Katarzyna Maciaszczyk

Auditory function in patients with systemic lupus erythematosus

OBJECTIVE Patients with systemic lupus erythematosus (SLE) may develop hearing and balance disorders as a result of the immune-mediated inner ear damage due to vasculitis or ototoxicity of drugs used in SLE treatment. The aim of the study was evaluation of the hearing organ disorders in patients with SLE with particular regard to their prevalence and relationship to duration and severity of disease. The severity was assessed from involvement of organs that resulted in poorer SLE outcome, i.e. kidneys and central nervous system (CNS), and from the presence of antibodies associated with unfavourable SLE prognosis. METHODS Thirty-five unselected, consecutive patients (33 women, two men, mean age 47.8 years) with SLE diagnosed in compliance to the international diagnostic criteria of the American Rheumatism Association (1982) were enrolled into the study. The control group consisted of 30 otologically healthy persons matched to the SLE group for age and sex. Case history was recorded for all patients from questionnaire data and laryngological examinations were performed, followed by pure-tone, speech and impedance audiometry and auditory brainstem response audiometry (ABR). RESULTS In the anamnesis 71.4% of patients reported vertigo, 62.9% headaches, 40% tinnitus, 25.7% hyperacusis, 17.1% hearing loss and 2.9% ear fullness. It was found that SLE patients had a significantly poorer mean hearing thresholds than the control group for all frequencies, except for 500; 2000 and 4000 Hz. Longer ABR latency averages were observed in the group of SLE patients compared to control. Ten patients (28.6%) developed high-frequency and symmetric sensorineural hearing loss (SNHL). Significant positive correlation between mean air-conduction hearing thresholds and SLE duration (r = 0.46, p < 0.001) was found. After taking age into consideration, hearing acuity in SLE was related to duration of disease in younger patients. Furthermore, no relation was seen between hearing level and severity of disease. CONCLUSIONS Auditory system involvement ought to be considered as one of elements of the clinical picture of systemic lupus erythematosus while determination of its character, original or secondary, requires further research.

Stan układu przedsionkowego u pacjentów z twardziną układową

Summary Objectives In systemic sclerosis (SSc) there may occur hearing and balance disorders as a result of the immune-mediated inner ear damage, the etiology being vasculitis and fibrosis. The objective is the vestibular organ evaluation in patients with SSc regarding their prevalence and relationship to duration of the disease and Raynaud phenomenon and also to type and severity of SSc. Material Twenty unselected, consecutive patients with diagnosed SSc, complying with international diagnostic criteria of the American Rheumatism Association (1982), were enrolled into the study. The control group consisted of 26 otologically healthy persons matched to the SSc group for age and sex. Methods In all patients the questionnaire about audiovestibular history, otolaryngological examination, static and dynamic vestibular tests and the electronystsgmography (ENG) were performed. The patients were investigated with the electronystsgmography (ENG) for spontaneous, positional and caloric-induced nystagmus. Also visual ocular-motor tests were performer. Results In the anamnesis 65% of patients reported vertigo, 55% – headaches, 50% – tinnitus, 40% – hyperacusis, 40% – hearing loss and 30% – ear fullness. Vertigo, dizziness balance disturbance and uncorrect results of Romberg and Utenberger tests were more frequent in patients with vestibular organ lesion. Abnormalities in vestibular organ in SSc patients were fund in 14 (70%) persons – the central type of lesion −8 (40%), mixed type in 3 (15%) and peripheral in 3 (15%). Conclusions Ear involvement is frequent in systemic sclerosis and should be taken into consideration during diagnostic and therapeutic procedures.OBJECTIVES In systemic sclerosis (SSc) there may occur hearing and balance disorders as a result of the immune-mediated inner ear damage, the etiology being vasculitis and fibrosis. The objective is the vestibular organ evaluation in patients with SSc regarding their prevalence and relationship to duration of the disease and Raynaud phenomenon and also to type and severity of SSc. MATERIAL Twenty unselected, consecutive patients with diagnosed SSc, complying with international diagnostic criteria of the American Rheumatism Association (1982), were enrolled into the study. The control group consisted of 26 otologically healthy persons matched to the SSc group for age and sex. METHODS In all patients the questionnaire about audiovestibular history, otolaryngological examination, static and dynamic vestibular tests and the electronystsgmography (ENG) were performed. The patients were investigated with the electronystsgmography (ENG) for spontaneous, positional and caloric-induced nystagmus. Also visual ocular-motor tests were performer. RESULTS In the anamnesis 65% of patients reported vertigo, 55% - headaches, 50% - tinnitus, 40% - hyperacusis, 40% - hearing loss and 30% - ear fullness. Vertigo, dizziness balance disturbance and uncorrect results of Romberg and Utenberger tests were more frequent in patients with vestibular organ lesion. Abnormalities in vestibular organ in SSc patients were fund in 14 (70%) persons - the central type of lesion - 8 (40%), mixed type in 3 (15%) and peripheral in 3 (15%). CONCLUSIONS Ear involvement is frequent in systemic sclerosis and should be taken into consideration during diagnostic and therapeutic procedures.

