Maciej Wiatr

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.

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.

Pseudomonas i Alcaligenes – patogeny przewlekłego zapalenia ucha środkowego w materiale klinicznym ORL

Summary Introduction Otitis media chronica is the most common disorders encountered in otolaryngology. The great multitude of different bacteria which may couse otitis media constitutes the need for bacteriological diagnostics, especially in cases where classical conservative treatement of the inflammatory process fails. Material and methods Bacterial culture results procured from hospitalized and ambulatory patients which chronic otitis media, admitted from 2003 to 2006 at the otolaryngological department were analyzed. Results In total 47 patients were found to have their middle ear infected with Pseudomonas species and 1 patient with Alcaligenes xylosoxidans rods. Conclusions In cases of ear infection which fails conservative treatment, especially in immunocomprimised can be caused by pathogens which are resistant to most commonly administered antibiotics.

Transcranial direct current stimulation (tDCS) and its influence on analgesics effectiveness in patients suffering from migraine headache

BACKGROUND Headache is one of the most common conditions troubling nearly 45% of the worlds population. Migraine headache itself, being more common among women, affects 7-18% of people. As much as 20-30% of the population report accompanying aura and neurological symptoms. In many cases, migraine headache can be effectively treated with suitably selected pharmacotherapies which include drugs used in symptomatic treatment. Frequent occurrence of the condition is treated with prophylaxis, which often fails. Neuromodulating methods are part of the multidirectional treatment and they may be valuable complement to pharmacotherapy. METHODS Our study evaluates the impact of the transcranial direct current stimulation (tDCS) on the consumption of drugs and on pain conditions (frequency, duration, intensity). We recruited 50 patients with migraine headache (30 with aura, 20 without aura) refractory to pharmacological therapy. In 30 patients (18 with aura, 12 without aura) previous unsatisfactory treatment was supplemented with tDCS performed tenfold. 20 patients (12 with aura, 8 without aura) from a control group were treated with pharmacological methods The observation continued for 30 days after the stimulation. RESULTS After tDCS, a reduction in the consumption of analgesics and triptans was reported. Additionally, we monitored pain intensity decrease during pain episodes, duration of episodes and the number of pain days. The subjective assessment of pain reduction in migraine patients encompassed 36-40% after tDCS much more effective in comparison to group with only pharmacotherapy (10-12.5%). CONCLUSIONS The study suggests that tDCS may be safe and useful clinical tool in migraine prophylaxis and treatment.

Analysis of difficulties occurring during the early auditory screening in children.

INTRODUCTION It is assumed that the critical period for diagnosis of hearing disorders is the babys first three months of life and that appropriate course and implementation of treatment and/or rehabilitation should begin before a child is six months old. However various kinds of problems may occur during auditory screening of a child may exceed this interval. This problem is particularly pronounced among children with development and health problems and leads to unreliable and varied results. AIM The aim of this study was an analysis of prevalence of difficulties occurring during the first year of auditory screening among groups of children with congenital hearing impairment. MATERIAL AND METHODS Patients were examined in The Universal Newborn Hearing Screening Program in the years 2012 - 2013 in Level III NICUs in Krakow. Results from 250 cases were analyzed retrospectively. Medical exam results of patients with high risk of hearing loss were also included in our analysis. The groups of children included in our study were: children with Down Syndrome, children with nervous system disorders , children with cleft palate or both cleft palate and lip and children with congenital CMV. RESULTS In the group of children with cleft palate or both cleft palate and lip the most frequent cause of not conducting objective audiometric tests was bad health condition of a child which precluded his arrival for administering the tests. The most common cause of difficulties in performing hearing tests was the emotional state of children from groups with Down Syndrome. In the group of children with congenital CMV the most common cause of difficulties was a lack of availability of their parents. CONCLUSIONS 1. We encountered the greatest diagnostic difficulties during the childs first year of life in chosen high-risk groups of children with congenital hearing loss in children with cleft palate or both cleft palate and lip. 2. The highest prevalence of not finished tests was in III and IV interval for all chosen high-risk groups with congenital hearing loss.

Postoperative bone conduction threshold changes in patients operated on for chronic otitis media--analysis.

BACKGROUND Postoperative hearing improvement is measured as Air-Bone gap changes. Changes in bone conduction threasholds as a results of otosurgery is also discussed. AIM We discuss factors that have influence on bone conduction threasholds changes in individuals operated due to chronic otitis media. MATERIAL AND METHODS The prospective analysis involves the patients operated on middle ear due to chronic infection in the Department of Otolaryngology at the Jagiellonian University of Krakow in the years 2010-2013. 457 otosurgeries were performed in this period of time. RESULTS 293 first time operated on patients with chronic otitis media were analysed. Statistically significant bone conduction improvement was noticed after myringoplasty and in individuals with intact ossicular chain. No bone conduction threasholds improvement was observed with defects to the ossicles. CONCLUSIONS Unchanged mucous lining middle ear spaces and intact ossicular chain are crucial for bone conduction improvement after otosurgery. Scars, especially in round window, are poor prognostic factor for hearing improvement. Cleaning of the middle ear from granulation has an positive influence for bone conduction threasholds changes.

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.

Zasady leczenia niezłośliwych guzów krtani u chorych w wieku podeszłym – amyloidoza krtani

Summary Introduction Amyloidosis’ are the heterogeneous group of diseases characterized by extracellular accumulation of secondary protein structures causing progressive disturbances of the organs. Amyloid deposits are localized mainly in the tissues of parenchymal origin (spleen, kidneys, liver) and as far as otorhinolaryngologic organs are concerned the primary pathological process is rare. Aim The case presentation and the diagnostic and surgical procedure analysis with the assessment of the effects of therapy in patients in elderly age with amyloidosis of larynx. Material and methods A 82-year-old patient with a tumor of the larynx hospitalized in Otorhinolaryngology Clinic in Cracow. The first symptom of the pathologic process in this patient was an increasing laryngeal dyspnoe and the preliminary macroscopic assessment based on indirect laryngoscopy and endoscopy suggested the proliferative process from the group of non-epithelial neoplasm. Results In this case tracheotomy was performed and four days later the pathologic change was endoscopically removed from larynx. The improvement of the local state was achieved which enabled to decannulate the patient. Conclusions The amyloid deposits in otorhinolaryngologic organs are rare. Isolated changes in larynx suggesting malign neoplasm are the benign changes but on account of the specificity of the organ they can be a real threat to life.