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Nasal obstruction caused by adenoid hypertrophy can lead to malocclusion. The research material consisted of children aged 7-12 years with adenoid hypertrophy qualified for adenoidectomy. On the basis of the conducted tests (laryngological, orthodontic, pediatric), the occurrence of open frontal bite in children with pharyngeal tonsil hypertrophy, in particular in boys, was confirmed in comparison to children without hypertrophy correctly breathing through the nose.

Bacterial lysates stimulate the general immunity of the body in a non-specific way. They act on non-specific defense mechanisms, leading to an increase in type A antibody in mucous membranes, phagocytic activity and INF-ƴ production. They can also stimulate the production of specific antibodies against the bacterial antigens that make up the preparation. The oral immunomodulatory preparations with the best documented clinical efficacy available on the Polish market are Ismigen, Broncho-Vaxom, Ribomunyl and Luivac. They are all lysates of bacterial strains that most often cause respiratory tract infections. In many clinical trials, oral bacterial lysates have been shown to minimize the risk of recurrent respiratory infections in children and adults and reduce the need for antibiotics.

Allergic rhinitis (AR) is the most common form of allergy, which - as epidemiological research has shown - applies to nearly 25% of the population. AR significantly affects the quality of life of the patient, and the more severe the disease, the greater the risk of developing bronchial asthma. One of the factors affecting the severity of symptoms and the degree of their control is air pollution. In some patients, despite proper treatment, persistence or only partial remission of symptoms (uncontrolled allergic rhinitis) is observed. This can lead to an increase in comorbidities - inflammation of the paranasal sinuses, otitis media and asthma - both in children and in adults. The treatment of allergic rhinitis, in accordance with the standards, consists in: education of the patient, elimination of the allergen from the environment and factors intensifying the course of the disease, selection of proper pharmacotherapy and specific allergen immunotherapy. Many factors influence the selection of the antihistamine used, e.g., the opportunity of safe increase of the dosage.

Objective: A tropism to epithelial cells and lymphocytes, an inhibition of apoptosis in host cells, an ability to occurrence in persistent form resistant to antibiotic treatment are the features of Chlamydia pneumoniae, which can have connection with chronic inflammation of an adenoid tissue and adenoid hypertrophy. This study aimed to (1) detect the C. pneumoniae in an adenoid in children undergoing adenoidectomy, (2) estimate a connection between C. pneumoniae occurrence and the size of adenoid, (3) demonstration in which of adenoid cells C. pneumoniae occurs most often., Material and Methods: The examined group consisted of 200 children aged from 2 to 16 years (mean age 6,4) undergoing adenoidectomy. In all children during qualification for adenoidectomy a fiberoscopic examination of the nasopharynx was performed. A part of removed adenoid tissue was analysed by real-time PCR for C. pneumoniae. Adenoids from children with positive PCR examination and from 10 children with negative PCR examination were examined using immunohistochemistry (IHC)., Results: C. pneumoniae in the adenoid was present in 5,5% children. Positive results were obtained most frequently (24,14%, 7/29) in the eldest group (10-16 years). A statistical analysis demonstrated the correlation between C. pneumoniae occurrence in an adenoid tissue and the size of adenoid. In immunohistochemistry C. pneumoniae was found the most frequently in lymphocytes and in epithelial cells., Conclusions: A presence of C. pneumoniae in lymphocytes and epithelial cells of the adenoid first of all in older children with adenoid hypertrophy confirms the participation of this bacteria in adenoid pathology.

