Tomasz Durko

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.

Predictive value of factors influencing recovery from sudden sensorineural hearing loss

Recovery from sudden sensorineural hearing loss (SSHL) is often very uncertain. Different factors are considered in predicting an outcome. The aim of the study was an evaluation of the hearing improvement in sudden deafness in relation to the duration of symptoms before treatment, the severity of hearing loss, the presence of vertigo and the patient age. A retrospective analysis of 119 patients aged between 16 and 71 years treated for sudden sensorineural hearing loss was carried out. Clinical otolaryngological, neurological and ophthalmological examinations, audiological and ENG tests were carried out. Hearing improvement was obtained in 51 patients (43%). Hearing recovery was recorded in 38 patients (66%) whose duration of disease before treatment was no longer than 7 days, in 9 patients (25%) with a period of 8–14 days and in 4 patients (16%) with a period of 15–30 days (66% vs. 25% vs. 16%, p<0.001, 25% vs. 16%, p=0.39). Hearing improvement was more frequent in patients with initially mild (51.6%) rather than severe (38.7%) and profound hearing loss (25%) (51.5% vs. 25%, p<0.05). Hearing recovery was observed in 18 patients (33.3%) with vertigo and in 33 patients (50.8%) without vertigo (p=0.056). In analysis of age (five groups: below 30, 31–40, 41–50, 51–60 and over 60 years) related to hearing recovery, no difference was found (respectively 45.5% vs. 45.8% vs. 46.4% vs. 37% vs. 38.9%, p=0.94). It was stated that in patients with sudden deafness, the duration of symptoms before treatment and the severity of hearing loss may predict a recovery. The presence of vertigo may worsen an outcome in SSHL, although it was not found to be statistically significant. On the contrary, patient age does not seem an important prognostic factor.

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.

Analiza ekspresji TIMP-1, TIMP-2 i TIMP-3 jako czynnika prognostycznego przebiegu raka krtani ☆ ☆☆

Summary Introduction Tissue inhibitors of matrix metalloproteinases (TIMPs) are natural regulator of activity of matrix metalloproteinases, that are responsible for ECM degradation. TIMPs have been identified in various carcinomas and in most of them dependence between TIMPs and clinical course of the disease have been observed. Aim Of the research was to evaluate expression of TIMP-1, TIMP-2 and TIMP-3 in laryngeal cancer and to asses the prognostic significance of these factors. Material and method 104 patients with laryngeal cancer, that underwent surgical treatment were included in the study. Only cases with at least a 5-year follow-up were included. Immunohistochemical studies were performed on formalin fixed, paraffin embedded sections by using monoclonal antibodies against TIMP-1, -2 and -3 antigens and ABC detection system. Results TIMPs expression was cytoplasmatic, mainly in cancer cells, but also in some stromal cells. TIMP-1 and TIMP-2 correlated with grading (TIMP-1 p = 0,05; TIMP-2 p = 0,001). There was an association between TIMP-2 and TIMP-3 expression and tumor size (TIMP-2 p = 0,037; TIMP-3 p = 0,022). TIMP-3 expression correlated with clinical stage of the disease (p = 0,037). There was an association between TIMP-2 expression and nodal recurrence (p = 0,05). Both overall and disease-free survival were shorter in cases with positive TIMP-2 expression (p = 0,049). Conclusions Our results demonstrate that there is an association between TIMPs expression and clinicopathological features of laryngeal cancer. Moreover TIMP-2 could be an important marker in prognosis of laryngeal cancer patients.

Revision Stapes Surgery – Retrospective Analysis of Surgical Findings in a Series of 21 Otosclerosis Patients

