Tomasz Gotlib

Prevalence of rhinitis in Polish population according to the ECAP (Epidemiology of Allergic Disorders in Poland) study

UNLABELLED The prevalence of allergic disorders, especially allergic rhinitis (AR), has dramatically increased in the past few decades and multicentre, standardized, randomized epidemiological studies are required to quantify this phenomenon in Poland. AIM The aim of the study was to estimate the prevalence of rhinitis and allergic rhinitis in Poland. MATERIAL AND METHOD The ECAP study was conducted using the ECRHS II and ISAAC questionnaires translated into the Polish language and validated, in selected nine regions of Poland, including eight cities and one rural area. The respondents within the regions were selected by means of multistage proportional stratified random sampling based on the identity number (PESEL) as the operat. The survey was conducted in 20,454 subjects (response rate of 41.9%) and 18,617 questionnaires were valid. Approximately 25% of the subjects (n=4783) were subsequently evaluated by clinicians (response rate of 43.4%). RESULTS Rhinitis was self-reported by 36.08% of the respondents (37.8% of 6- 7-year-olds, 34.5% of 13- 14-year-olds, and 36.0% of adults). The lowest prevalence rate was in the rural region (22.9%). Allergic rhinitis (AR) was self-reported by 22.54% of the respondents (23.6% of 6- 7-year-olds, 24.6% of 13- 14-year-olds, and 21.0% of adults). Again, the lowest prevalence rate was in the rural region (16.0%). AR was more frequent in males (24.0%) than in females (21.2%) (OR = 1.079; 95% CI: 1.044-1.116). AR was actually diagnosed by a clinician in 28.9%, including intermittent AR in 47.7% and persistent AR in 52.3%. Seasonal AR was diagnosed in 15.55%, and perennial rhinitis in 15.2%. CONCLUSION Allergic rhinitis is common in Poland as it affects nearly 25% of the population and it is a major social problem. Standards of early detection and prevention of allergic rhinitis should be introduced.

Changes in nasal cavity dimensions in children and adults by gender and age.

Objective: The aim of the study was to establish the dynamics of changes in the intranasal spaces of children and adults by gender and age.

Endoscopic transnasal management of inverted papilloma involving frontal sinuses

Inverted papilloma is a benign locally aggressive tumor of paranasal sinuses which has been traditionally managed with external surgical approaches. Advances in tumor imaging, surgical instrumentation and intraoperative visualization have led to a gradual shift to endonasal attachment-oriented surgery. Involvement of both frontal sinuses by inverted papilloma is rare. There are scant reports in the literature regarding this topic. We present 2 cases of the tumor involving both frontal sinuses removed by median drainage (Draf III procedure) under endoscopic guidance without any additional external approach. The whole cavity of both frontal sinuses was easily inspected at the end of the procedure. No early or late complications were observed. No recurrence was seen in 1-year or 2-year follow-up. Management of frontal sinus inverted papilloma with the endoscopic median drainage approach is feasible and seems to be effective.

Endoscopic transnasal management of sinonasal malignancies - our initial experience

Introduction Malignant tumors of the paranasal sinuses are traditionally managed through external approaches. Advances in endoscopic transnasal surgery have allowed for the endoscopic treatment of some of these tumors. Aim To present the results of treatment of a series of patients with paranasal sinus malignancies treated with an endoscopic approach at a single institution. Material and methods The data on tumor type, operative technique, perioperative complications and postoperative course were analyzed. Results Eleven patients meeting the inclusion criteria were identified. The histopathology was as follows: malignant melanoma in 3 patients, squamous cell carcinoma in 2, adenocarcinoma in 2, poorly differentiated carcinoma in 1, hemangiopericytoma in 1, adenoid cystic carcinoma in 1 and fibrosarcoma in 1. There were no severe perioperative complications with the exception of 1 case of cerebrospinal fluid leak, which was successfully closed. The mean observation period was 13.5 months. One of the patients died of disease, another was lost to follow-up, and one was reoperated on due to recurrence. The remaining 8 patients are alive with no signs of recurrence. Conclusions Our initial experience seems to confirm results obtained by other authors indicating that in selected cases endoscopic surgery of sinonasal malignancies is similarly effective as external approach surgery.