Introduction: The development of medicine, in this the new techniques and antibiotic therapy enlarged the survivability of patients in hospital. Applying antibiotics caused breakthrough in treatment stepping out in ill's group infections treated in hospital, however enlarging resistance is natural this effect, resulting from: the selection of resistant strains, the formation of new mechanisms of resistance, and/or the spreading of gene of resistance. Multidrug-resistant strains were included to emergence-pathogens group: MRSA, penicillin-resistant Streptococcus pneumoniae, VRE, Gram-negative producing beta-lactamase of type the ESBL and/or resistant to carbapenems. Emergence-pathogens occurrence leads to: therapeutic failures, the use extorts in therapy of dear medicines or with possibility of workings undesirable. The multidrug-resistant strains spread in hospital environment easily, especially on departments about high waste of medicines with the patients' simultaneously large susceptibility on infection, resulting mainly with state of reduced resistance of organism. The control of hospital infections recognize by present hospitality for the most important criterion of quality of work., Aim: Analysis of the emergence-pathogens isolated during treatment in hospital in 2005-2008, from special regard the ENT Department., Material and Methods: 50586 children treated in this period in hospital in which was executed 39386 bacteriological investigations, in this 6528 (12.9%) children in ENT Department in which was executed 1566 bacteriological investigations (3.98%). The diagnostics were executed according to routine microbiological procedures with qualification of resistance to antibiotics., Results: Emergence-pathogens infection was confirmed at 2369 children's (4.68%) treated in Hospital, in this in ENT Department at 84 children (1.29%). The most frequent emergence-pathogens in ENT Department were Streptococcus pyogenes, Streptococcus pneumoniae penicillin-resistant and average sensitive on penicillin, Staphylococcus aureus methicillin-resistant and Rotavirus., Conclusions: Streptococcus pneumoniae penicillin-resistant and average sensitive to penicillin and Rotavirus infections are the most frequent hospital infections. The systematic microbiological supervision is indispensable in prevention the spreading of infections of the emergence-pathogens in hospital.

Objectives: Estimation of the treatment of the nasal septal hematoma and abscess after injury was performed., Material and Methods: In 1998-2005 in Department of Otolaryngology Children's Hospital in Warsaw 2500 children after nasal injury were examined. Nasal septal hematoma and abscess were diagnosed in 22 (0,9%). They were reviewed retrospectively and some of them were examined 1-8 years after., Results: In 22 children with nasal septal hematoma and abscess no complication were observed during treatment. In 12 children examined 1-8 year after treatment 1 child developed saddle nose deformity (qualified to observation) and 1 child developed nasal septum deformities with nasal obstruction (qualified to septoplasty)., Conclusions: Complex treatment of nasal septal hematoma, drainage of the hematoma with septoplasty and reduction of fracture of the nose, makes good functional and cosmetic effect. Drainage of the nasal septal abscess with antibiotic prevent the early complications but it isn't enough functional and cosmetic effect in the future.

The influence of chemical substances (feromones) on human emotional and physical condition has fascinated psychologists, sexuologists and laryngologists since centurie. Literature conveys inconsistent information on vomeronasal organ (VNO) occurrence in humans. This organ is often called Jacobson's, and 2 symmetrical openings leading into it, located on both sides of septum, are called Ruyasch's ducts. The aim of the study was to analyze vomeronasal organ occurrence in humans in relation to age and sex. The study was conducted in a group of 634 patients, aged 18-80 years. All patients underwent routine ENT examination including rhinoscopy, nasal cavity examination with usage of 2.5x magnification lens (surgical glasses) and surgical microscope with 10x magnification. All persons had nasal cavities examined endoscopically. Every time presence of vomeronasal organ openings, along with localization, size and symmetry of these was noted. Subjects, who presented Jacobson's organ, were asked to fill a questionnaire concerning influence of smells on erotic sensations. Vomeronasal organ was fund in 312 persons, that is 49.21%. In 83.65% of cases vomeronasal organ opening size was smaller than 0.2 mm, what restricted its visibility to usage of magnifying lens, microscope, or endoscope. In 16.34% of cases only vomeronasal organ ducts openings were well visible in routine rhinoscopy without magnification. Vomeronasal organ was found more often in men than women. VNO was significantly more rare in patients with nasal septal deviation. In these cases, vomeronasal organ was usually found unilaterally, in all the cases on the concave side of deviated nasal septum.