AIM Retrospective analysis of surgical findings in revision stapes surgery in a group of 21 otosclerosis patients qualified for the secondary procedure at the Otosurgery Department of the Medical University of Lodz, Poland, from 1980 to 2002. MATERIALS AND METHODS 21 cases of revision stapes surgery out of a total of 350 surgically treated otosclerosis cases are discussed. Group A consisted of 17 cases of revision surgery out of 274 patients who had undergone total stapedectomy (1980-1995) and group B consisted of 4 cases out of 76 patients after stapedotomy (1996-2002). RESULTS In group A, 17 patients underwent revision surgery, corresponding to 6.2% out of 274 total stapedectomy cases. Among the indications for the secondary surgical procedure in this group of patients were: (a) platinum wire prosthesis displacement with ossicular chain discontinuity (n = 12); (b) perichondrium or adipose tissue atrophy (n = 3), and (c) incudostapedial joint luxation (n = 2). Group B was composed of 4 cases, i.e. 5.3% out of 76 stapedotomy patients (Teflon piston operation, 0.6 mm). For both groups, the mean percentage of revision cases was 6% of all patients operated for otosclerosis. Time from the initial surgical procedure to reoperation varied from 1 to 8 years. CONCLUSIONS (1) The most common indication for revision stapes surgery in patients after total stapedectomy was prosthesis displacement and necrosis of the long crus of the incus. (2) Obliteration of the stapes footplate after small fenestra operation was observed to be the most frequent indication for the secondary stapes procedure in our patient groups.

Subiektywna śródoperacyjna poprawa słuchu u chorych po stapedotomiach w porównaniu z wynikiem kontrolnego badania słuchu w audiometrii tonalnej progowej

Summary In otosclerosis patients the most common procedure followed at Otosurgical Dept. Medical University of Lodz is stapedotomy with insertion of teflon-piston prosthesis. When surgery is finished a whisper hearing test is done from the 1 meter distance for brief intraoperative hearing improvement assessment. There is a number of patient who report subjective intraoperative hearing improvement which is not confirmed by postoperative pure-tone audiometry (2-3rd post-op day). The aim of the study was the analysis of factors influencing stapedotomy (teflon-piston procedure) patients in which intraoperative hearing improvement was not confirmed by postoperative pure-tone audiometry. Material and method Retrospective analysis of postoperative hearing results in patients who underwent stapedotomy (teflon-piston operation) at the Otosurgical Dept. Medical University of Lodz from 2005 to 2009. Results The total number of 142 stapedotomies were analyzed. In 27 ears no hearing improvement was reported (19.1%). Among them 18 reported intraoperative hearing improvement not confirmed on postoperative pure-tone audiometry and 9 cases intraopertively reported no hearing improvement. Patients in Group A (hearing improvement 1–2 month post stapedotomy) – 12 cases (44.4%) with hearing improvement confirmed by pure-tone audiometry and Group B – 15 cases (55.6%) in which no sign of hearing improvement in pure-tone audiometry was reported. Conclusion In patients who intraopertively reported hearing improvement not supported by the pure-tone audiometry the following factors seem to play a vital role: a) strong suggestion and willingness of improvement after surgical treatment, b) specific condition of the whisper hearing test at the operating room environment, c) patients stress during the surgery and strong fear of possible revision surgery.UNLABELLED In otosclerosis patients the most common procedure followed at Otosurgical Dept. Medical University of Lodz is stapedotomy with insertion of teflon-piston prosthesis. When surgery is finished a whisper hearing test is done from the 1 meter distance for brief intraoperative hearing improvement assessment. There is a number of patient who report subjective intraoperative hearing improvement which is not confirmed by postoperative pure-tone audiometry (2-3rd post-op day). THE AIM OF THE STUDY was the analysis of factors influencing stapedotomy (teflon-piston procedure) patients in which intraoperative hearing improvement was not confirmed by postoperative pure-tone audiometry. MATERIAL AND METHOD Retrospective analysis of postoperative hearing results in patients who underwent stapedotomy (teflon-piston operation) at the Otosurgical Dept. Medical University of Lodz from 2005 to 2009. RESULTS The total number of 142 stapedotomies were analyzed. In 27 ears no hearing improvement was reported (19.1%). Among them 18 reported intraoperative hearing improvement not confirmed on postoperative pure-tone audiometry and 9 cases intraopertively reported no hearing improvement. Patients in Group A (hearing improvement 1-2 month post stapedotomy)--12 cases (44.4%) with hearing improvement confirmed by pure-tone audiometry and Group B--5 cases (55.6%) in which no sign of hearing improvement in pure-tone audiometry was reported. CONCLUSION In patients who intraopertively reported hearing improvement not supported by the pure-tone audiometry the following factors seem to play a vital role: a) strong suggestion and willingness of improvement after surgical treatment, b) specific condition of the whisper hearing test at the operating room environment, c) patients stress during the surgery and strong fear of possible revision surgery.

