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Unlabelled: Acquired post inflammatory external auditory canal atresia is a rear complication of external ear disease. It is presented as a connective tissue scar in bony part of external auditory canal. The aim of this study is clinical and epidemiological analysis and presentation of diagnostics and treatment results of patients with atresia treated in the Otolaryngology Department of Medical University of Gdansk., Material and Methods: In the period of 3 years (2008-11) 10 patients (8 women and 2 men) aged 30 to 70-years-old (medium 53 years) were treated for acquired atresia. All of these patients had medial closure of EAC with thick connective tissue scar and tympanic membrane involvement. Intrameatal access was performed in 5 patients, intraural access in 3 patients and retroaurical access in 2 patients. In all cases canaloplasty with meato-tympanic angle enlargement was performed, skin defect was replaced with free epidermal flap, silicon foil with fibrinous sponge was used for coverage., Results: In all of our patients external auditory canal widening and hearing improvement was achieved. Due to increasing EAC narrowing four patients underwent second surgery with another free epidermal flap grafting., Conclusion: The selection of surgical access in patients with acquired atresia should comply with the etiology of the disease and the shape of EAC. During surgery we aim at maximal broadening of the bony part of EAC. The success of the treatment depends on meato-tympanic angle enlargement and free epidermal flap grafting., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Introduction: To assess an effect of cochleostomy on hearing threshold in guinea pigs., Material and Methods: The authors performed animal experiments using five 3-month-old guinea pigs. Before experiment hearing threshold were evaluated. Surgery involved access to the temporal bone by a post-auricular incision. After a wide opening of the bulla cochleostomy was created (10,000 turn/min, diamond bur of 0.8 mm diameter). Hearing threshold was identified on the basis of presence of wave V in auditory brainstem responses (ABR) for click and frequency-specific stimulation. Also morphology and latency changes for wave V for this stimulation was assessed. Hearing status was evaluated before, just after and 1-, 2-, and 4-weeks after surgery. For surgical procedure and ABR examination all animals were anesthetized with an intramuscular injection of ketamine (50 mg/kg) mixed with xylazine (9 mg/kg) in the supplemental doses. After surgery the animal was treated by antibioticoterapy for 3 days--Enrofloksacyna 0.3 ml subcutaneouly and analgesic--Tolfedine 0.05 mg in second day., Results: Four week observation of ABR morphology and hearing thresholds for click and frequency-specific stimulation of 100 dB SPL intensity showed only temporary changes confirming that cochleostomy did not affect cochlear function., Conclusions: The correctly performed cochleostomy in guinea pigs did not affect persistently the cochlear function indicating that such an option of CI electrode insertion in patients is safe.

The paper is a review of primary and secondary historical and scientific literature concerning the surgical treatment of the middle ear diseases. The development of mastoid surgery can be traced through the past 4 centuries. Once used as a means of evacuating a postauricular abscess, it has evolved to become a method for gaining entry into the middle ear to control acute and chronic ear diseases, or for treatment of otogenic complications. Earlier works led the way to the postauricular "Wilde incision", which gave rise to Schwartze mastoidectomy. Oscar Wilde's ultimate demise from an otogenic meningitis appears all the more ironic when one considers the role his father, Sir William Wilde, played as one of the founding fathers of modern otology. The death of baron von Berger after mastoidectomy performed for treatment of tinnitus and hypacusis, stopped the further development of surgical procedures for about hundred years. The Joseph Toynbee's "Diseases of the ear" was the first work about ear diseases on a pathologic anatomical base, and fundamental for otology of the German speaking countries in the nineteenth and early twentieth centuries. Otology was emerging as a specific specialty. Von Tröltsch was the first surgeon, who proposed the antral opening through the external ear canal. When Schwartze and his assistant, Eysell, published their paper: "On the Artificial Opening of the Mastoid Air Cells," a century or so had passed since the few previous attempts to remove the tegmen of the mastoid had been reported. One of the greatest otologists of the 19th century was Adam Politzer, His influence on the 50 years of otology has never been equaled. It is in his honor that the International Society of Otology bears his name.

Unlabelled: The aim of the thesis is the analysis of the anatomical abnormalities and atypical conditions in the middle ear encountered during the surgery for otosclerosis and their influence for the course of the operation. These atypical conditions could result either from the congenital anomalies or from the disease itself., Material and Methods: The material comprises 572 stapedectomies performed in ENT Department of the Pomeranian Academy of Medicine in Szczecin (Poland) between 1969 and 2004. Partial stapedectomy was performed with removal of the stapes crura and usually posterior part of the footplate., Results: Among 572 ears which underwent the operation different abnormalities in the tympanic cavity were found in 134 cases (23,4%). These included: narrowed oval window niche in 71 cases, stapes anomalies in 46 cases, obliterative otosclerosis in 20 cases, red otospongiosis of the stapes in 9 cases, increased perilymph pressure in 7 cases, malleus and incus bony fixation in 3 cases. The presented abnormalities were the reasons of many failures at the time of the operation. While in the 438 ears with normal anatomical status in the tympanic cavity failures during the operation occurred in only 6 cases (1,4%), in the 134 ears with such abnormalities failures happened in 33 cases (24,6%). The most frequent failure - 20 cases - was premature mobilization of the stapes followed by other consequences. In the other 9 cases the operation was discontinued for different reasons. Another failure was the floating footplate in 2 ears, facial nerve paresis in 1 ear and incus subluxation also in 1 ear. In a few cases in which the operation was stopped the successful stapedectomy was performed at the 2nd stage. Only in 3 ears the stapedectomy was totally given up what makes 0,5% out of the 572 ears operated on.