Introduction: An increasing antibiotic resistance of pathogens is the main cause of failures during treatment of acute otitis media (AOM). Aim. A qualitative and quantitative bacteriological analysis of material isolated from the middle ear in children with AOM treated with antibiotic without improvement., Material and Methods: This is a prospective study performed in Department of Otolaryngology in Warsaw between 2005 and 2007. An examined group consisted of 72 children aged from 6 months to 17 years, admitted to Department of Otolaryngology because of failure of antibiotic therapy of AOM, severe course of this disease and complications of AOM or persistent AOM. In all children were performed the myryngotomy and/or ventilatory tube insertion and/or mastoidectomy and the material from the middle ear was collected to bacteriological examinations., Results: The positive cultures were obtained in 63.9% patients. Streptococcus pneumoniae (40.4%), Staphylococcus aureus (14%), Haemophilus influenzae (10.5%) and Pseudomonas aeruginosa (10.5%) were the most frequently found bacteria in the culture of middle ear. beta-lactamase producing bacteria were isolated in 12 children (21.1% of isolated bacteria). Staphylococcus aureus (7 children, 12.3% of positive cultures) was the bacteria most frequent producing beta-lactamase. The most of organisms were susceptibility to amoxicillin/clavulanate--56.1% of bacteria from the middle ear. The most of organisms presented resistance to penicillin--63.9% of bacteria from the middle ear., Conclusions: Microbiological identifications and antibiotic resistance determination of pathogens isolated from the middle ear in children with AOM not responding to empirical antibiotic treatment gives possibility of the choice of an effective antibiotic and its proper dosage. The pathogenic bacterial flora isolated from the middle ear in children with AOM shows evidence to accomplishing changes in the most frequent pathogens causing acute otitis media in children.

We describe children with orbital complications of acute sinusitis and analyse symptoms, diagnostic procedure and treatment options. We used X-ray and/or CT of paranasal sinuses to make diagnosis. The most frequent presenting orbital and occular symptoms are preseptal cellulitis and orbital cellulitis. Management of these children included intravenous antibiotic and we made maxillary sinus puncture with drainage. Proper recognition and treatment lead to total recovery.

Introduction: Otitis media with effusion is a common problem in childhood. The tympanostomy tubes is a standard treatment of persistent otitis media with effusion in children which improves hearing level. However some pathological changes of the tympanic membrane and middle ear few years after treatment are observed. The aim of the study was prevalence of middle ear sequelaes in children with persistent otitis media with effusion treated by tympanostomy tubes 4-10 years after treatment., Material and Methods: The group of 61 patients aged between 1-13 with otitis media with effusion treated by tympanostomy tubes in Department of Otolaryngology Childrenís Hospital in Warsaw between 1994-2001 were controlled. 113 ears treated with tympanostomy tubes were examined 4-10 years after treatment. At the examination otomicroscope, pure-tone audiometry and tympanometry were used., Results: Out of the 113 ears after ventilation tubes insertion as a method of otitis media with effusion treatment in 83 (73%) developed one or more middle ear sequelaes. Myringosclerosis in 47 ears (41,59%), segmental atrophy in 19 ears (16,81%), atrophy in 14 ears (12,38%), disfunction of Eustachian tube in 8 ears (7,07%), otitis media with effusion in 7 ears (6,19%), perforation of tympanic membrane in 6 ears (5,3%), chronic otitis media in 2 ears (1,76%), retraction pocket in 2 ears (1,76%) and tympanostomy tube in the middle ear cavity in 1 ear (0,88%) were found. No cases of cholesteatoma were found. In 22 ears (19,46%) the conductive hearing loss was greater than 20 dB. In 4 ears (3,5%) mixed hearing loss and in 3 ears (2,6%) receptable hearing loss was diagnosed. Tympanogram type A was in 86 ears (76,1%), tympanogram type B was in 11 ears (9,7%) and tympanogram type C was in 12 ears (12,6%)., Conclusions: In children with otitis media with effusion treated with tympanostomy tubes the amount of sequelaes increased with time. In children with otitis media with effusion who started treatment with tympanostomy tubes in age to 4 years old the amount of sequelaes is less. The follow-up is recommended up to 8 years after the treatment.