Znaczenie czynnościowej chirurgii nosa w leczeniu obturacyjnego bezdechu podczas snu (OBPS)

Summary Introduction Nasal obstruction is widely mentioned among the factors influencing pathophysiology of obstructed breathing disorders during sleep. However numerous observations confirm such relation, influence of nasal surgery on frequency and intensity of obstructive episodes during sleep remains modest and unpredictable in vast majority of cases. The aim of this study was to evaluate the role of functional nasal surgery in the treatment of Obstructive Sleep Apnea Syndrome (OSAS). Material and methods The study included 83 subjects with OSAS diagnosed by polysomnography and elevated nasal resistance due to different deformities of nasal skeleton. All patients underwent appropriate surgical treatment. Evaluation of day somnolence using Epworth Scale and subjective analysis of snoring and other sleep disturbances using linear scale was carried before and after surgery. Objective results of treatment were assessed by polysomnograpy performed 3 to 4 months after operation. Results The results obtained in our group of patients showed a large discrepancy between the subjective estimation of the treatment indicated by the patients and the objective determinations of the polysomnographic test. The average day somnolence intensity was decreased approximately 2 times and 72 (86%) patients stated that snoring intensity as well as other night time symptoms of sleep apnea greatly diminished. Furthermore in the group of 19 patients who continued nCPAP therapy after surgery the side effects of this treatment diminished and lower therapeutic pressure could be provided. Conclusions Correction of nasal obstruction have to be considered in all patients with OSAS because it may help relieve airway obstruction during sleep and improve the general quality of life at least in patients self estimation. Furthermore, an improvement of nasal patency diminishes the side effects of nCPAP therapy and provides lower therapeutic pressure.

Extended Draf IIb Procedures in the Treatment of Frontal Sinus Pathology

Objectives Draf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures. Methods Patients treated with extended Draf IIb procedures in a single center were retrospectively assessed. Results Ten patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient. Six patients had undergone prior surgery, including external procedures in 3 cases. Modifications of Draf IIb were classified as the following: removal of the anterosuperior nasal septum adjacent to the nasal beak, removal of the intersinus septum, and a combination of the above-mentioned methods (upper nasal septum and intersinus septum removal). There were 3 patients operated on with type 1 modification, one patient with type 2 modification, and 6 patients with type 3 modification. There were no perioperative complications. Conclusion In selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease.

Operacje z dostępu Draf III w materiale Kliniki Otolaryngologii WUM

Summary During last decades Draf III procedure gained popularity in treatment of different pathologies of the frontal sinus such as chronic sinusitis or benign tumors. We present a series of 10 patients treated with this procedure from a 2 year-period. Indications included chronic rhinosinusitis – four patients, frontal sinus mucocele – four patients (one with destruction of the posterior table), osteoma – one patient (stage 3 according to Kennedys grading system), and inverted papilloma – one patient (Krouse T3 lesion). Observation period ranged from 4 months to 2 years. Results There were no early complications. Gradual narrowing of the created ostium was observed in all of the patients. This led to total obstruction in two, and stenosis (not allowing for passing with 4 mm endoscope) in another two patients. The patient after inverted papilloma removal showed no recurrence in 11 months follow-up. Conclusion Draf III procedure is alternative for external approach that can be used for treatment of chronic rhinosinusitis and benign frontal sinus tumors of different size.