The authors describe various methods of surgical treatment of extensive petrous pyramid cholesteatoma. The surgical technics were selected to each individual patient. The approach depended on the disease's course, the lesion extention and the ear functional state. Total removing of cholesteatoma were possible by the lateral petrosectomy or by the middle fossa approach. The authors underline that petrous cholesteatoma can develop after previous radical mastoidectomy. The origin of this type of cholesteatoma is usually supratubal recess.

The problem of treatment of the mastoiditis was discussed long ago--in XVII and XVIII centuries by Jean Riolan (1580-1657), Werner Rolfinck (1599-1673), Jean L. Petit (1674-1750), Jasser and the others. The therapeutic indications of mastoidectomy in 1873 by Hermann Schwartze (1837-1910) is mentioned. The achievements of such German physicians as Friedrich Bezold (1842-1908) and Ernst Küster (1839-1930) are described in detail. The achievements of such Varsovian physicians as Teodor Heiman (1848-1917), Andrzej Alfred Heiman (1984-1933), Edmund Modrzejewski (1849-1893), Samuel Meyerson (1851-1939) and Ludwik Guranowski (1853-1926) are also presented.

The treatment of nasal polyps in the past is described. The role of such physicians as Aetius of Amida, Paul of Aegina, Guy de Chauliac, Gabrele Fallopio, Fabricius Hildanus are depicted, the significance of such XIX century physicians as Joseph Toynbee, Anton von Troeltsch, Joseph Gruber, Adam Politzer, Friedrich Voltolini and Bronisław Taczanowski, Teodor Heiman at Polish territories are presented with full particulars. The problems of pathological anatomy, symptomatology and especially the treatment of aural polyps is strongly pointed out. The significance Bonnafont's instrument, Blake's and Wilde's nooses, galvanocaustic operations are described in more detail. The danger of those operations is pointed out.

We have analysed results treatment of 253 patients with chronic otitis media. Our tactic includes operation with application one-momental sanation and reconstruction of a middle ear. Sanational stage was performed in volume atticoantrotomia or radical operation. Reconstruction included reconstruction of a tympanic cavity and retrotympanic space. The shape of a plate was made so that to make a base for neotympanic membrane and to forma a lateral attic wall. Defect of a drum-type membrane restored free flap of a fascia temporal muscle. The mastoid process cavity was filled allogenic cartilage transplants the first variant of reconstruction formed artificial antrum cartilage by fragments and plates. At the second variant was acted similarly, however the artificial cavity wall of the antrum we made soft and mobile from the skin of external acoustical passage and neotympanic fascia flap. In postoperative period the position of a posterior wall of external acoustical passage was formed depending on intratympanic pressure, which depended on a acoustical tube function. Such technique allowed us to reduce formation retraction complications from 15% up to 6.7%.

The authors described a technique and presented the results of the modified labyrinthectomy in 9 cases. A labyrinthectomy was performed during the removal of neuromas by translabirynthine approach, in advanced unilateral Meniere disease, in a huge perylimphatic fistula and in a case of labyrinthitis latens. In 3 cases of the neuromas removal the residual hearing was preserved. In remained cases of labyrinthectomy hearing was preserved partially.

Indication to translabyrinthine approach to removing of the cerebello-pontine angle tumors--anatomical aspects. Translabyrinthine approach was used in surgical procedures performed for stage II, III and IV tumors of the cerebello-pontine angle of various sizes in 15 cases. In order to ensure a correct course of the procedure and successful removal of the tumor, translabyrinthine approach should be carefully planned on the basis of radiological criteria (CT, NMR). Anatomical limitations of the approach are connected with the localization of the sigmoid sinus, the bulb of the internal jugular vein, pneumatization of the mastoid process and the location of the superior petrosal sinus. In approach planning it should be considered whether the bulb of the internal jugular vein is not located high in relation to the internal auditory meatus, what is the meatus diameter (IAC), location of the sigmoid sinus--its shift to the front is a serious limitation for the approach. The pneumatization state of the mastoid process is also important because of the duration of petrosectomy. Taking into consideration the aforementioned conditions allows to plan precisely and perform the approach appropriate for the tumor size.

On the basis of the presented clinical material, the authors present their own observations concerning qualification of the patients with cerebello-pontine angle tumors for surgery utilizing the translabyrinthine approach. The clinical material includes 15 cases of stage II, III and IV cerebello-pontine angle tumors removed through translabyrinthine approach. In view of the fact that there are different opinions concerning the selection of appropriate surgical approach and of a conviction that translabyrinthine approach should be used in case of stage II, relatively small tumors, and that larger, stage III and IV ones should be operated on using the retromastoid approach, we are presenting our views concerning the qualification of patients. In our opinion, the translabyrinthine approach can be used for larger tumors--also for stage IV ones. The translabyrinthine approach was considered only in the cases with total hearing loss and not useful hearing. Of course, in the cases when the tumor penetrates into the middle cranial fossa or into the foramen magnum, the approach may prove rather difficult. As it has been known, the dimensions of the access route are determined by three main anatomical structures: altitude of the bulb of the internal jugular vein, location of the sigmoid sinus and the diameter of the internal auditory meatus. The fundamental advantages of the approach include: no cerebellum retraction required in the case of classic retromastoid approach, easy anatomical and neurophysiological identification of the course of the facial nerve and maintaining its continuity. An approach involving damage of internal ear structures can be performed only if the patient is deaf.

The authors described two rare cases of tumors of the external auditory meatus. All patients were male 40 and 51 years old. The tumors were removed via external auditory canal approach and extraauricle approach with successful.