We report on 34 children with acute lymphadenitis of the neck at the age between 10 months to 12 years who were admitted in our Department of Otolaryngology Children Hospital in Warsaw between 2001-2003. In a retrospective study we evaluated clinical features and diagnostic impact of ultrasonography, white blood cell count, C-reactive protein as well as bacterial etiology of children treated surgically for bacterial cervical lymphadenitis. Leukocytosis and elevated concentrations of C-reactive protein occurred in the majority of patients in 32 children (94.12%). 24 children (70.59%) we treated conservatively. Clinical appearance and the result of ultrasound examination were relevant for diagnosis of suppurative inflammation. Treatment included antibiotic therapy in all cases and incision and drainage in 10 cases (29.4%). A positive culture grew in 20% of children treated surgically and of these isolates we found Streptococcus pyogenes and Streptococcus species. In these cases surgical drainage is a key to appropriate resolution. USG diagnoses were retrospectively correlated with clinical and surgical findings or with the outcome of treatment in 87.5% of children.

Hypertophy of pharyngeal tonsil and palatine tonsils is the most common cause of nasal obstruction in children. When the obstruction of the nasopharynx causes recurrent infections of upper respiratory tract, chronic otitis media secretoria or sleep apnoea, then adenoidectomy with or without tonsillectomy is indicated. The purpose of the study was analysis of postoperative hemorrhage after adenoidectomy with or without tonsillectomy. The influent of frequent infections of upper respiratory tract, disorders of blood clotting, chronic diseases, seasons of the year, operation time and general anesthesia on postoperative hemorrhage was estimated. A group of 1184 children after adenoidectomy with or without tonsillectomy was studied. Postoperative hemorrhage occurred in 59 children (4.98%). Early bleeding was frequently occurred after adenotonsillectomy and late bleeding after adenoidectomy. There was relationship between the time of general anesthesia and incidences of postoperative bleeding. Food or inhalation allergy, recurrent infections of upper respiratory tract and male sex are risk factors of postoperative hemorrhage after adenoidectomy with or without tonsillectomy.

Otitis media with effusion and eustachitis occur very often in childhood. In dependence on advanced of otitis media with effusion and eustachitis, we use surgical and nonsurgical treatment. In short-term otitis media with effusion and eustachitis performs tympanotomy, insufflation of the Eustachian tube by Politzer and Valsava's methods and vibro-pressure massage AMSA. The aim of this study is estimation of efficacy vibro-pressure massage AMSA in otitis media with effusion and eustachitis in children. The study population consisted of 34 children and youth aged between 3-17 years with otitis media with effusion or eustachitis. In all people we performed 10 procedures of vibro-pressure massage AMSA administered 4 mg dexamethasone in vibro-aerosol. Efficiency of treatment was estimated by comparison otolaryngology examination, pure tone audiometry and tympanometry. In 76.7% ears with eustachitis we observed correct results of examinations of hearing acuity after treatment. It was more two times better then in children with otitis media with effusion. Vibro-pressure massage AMSA 10 times with 4 mg dexamethasone in vibro-aerosol is good method in treatment of eustachitis. In otitis media with effusion isn't efficacious enough. In this case we recommended tympanostomy tube.