Transnasal endoscopic piezoelectric‐assisted removal of frontal sinus osteoma

INTRODUCTION Piezosurgery, a method of bone cutting utilizing ultrasound vibrations, widely used in oral and maxillofacial surgery, is being used in a growing number of new clinical applications. Its main advantages are preservation of soft tissues, precise bone cutting, and the possibility of use in narrow spaces. Over the past 5 years, several authors have presented their experience with the use of this tool in ENT including antromastoidectomy, stapedectomy, osteoplastic flap procedure, removal of osteomas of the frontal bone, and revision endoscopic sinus surgery. Osteomas of the paranasal sinuses are benign, slow-growing, usually asymptomatic tumors. The frontal sinus and recess are the most commonly affected sites. In most cases, surgery is not required, and radiological follow-up is performed. Indications for removal include frontal pain, rapid tumor growth, blockage of sinus drainage, involvement of more than half of the sinus volume, and intracranial or intraorbital complications. Endonasal endoscopic surgery of frontal sinus osteomas became possible due to the development of extended approaches to the frontal sinus. Draf IIb, IIb/III, and III procedures are limited mainly by individual anatomic conditions such as narrow anterior-posterior dimension of the frontal recess, not allowing the scope and burr to pass. The most common late complication of these procedures is scaring of the created ostium, which depends on the amount of removed mucosa created by the use of the burr. The use of mucosa-sparing, slim-shaped instruments allows for better visualization of the operative field, minimizes trauma, and improves late outcomes. Removal of large osteomas with currently available equipment (irrigated curved burrs) is rather time consuming. Cavitation of the lesion with burrs and then fracturing and piecemeal removal of eggshell remnants is the method of choice. The use of saw-like cutting instruments allows for creation of narrow gaps through the tumor, decreasing resection time. Another advantage of the use of piezoelectric systems is decreased risk of cerebrospinal fluid (CSF) leak and bleeding due to preservation of the dura and vessels. For these reasons, it is a promising tool for use in endonasal surgery of bony tumors of the paranasal sinuses. The purpose of this article was to present our initial experience with the use of piezosurgery for transnasal endoscopic frontal sinus osteoma removal. The patient was a 50-year-old, obese, asthmatic female complaining of severe frontal pain/headaches. She had previously undergone endoscopic sinus surgery for chronic rhinosinusitis with polyps 6 months prior with no improvement in headaches. Computerized tomography revealed osteoma type IV, according to Chiu and Kennedy classification, in her hypoplastic right frontal sinus, relatively thick frontal beak, and lower intersinus septum (Fig. 1). The maximum dimension of the tumor was 2.2 cm.

Asymmetry of the anterior skull base at the level of frontal ostium, a radioanatomical study.

BACKGROUND Radioanatomical studies have shown that the ethmoid roof is asymmetric in 10 to 40% of individuals. The right ethmoid roof has been found on average to be lower compared to the left. The aim of this study was to extend existing results by assessing asymmetry between the right and left anterior skull base at the level of the frontal ostium. METHODOLOGY Curved multiplanar reconstruction was used to analyse 247 consecutive paranasal sinus CT scans. The corresponding left and right parasagittal profiles of the skull base marked from the anterior ethmoidal artery to the level of the orbital roof were superimposed and compared. RESULTS Asymmetry greater than 1 mm was found in 87% of patients, greater than 2 mm in 40.5% of patients, and greater than 3 mm in 8% of patients. The prevalence of the patients with lower skull base on the right side was greater than those with lower skull base on the left side at a ratio of more than 2:1. CONCLUSION Skull base asymmetry in the region of the frontal ostium is observed in a large percentage of the population and may be a potential source of complications during endoscopic sinus surgery.

Włókniak chrzęstno-śluzowaty przegrody nosa

Summary Introduction Chodromyxoid fibroma (CMF) is a rare benign tumor, typically occurring in the metaphysis of long bones. Involvement of craniofacial bones is extremely unusual. The histologic diagnosis of this tumor is difficult because of its similarities to chondrosarcoma. Preferably, chondromyxoid fibroma is treated by complete local excision. Recurrences, or soft tissue implants, may follow incomplete curettage. Aim of study Presentation of the case of 51-year-old woman who presented with a CFM of the nasal septum with extension into the maxillary and sphenoid sinuses. In addition, a literature review of the clinical and histologic features, as well as recommended modalities of treatment, are presented. Material and methods Analysis of clinical records of patient treated of CMF in Department of Otolaryngology Warsaw Medical Univercity. Radiologic imaging showed a soft tissue lesion invading the adjacent bony structures. The initial microscopic examination of a segment of the tumor gives no diagnose. The tumor was excised. Postoperative microscopical examination of the tumor revealed the typical pathologic features of CMF. Patient was free of disease at 12-month follow-up. After it signs of recurrence appeared. Reoperation was performed. Conclusion Although surgery is a base of treatment, radiotherapy should also be discussed. Surgical excision must be complete. Radiotherapy should to be reserved for the cases that are surgically difficult to reach. Because of the similarities between CMF and chondrosarcoma, great care must be taken in the assessment of the biopsy.