images were then compared with the available database of the biofilm images. RESULTS Using SEM morphologic criteria, the biofilms were identified in the studied material in nineteen patients (83%). In four patients with chronic rhinosinusitis, no biofilms were found on the samples taken. A bacteriological examination of smears from inside of the sinus, revealed the presence of various types of bacteria. In two patients no bacteria was found in the smears. CONCLUSIONS It is supposed that bacterial biofilms perform an essential role in the pathogenesis of chronic sinusitis. One may speculate that, the presence of biofilms in patients with chronic rhinosinusitis could induce the co-occurrence of such illnesses as nasal polyps, bronchial asthma, aspirin-induced asthma or a NSAIDs allergy. In order to evaluate better the role of biofilms in chronic rhinosinusitis, it seems justified to extend the research to a larger group of patients and a control group.Summary Introduction Bacterial biofilm is a three-dimensional structure made of aggregates of bacterial cells (microcolonies) and the extra cellular matrix released by them, adhering to organic and inorganic surfaces. It is estimated that 99% of all bacteria exist in biofilms, and only 1% live in a free-floating or planktonic state at any given time. The aim of the study was to demonstrate biofilms in mucosal specimens of patients undergoing endoscopic sinus surgery for chronic rhinosinusitis and co-occurrence of such illnesses as nasal polyps, bronchial asthma, NSAIDs allergy, and aspirin-induced asthma. Material and methods A prospective study of 25 patients suffering from chronic rhinosinusitis. All patients underwent completed a otolaryngological examination and paranasal sinus CT scans. Endoscopic surgery of nasal sinuses (ESS) was performed in all patients. The mucous membrane samples were taken from the inside of the sinus and concha bullosa. They were prepared and examined with a scanning electron microscope (SEM). The images were then compared with the available database of the biofilm images. Results Using SEM morphologic criteria, the biofilms were identified in the studied material in nineteen patients (83%). In four patients with chronic rhinosinusitis, no biofilms were found on the samples taken. A bacteriological examination of smears from inside of the sinus, revealed the presence of various types of bacteria. In two patients no bacteria was found in the smears. Conclusions It is supposed that bacterial biofilms perform an essential role in the pathogenesis of chronic sinusitis. One may speculate that, the presence of biofilms in patients with chronic rhinosinusitis could induce the co-occurrence of such illnesses as nasal polyps, bronchial asthma, aspirin-induced asthma or a NSAIDs allergy. In order to evaluate better the role of biofilms in chronic rhinosinusitis, it seems justified to extend the research to a larger group of patients and a control group.