Udział IFN-gamma i TNF-alfa w etiopatogenezie polipów nosa – badania wstępne

Summary Objective Nasal polyposis is a chronic inflammatory disease of the nasal mucosa. The pathogenesis of nasal polyps is still not entirely known and has been debated for many years. The aim of the present study was to evaluate the expression of interferon gamma and TNF-alpha secreted by Th1 lymphocytes and to analyze their role in the etiology of nasal polyps. Methods 12 patients with nasal polyposis were selected – 6 of them allergic and 6 non-allergic. Patients with allergy were distinguished from those without allergy on the basis of positive allergy skin tests to dust and serum levels of IgE. Blood sample was obtained from patients and examined for the expression of IFN-gamma and TNF-alpha by intracellular staining procedure after stimulation with PMA/ionomycin and allergen. Results Negative correlation was found between expression of IFN-gamma and TNF-alpha after PMA/ionomycin stimulation and allergen stimulation (p >0,05). Statistical analysis of two groups of patients demonstrated that no significant differences in the cytokine expression in allergic versus non-allergic patients were observed although mean value of IFN-gamma and TNF-alpha were lower in allergic patients in comparison to non-allergic (p>0,05). We didn’t observe any correlation between expression of INF-gamma and TNF-alpha and: coexistence of bronchial asthma, allergy to aspirin and local corticosteroid treatment. In patients with recurrent polyposis the expression of INF-gamma was significantly lower (p = 0,05). Conclusion This research suggests that IFN-gamma and TNF-alpha play a role in the pathogenesis of nasal polyps but the allergic mechanism may not play a fundamental role in this process. It needs further investigations.

Wpływ rodzaju protezki strzemiączka na stopień poprawy słuchu w chirurgii strzemiączka – analiza retrospektywna 350 przypadków

Summary Aim Retrospective analysis of the post-op hearing results in stapes surgery using different types of materials for stapes prosthesis after 12 months follow up. Material and methods The total number of 350 otosclerosis patients who underwent surgical treatment at the Otosurgery Department, Medical University of Lodz from 1980–2002. All patients included in the study were divided into 4 groups: group 1 (N = 54) – Portmanns method interposition, group 2 (N = 160) – stapes replaced with the Shea – type prosthesis, group 3 (N = 60) – platinum wire prosthesis (Zini – type), group 4 (N = 76) – teflon-piston operation (Fisch – type). Results The 12 months post-op mean value for air-bone gap (500, 1000, 2000 Hz) presented the following values: group 1–19 dB, group 2–15.9 dB, group 3–18.4 dB, group 4–13.5 dB. The percentage of patients with the mean air-bone gap value of 15 dB or less (500, 1000, 2000 Hz) has the following values in each group: group 1–75%, group 2–81.3%, group 3–83%, group 4–85%. Conclusions 12 months post-op hearing results compared between the 4 studied groups showed statistically not significant differences. Our experience with teflon-piston prosthesis shows the lowest postop mean value of the air-bone gap.

Participation of mast cells in chronic otitis media

In the pathogenesis of chronic otitis media (COM), much attention is paid to the molecular mechanisms of local inflammatory reactions in which mast cells (MCs) may be involved due to their role not only in allergic but also inflammatory processes. The aim of this study was to assess the density of mast cells in chronic otitis media in relationship to different clinical courses of COM, bacterial infections and types of disease. The MCs expression was measured immunohistochemically in paraffin-embedded granulation tissue specimens taken during surgery, by staining with a monoclonal antibody against tryptase. The density of tryptase-positive mast cells was lower in tissue samples from the group with a good clinical course than in those from the group with poor healing and recurrence (p = 0.006). There were no differences between the groups of patients with granulomatous and cholesteatomatous chronic otitis media (p = 0.66) or between the groups of patients with and without bacterial infection (p = 0.30), although the density of mast cells was lower for those with Pseudomonas aeruginosa/Proteus sp./ /Staphylococcus MRSA infection. In conclusion, the expression of mast cells in chronic otitis media granulation tissue was found to differ depending on the clinical course of the disease, but not on bacterial infection or type of COM. This may suggest that mast cells contribute to the maintenance of the inflammatory process, but not to antibacterial defense in chronic otitis media.

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.