We report a case of nasal septal abscess and palatine process of the maxilla abscess secondary to acute rhinosinusitis in an 12-year-old boy. Rare complication of acute sinusitis is the nasal septum abscess; even rarer is the abscess of the palatine process of the maxilla, which our patient presented. Nasal septum abscess is an reservoir of suppurative secretion between cartilage or bone of the septum and their periostium or perichondrium. Nasal septum abscess is most often bilateral, causing nasal cavities obstruction. Other symptoms are: nasal pain, fever, headache, nasal tenderness, bad general feeling. Spontaneous abscesses of nasal septum are rare and occur due to acute ethmoid or sphenoid sinusitis and inflammations originating from teeth. Patophysiology of nasal septum abscess depends on its etiology. The isolated acute sphenoid sinusitis may lead to occurrence of nasal septum abscess by spreading of inflammatory changes under periostium along the anterior surface of sphenoid bone and damaging the periostium of vomer and perpendicular lamina of ethmoid bone into subperichondrial space of quadrangular cartilage. Inflammation of inferior wall of sphenoid sinus located over fornix of nasopharynx might have lead to appearance of the palatine process of the maxilla abscess. We consider this mechanism of abscess creation occurred in our patient. Another possible mechanism comprehends spreading of inflammatory process through bone fissures, congenital bone malformations of due to thrombophlebitis. Recommended procedure in cases of confirmed nasal septum abscess is surgical decompression from semitransverse incision of the column and abscess drainage. Aspiration and bacteriological culture allow for exact establishment of proper antibiotic treatment. Antibiotic therapy should be conducted for 2-3 weeks according to bacterial sensitivity to chemotherapeutics. In reexamination of our boy's nasal septum cavity of abscess was assessed and a small cartilage defect was noted. Necrotic changes in nasal septum cartilages arise due to ischemia and compression by residual pathological contents between perichondrium and cartilage. Proper recognition and surgical and preservative treatment lead to total recovery. In our boy, control examinations after 2 and 6 months confirmed recovery without recurrence and later complications.

Nasopharyngeal flora can be a reservoir of bacteria caused acute otitis media in children. The aim of the study was to identify microorganisms and antimicrobial susceptibilities of pathogens from the nasopharynx and middle ear of children with acute otitis media. The study comprised 128 children ages 1 year to 14 years with diagnosed of acute otitis media with purulent discharge. The nasopharyngeal and middle ear samples were collected at the same time. Agar, chocolate, blood and Chapman plates were inoculated for isolation of bacteria. The plates were incubated at 37 degrees C and examined at 24 hours. The susceptibility of bacteria was determined by disk diffusion technique containing concentration gradients for following antibiotics: penicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefaclor, cefprozil, cefuroxime, erythromycin, azithromycin, clindamycin and trimethoprim/sulfamethoxazole. 196 organisms from nasopharynx and 325 organisms from middle ear were isolated. Most frequent cultured bacteria were: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis--75.6% in nasopharynx and 77.8% in middle ear. We observed statistically significant (p < 0.01) increased of Moraxella catarrhalis in specimens from the middle ear than from nasopharynx. Most of the organisms were susceptible to amoxicillin/clavulanate--83.2% of bacteria from nasopharynx and 81.8% of bacteria from middle ear. Most organisms were resistant to trimethoprim/sulfamethoxazole--60.7% of bacteria from nasopharynx and 62.6% of bacteria from middle ear. Penicillin resistance was observed in 25.0% of bacteria from nasopharynx and 25.6% of bacteria from middle ear. The correlation in resistance of bacteria between trimethoprim/sulfamethoxazole and erythromycin (r = 0.4886) and between trimethoprim/sulfamethoxazole and penicillin (r = 0.5027) was observed. Nasopharyngeal and middle ear flora in children with acute otitis media is similar. In that case susceptibility of bacteria from the nasopharynx can be useful for empirical treatment of acute otitis media in children.

The palatine tonsils are cluster of lymphatic tissue located at the border of the respiratory system and the digestive system. Hypertrophy of palatine tonsils is the consequence of the stimulation of the children's immunological system by antigens of the breathing air and food intake. The aim of this study is the estimation of the size of the palatine tonsils depends on the age and the estimation of the correlation between size of the palatine tonsils and the frequency of otitis media and sinusitis in children, youth and young adults. 326 children divided into three groups: group I aged 3-6, group II aged 7-14, group III aged 15-22. We examined the oral cavity, the throat, the nose and the ears. The size of palatine tonsils was qualified according to Pirquet's classification. The questionnaire was included. The fifth degree of the size of the palatine tonsils observed more often in youngest group then in the other. Otitis media occurs in 80% children with fifth degree of the size of the palatine tonsils and in 50% children with I, II, III degree. The sinusitis was the most frequent in group of children with I and II degree of the palatine tonsils. In group of children with fifth degree sinusitis didn't occur. The size of the palatine tonsils can influence occurring and frequency of otitis media but it doesn't influence occurring and frequency of sinusitis.

