Robert Bartoszewicz

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.

Hemihypoglossal-facial nerve anastomosis for facial nerve palsy

BACKGROUND AND PURPOSE Commonly used classic hypoglossal (CN XII) to facial nerve (CN VII) anastomosis has the disadvantage of tongue hemiatrophy. Thus, various attempts have been made to modify this method to reduce the tongue damage. The aim of this report was to present the results of hemihypoglossal-facial nerve anastomosis (HHFA) technique in relation to facial muscles reanimation and hemitongue atrophy. MATERIAL AND METHODS The first 7 consecutive patients who underwent CN VII anastomosis with half of the CNXII, for which the follow-up period exceeded 12 months, were analysed. During the procedure, CN VII was transected as proximally as possible after drilling the mastoid process. CN XII was separated longitudinally into two parts at a short distance to allow suture of the stumps without any tension. One half of CN XII was transected and sutured to the distal stump of CN VII. Recovery from facial palsy was quantified with the House-Brackmann grading system (HB). Tongue function was assessed according to the scale proposed by Martins. RESULTS Features of initial reinnervation of facial muscles were visible after 6 months in all 7 patients. All patients achieved satisfactory outcome of CN VII regeneration (HB grade III) until the last control examination (12-27 months after surgery, mean 16). No or minimal tongue atrophy without deviation (grades I-II according to the Martins scale) was found in 4 patients. Mild hemiatrophy with tongue deviation < 30 degrees (grade III) was visible in 3 patients. CONCLUSIONS In our experience, HHFA is effective treatment of facial palsy and gives a chance to reduce damage of the tongue.

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

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.

Zapalenie ucha zewnętrznego

Summary Treatment of otitis externa has changed and developed along the years. Pain and discomfort caused by the inflammation of the external ear canal impells the patient to seek medical care. Etiology of otitis externa is most often bacterial, but can also be viral, fungal or mixed. Epidermal lesions of the external ear canal caused by mechanical cleansing, foreign bodies as well as skin maceration due to moist environment are usually the primary causes of otitis externa. Underlying cause of inflammatory process in the external ear may also be conditions like psoriasis, acne, seborrheic dermatitis, allergies, diabetes, immune deficiency. Effective treatment is only possible with proper diagnosis. Due to frequent recurrence of otitis externa all the patients should undergo control examination, even if the symptoms have dissolved.

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.

Poszerzony dostęp przez środkowy dół czaszki w leczeniu nerwiaków nerwu słuchowego – technika operacyjna w aspekcie możliwych powikłań

INTRODUCTION The main tumor of cerebellopontine angle are vestibular schwannoma (80-90%). According to National Institute of Health Consensus Development Conference the best treatment method is microsurgery. There are three principal surgical approaches: translabyrinthin, retrosigmoid and middle fossa. Only the latter two approaches provide the possibility of hearing preservation. AIM Technique of surgery and postoperative morbidity after MFA. MATERIAL AND METHODS 39 patients (40 tumor) suffered from tumor of cerebellopontine angle, operated by using middle fossa approach in years 1998-2007. We evaluate hearing preservation and function of facial nerve and others postoperative morbidity. RESULTS 22.5% of patients has hearing impairment and 32.5% has facial weakness. By individual cases we observed: CSF leak, meningitis, corneal ulceration, ischialgia, wound bleeding and venue thrombosis. 1/3 of patients suffered from headache and disequilibrium and 1/6 suffered from tinnitus. CONCLUSION According to NIH middle fossa approach is one of three possible approaches in microsurgery of cerebellopontine angle tumors. There is possible total tumor removal with hearing preservation. Monitoring of facial and cochlear nerve during operation is recommended.Summary Introduction The main tumor of cerebellopontine angle are vestibular schwannoma (80–90%). According to National Institute of Health Consensus Development Conference the best treatment method is microsurgery. There are three principal surgical approaches: translabyrinthin, retrosigmoid and middle fossa. Only the latter two approaches provide the possibility of hearing preservation. Aim Technique of surgery and postoperative morbidity after MFA. Material and methods 39 patients (40 tumor) suffered from tumor of cerebellopontine angle, operated by using middle fossa approach in years 1998–2007. We evaluate hearing preservation and function of facial nerve and others postoperative morbidity. Results 22.5% of patients has hearing impairment and 32.5% has facial weakness. By individual cases we observed: CSF leak, meningitis, corneal ulceration, ischialgia, wound bleeding and venue thrombosis. 1/3 of patients suffered from headache and disequilibrium and 1/6 suffered from tinnitus. Conclusion According to NIH middle fossa approach is one of three possible approaches in microsurgery of cerebellopontine angle tumors. There is possible total tumor removal with hearing preservation. Monitoring of facial and cochlear nerve during operation is recommended.