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Introduction: The most common cause of vocal fold paralysis (VFP) is iatrogenic injury. Patients with symptoms of VFP present to the specialist after a couple of weeks or even months since the onset of symptoms. In the literature, the data regarding speech impairment during the first days after a iatrogenic injury is lacking., Aim: to evaluate the quality of voice during first days of vocal fold paralysis following a iatrogenic injury., Materials and Methods: Twenty-five patients with iatrogenic vocal fold paralysis who presented for phoniatric consultation at the Department of Otolaryngology of the Medical University of Warsaw between May 2015 and December 2016 were enrolled in the study. The patients were examined 1-2 days since the onset of speech deterioration. In all patients, laryngeal videolaryngostroboscopy was performed, based on which the following were assessed: vocal fold mobility, mucosal wave, phonation closure, simultaneity and amplitude of vocal fold vibration. Acoustic analysis was performed, and the following acoustic parameters were evaluated: DSI, F0, Shimmer, Jitter, NHR. Also, the maximal phonation time of [a] sound (MPT a) was assessed and the voice perception analysis with the GRBAS scale was performed. The patients self-evaluated their voice using a 10-point VAS scale., Results: Based on the videolaryngostroboscopy, phonatory insufficiency and asymmetrical vocal fold vibration were observed. On perception assessment with GRBAS scale, we noticed slight to mild degree hoarseness, breathiness of sound and weakened voice. In majority of patients, the maximal phonation time of [a] sound was significantly reduced. All patients showed abnormal acoustic parameters. None of them rated their voice as perfectly normal on VAS scale.

Wstęp: Cel badania stanowi ocena efektów długoterminowych augmentacji krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia. Materiał i metody: W badaniu wzięło udział 17 pacjentów, którzy z powodu niewydolności szpary głośni (z powodu jednostronnego porażenia krtani oraz niewydolności mięśni wewnętrznych krtani) zostali zakwalifikowani do przeprowadzenia augmentacji krtani (10 kobiet i 17 mężczyzn), w wieku: 57,6±17,7 lat, mediana 61 lat, z zakresem: 32-83 lata. U wszystkich pacjentów wykonano augmentację krtani w znieczuleniu miejscowym, przez jamę ustną, podając bocznie od fałdu głosowego/ fałdów głosowych hydroksyapatyt wapnia (preparat Radiesse). W celu oceny efektów długoterminowych augmentacji krtani - przeprowadzano ocenę jakości głosu pacjenta przed augmentacją, a następnie 3 i 12 miesięcy po augmentacji krtani, przy pomocy oceny videolaryngostroboskopowej krtani, oceny odsłuchowej, analizy akustycznej, oceny aerodynamicznej oraz samooceny głosu dokonanej przez pacjenta przy pomocy kwestionariusza VRQoL. Wyniki: Uzyskano istotną statystycznie poprawę w ocenie odsłuchowej głosu dla parametrów G i A, po 3 miesiącach, dobre wyniki utrzymywały się w czasie 12-miesięcznej obserwacji. W ocenie akustycznej MDVP_Jitt, MDVP_Shim i MDVP_NHR poprawiły się odpowiednio do wartości: 2,5; 5 oraz 0,1 (3 miesiące po augmentacji) i 1,9; 3,6 oraz 0,1 (12 miesiące po augmentacji). MPTa wydłużył się do 12,2 i 11,9 s., odpowiednio po 3 i 12 miesiącach od augmentacji. Natężenie głosu poprawiło się z 67 do 68 oraz 71 dB(A), odpowiednio po 3 i 12 miesiącach. Wyniki: VRQoL poprawiły się do wartości 19,5 i 20, odpowiednio 3 i 12 miesięcy po augmentacji. Dyskusja Augmentacja krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia daje długotrwałe, dobre efekty leczenia.

Objective: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds., Material and Methods: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated., Results: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively - 90.7%, 31.4%, 78.9%, 84.1% and 45.8%., Conclusions: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.

Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy., The Aim: The evaluation of voice results in patients after medialisation throplasty., Material and Methods: In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma., Results: There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement., Conclusions: The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.

Introduction: Vocal fold paralysis it is an important problem in Phoniatrics' Ambulatory. There are a lot of difficulties in estimation a precise incidence of vocal fold paralysis in the population. As many as 50% of cases with paralysis might present nonspecific symptoms., Aim of the Study: The aim of the research it was to determine a vocal fold paralysis' epidemiology and etiology in material of the Medical University of Warsaw's Ambulatory of Phoniatry., Material and Methods: Authors present a group of 593 patients with vocal cord paralysis who were diagnosed and treated in The Ambulatory of Phoniatry from 2000 to 2011. The paralysis was observed in 439 women and in 154 men. In 488 patients paralysis was unilateral and in 105 - bilateral., Results: In the study, surgery was responsible for most vocal fold paralysis (79.0%). In 357 patients, paralysis was caused by thyroid surgery. Other surgical causes of the paralysis there were: endarterectomy, thoracic surgery and skull base surgery. Of the total group, 1.2% of cases were diagnosed after intubation. In the review, in another 19.8% cases, paralysis was caused by thoracic, neck or brain tumors, by traumas and in 21 patients there was no obvious reason (idiopathic cases)., Conclusions: Etiology of vocal fold paralysis seems to be affected by a character of institutions or hospitals who make a study and by geographic location. The most common etiology of vocal cord paralysis is iatrogenic., (2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o.)

Introduction: Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5-4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach., The Aim of Study: was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009., Material: The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years., Results: Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell-Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy., Conclusions: 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualification for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.

Introduction: Tracheotomy is one of the most oldest operations in surgery. Percutaneous dilational tracheotomy has become increasingly popular as an alternative to standard tracheotomy over the last 30 years. It is particularly useful in patients who require prolonged mechanical ventilation, in the intensive care units. Percutaneous tracheotomy is a technique that can be performed at the bedside. It is cost effective, minimally invasive and can be done rapidly., Case Report: We report a case of subglottic stenosis after percutaneous tracheotomy. A 56- year old obese man with chronic obstructive lung disease, insulin-independent diabetes, arterial hypertention and atrial fibrillation was admitted to the ENT Department because of stridor. 3 months earlier he had undergone percutaneous dilational tracheotomy due to respiratory failure. Laryngostroboscopy and a CT scan were performed, and showed 25 mm subglottic airway obstruction of the trachea., Discussion: The incidence of asymptomatic subglottic tracheal stenosis after decannulation of percutaneous tracheotomy patients has been reported in over 25% with to 2% case reports of symptomatic stenosis. Although percutaneous dilational tracheotomy is considered as a safe procedure, there is a high incidence of tracheal stenosis.