In paper a case of pyogenic granuloma of the tongue in an 8-week-old child was presented. The signs and symptoms, etiological agents, surgical treatment, and complications are discussed. This case is the youngest case with an unusual location. The lesion was presented as sessile, soft, single and pink erythematous nodule with tendency to spontaneous hemorrhage, 3 cm in diameter. We performed conservative excision because of anaemia and not good condition of the child. We didn't observe recurrence of this lesion in follow-up after 2 weeks, 6 months and 3 years. We report this case to alert the otorhinolaryngologist of this rare condition. There have been very few reports in the literature of this condition.

Subglottic laryngitis is one of the acute children's diseases, directly caused by a violently growing edema of the subglottic area. Its symptoms generally appear very suddenly, when children seem to be in perfect health, at night, several hours after falling asleep. Their symptoms included barking cough, clear voice, stridor, inspiratory dyspnoea with participation of auxiliary respiratory muscles, excitation and anxiety of a child, changes in skin coloration. The movement of the wings of the nostrils is intensified. In especially severe cases, agitation, cyanosis, pallor of skin, obnubilation, apnea, loss of consciousness and circulatory failure may also occur. Subglottic laryngitis is a disease, which can threaten the life of a small child. The aim of this study was to observe efficacy of the treatment of the subglottic laryngitis with glucocorticoids, especially budesonide in nebulization. The research covered 169 children: 58 girls (34.31%) and 111 boys (65.69%) aged 9. months do 5. years (mean 3 years 6 months) hospitalized in the Children's Hospital in Warsaw with the following symptoms: dry barking cough, stridor, inspiratory dyspnoea with the participation of auxiliary respiratory muscles, agitation and change of colour of skin. The examination of each patient included subjective, objective (pediatric and laryngological). Disease severity was assessed by a clinical croup score based on stridor, cough retractions, dyspnoea and cyanosis and the overall clinical assessment was scored on a visual scale. The results indicate that nebulised budesonide can be used as a safe and effective alternative treatment in children with moderate to severe subglottic laryngitis.

Pott's puffy tumor is an infrequent entity characterized by subperiosteal abscess associated with frontal bone osteomyelitis. It is usually seen as a complication of frontal sinusitis. Although cases, in patients of all ages have been reported, teenagers are the most frequently affected. Despite modern methods of diagnosis and treatment, 9 new cases in children, have been published in the last 7 years. This paper describes the case of 13-year-old boy with subperiosteal abscess resulting from exacerbation of chronic frontal sinusitis. Complete resolution occurred with an intensive antibiotic regime and drainage of frontal sinus and subperiosteal abscess.

Neck tumor is always an alarming symptom. Neck tumors are be divided into primary tumors and metastatic tumors. The latter may in turn be divided into tumors which come from a known primary focus and those coming from an unknown primary source. The most commonly found neck tumor takes the form of an enlarged lymph node which may be a primary or a secondary symptom of a disease developing in this area. The diagnostic methods consisted of a otolaryngological examination, laboratory examination, histopathological examination and image examination. In primary neck tumors the treatment proceedings depend on the kind of tumor. The most difficult case, however, is a neck metastasis from an unknown primary focus. In such cases, the most appropriate method of treatment appears to be a radical neck dissection. Combined radiation should be performed in those cases, in which sample tests show cancer infiltration of the node capsule or the presence of cancer plugs in the blood or lymph vessels.

The authors present their observations upon surgically treated children with otitis media with effusion. The results are indicative of usefulness of ventilation tubes, myringotomy and adenoidectomy in the treatment of the otitis media with effusion in children. The efficiency of the treatment is based on the hearing examination and tympanometry, and the lack of recurrence of inflammation of the middle ear. 67.6% of cases revealed normal hearing.