Robert Przeklasa

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.

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.

Optymalizacja leczenia chorych z perlakiem ucha środkowego

Summary Background The chronic otitis media is a frequent condition in ENT practice. The presence of cholesteatoma can lead to the destruction of bony structures in the middle ear spaces to a different extent. Aim We discuss the way of the patients’ treatment with the chronic cholesteatoma otitis media that were operated on for the first time. Material and methods We analyze the patients with the chronic cholesteatoma otitis media who were diagnosed, operated on and followed up in our Department between 2006 and 2009. 410 operations on ears were performed in that period of time. We discuss the extent of cholesteatoma, the hearing impairment, the type of otosurgery and the distant results of performed therapy. Results We discuss 44 patients operated on chronic cholesteatomatoma otitis media for the first time. It constitutes ca. 10% of all middle ear operations performed in analyzed period of time and 40% of all individuals operated on cholesteatoma. Conclusions There is a group of patients with the chronic cholesteatoma otitis media that have no hearing improvement after the reoperation. The main aim of the therapy in this group is to remove the pathology and therefore obtain the ‘dry ear’ and prevent against otogenous complications.

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.

Uszkodzenia ścian kostnych ucha środkowego u chorych operowanych z powodu schorzeń ucha w Klinice Otolaryngologii CM UJ w latach 2008–2012

BACKGROUND We perform the middle ear operation to remove pathological tissue and in the next step present ossicular chain reconstruction. Otosurgeon has to also identify bone dehiscences, as a potential way to develop otogenic intracranial and intratemporal complications. AIM We analyzed the patients with bone defects in the middle and/or posterior cranial fossa who present also defects of the bony wall of the facial nerve canal and lateral semicircular canal. MATERIAL AND METHODS We observed 537 patients who were operated on middle ear for the first time in the Department of Otolaryngology at the Jagiellonian University of Cracow from 2008 to 2012. We used a special questionnaire that includes diagnostics of the ears disease, method of the operation and short- and long-term effects. RESULTS We discuss 45 patients with the skull base defects in the middle and/or posterior cranial fossa. Dehiscence of the bony wall of the facial nerve canal was present in 7 patients. In 4 cases semicircular canal fistula coexisted. The most common cause of bone dehiscence was granulation tissue, less frequently cholesteatoma. CONCLUSIONS

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).

Ubytki kości podstawy środkowego i tylnego dołu czaszki przy niezmienionej wyściółce ucha środkowego

BACKGROUND Skull bone defects in the region of middle ear are usually observed in the cases of chronic otitis media. Such loses can also be congenital, posttraumatic, iatrogenic or due to hyperplasia. They can potentially lead to development of otogenic intracranial complications. AIM We present the patients who were not observed during otosurgery to have any pathological changes to the mucous of the middle ear and were diagnosed as having bone defects in the middle and/or posterior cranial fossa. We discuss also methods of reconstruction during otosurgery. MATERIAL AND METHODS The prospective analysis involves the patients operated on middle ear in the Department of Otolaryngology at the Jagiellonian University of Krakow in the years 2007-2011. 495 first-time otosurgeries were performed in this period of time. RESULTS Skull bone defects were diagnosed in 46 patients who had undergone surgery and 25% of these patients had no changes to the middle ear mucous. This points to congenital etiology of the defects. In this group the most common cause for otosurgery was chronic otitis media (10 patients). In 1 patient, bone defect occurred along with otosclerosis. In patients with congenital skull bone defects otogenic intracranial complications were described in 4 cases. CONCLUSIONS Nearly 80% of skull bone defects remain asymptomatic; they are revealed incidentally during the surgery of the middle ear. The above observations emphasize the significant role of preoperative imaging diagnostics. The methods of bone defects reconstruction using the fascia, strengthened with the pedicle muscle flap where larger defects occurred, as well as with either bone lamella or cartilage in particular cases, proved successful.

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.