Ropień podtwardówkowy w przebiegu przewlekłego zapalenia zatok przynosowych – opis przypadku

Subdural empyema is an uncommon and serious complication of sinusitis. Authors reported a case of 34-year-old man without internal loads/ chronic diseases in the course of chronic sinusitis of odontogenic origin. Diagnostic procedures were described. Early employed wide spectrum antibiotic therapy and inflammatory focus removal did not prevent intracranial complications. The patient required two-staged neurosurgical operation.Summary Subdural empyema is an uncommon and serious complication of sinusitis. Authors reported a case of 34-year-old man without internal loads/chronic diseases in the course of chronic sinusitis of odontogenic origin. Diagnostic procedures were described. Early employed wide spectrum antibiotic therapy and inflammatory focus removal did not prevent intracranial complications. The patient required two-staged neurosurgical operation.

Ocena fenotypowa pacjentów z zespołem Pendreda

INTRODUCTION The Pendred syndrome (PS) is an autosomally recessively inherited disease. Its diagnosis requires identification of the classical triad of symptoms, including hypoacusis, thyroid goitre and iodine organification defect in the thyroid, which may lead to thyroid functional disorders of hypothyroidism. SP is accompanied by anatomical anomalies. The objective is the hearing and balance system evaluation and the analysis of the inner ear structure and also the assessment of the function and structure of thyroid gland. MATERIAL AND METHODS For the research four families were qualified, 7 persons with PS, 12 persons altogether. In all the patients the anamnesis in the form of a questionnaire and laryngological examination were performed. It was followed by pure tone, speech and impedance audiometry and brainstem response testing as well. ENG was also conducted. Patients with hearing loss were subjected to magnetic resonance of temporal bone. For the whole group thyroid hormones levels and iodine organification in the thyroid identified in a test with potassium perchlorate were measured and also USG and scyntography were conducted. RESULTS In audiological examination in 3 cases deafness, in 2 cases profound hypoacusis and in 2 mild hypoacusis were recognised. In the group in 2 patients the hypoacusis was of a mixed type. In radiological assessment the labirynth showed anatomical anomalies in the form of enlargement of the vestibular aqueduct and the endolyphatic sac, yet in 3 patients the anomalies also concerned the structure of cochlear and semicircular canals. Endocrine examination showed hypothyroidism in 5, its subclinical form in 1, diffuse thyroid goitre in 4 and nodular thyroid goiter in 2 cases. CONCLUSIONS A complex clinical evaluation: endocrine and audiological, together with radiological diagnostic imaging, supported by molecular studies of SLC26A4 gene, are the procedures, necessary for complete and accurate diagnosis of PS and EVAS.Summary Introduction The Pendred syndrome (PS) is an autosomally recessively inherited disease. Its diagnosis requires identification of the classical triad of symptoms, including hypoacusis, thyroid goitre and iodine organification defect in the thyroid, which may lead to thyroid functional disorders of hypothyroidism. SP is accompanied by anatomical anomalies. The objective is the hearing and balance system evaluation and the analysis of the inner ear structure and also the assessment of the function and structure of thyroid gland. Material and methods For the research four families were qualified, 7 persons with PS, 12 persons altogether. In all the patients the anamnesis in the form of a questionnaire and laryngological examination were performed. It was followed by pure tone, speech and impedance audiometry and brainstem response testing as well. ENG was also conducted. Patients with hearing loss were subjected to magnetic resonance of temporal bone. For the whole group thyroid hormones levels and iodine organification in the thyroid identified in a test with potassium perchlorate were measured and also USG and scyntography were conducted. Results In audiological examination in 3 cases deafness, in 2 cases profound hypoacusis and in 2 mild hypoacusis were recognised. In the group in 2 patients the hypoacusis was of a mixed type. In radiological assessment the labirynth showed anatomical anomalies in the form of enlargement of the vestibular aqueduct and the endolyphatic sac, yet in 3 patients the anomalies also concerned the structure of cochlear and semicircular canals. Endocrine examination showed hypothyroidism in 5, its subclinical form in 1, diffuse thyroid goitre in 4 and nodular thyroid goiter in 2 cases. Conclusions A complex clinical evaluation: endocrine and audiological, together with radiological diagnostic imaging, supported by molecular studies of SLC26A4 gene, are the procedures, necessary for complete and accurate diagnosis of PS and EVAS.

Wtórna gruźlica migdałków podniebiennych – opis przypadku i przegląd piśmiennictwa

Summary Introduction Tuberculosis, though rarely, is still present in the anatomical area of the laryngological examination. Material and methods A case of 45-year-old woman with secondary tonsillar tuberculosis and poorly symptomatic pulmonary involvement is reported. Results She presented with symptoms of chronic tonsillitis and was subjected to tonsillectomy. Because of systemic infection ailments she underwent further internal diagnosis. The histopathological examination of palatine tonsils and result of chest X-ray established the diagnosis of tuberculosis. She was treated with antituberculous drugs for 6 months and achieved improvement. Conclusions The difficulties in diagnosis in this unusual presentation of tuberculosis mimicking chronic non-specific inflammation as well as poorly symptomatic massive pulmonary involvement are outlined.INTRODUCTION Tuberculosis, though rarely, is still present in the anatomical area of the laryngological examination. MATERIAL AND METHODS A case of 45-year-old woman with secondary tonsillar tuberculosis and poorly symptomatic pulmonary involvement is reported. RESULTS She presented with symptoms of chronic tonsillitis and was subjected to tonsillectomy. Because of systemic infection ailments she underwent further internal diagnosis. The histopathological examination of palatine tonsils and result of chest X-ray established the diagnosis of tuberculosis. She was treated with antituberculous drugs for 6 months and achieved improvement. CONCLUSIONS The difficulties in diagnosis in this unusual presentation of tuberculosis mimicking chronic non-specific inflammation as well as poorly symptomatic massive pulmonary involvement are outlined.