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Objectives: The aim of the study was to determine the usefulness of 18-FFDG PET/CT in oncological diagnostics in laryngology., Material and Methods: 45 PET/CT examinations were performed in 41 patients diagnosed with head and neck cancer in Department of Otolaryngology and Nuclear Medicine Department WUM from 2008 to 2011. In 3 patients PET/CT study was conducted several times., Results: In 18 patients the result of PET/CT examination was negative, in 27 – positive. Based on PET/CT imaging the recurrent disease was diagnosed in 9 patients, cervical lymph node metastases – in 12 patients, distant metastases – in 6 patients, possible primary tumour localization – in 3 patients. In 7 cases additional foci of increased FDG uptake were revealed outside the head and neck. Among 22 contrast enhanced CT scans performed earlier, in 18 cases results were confirmed. In 2 cases there was no increased FDG concentration in lesions considered suspicious due to CT, in 2 patients increased focal FDG uptake was observed despite no changes in CT scans. The mean SUVmax value in all the lesions in head and neck region was 3.0; for examinations revealing recurrent disease, nodal or distant metastases mean SUVmax was 7.9., Conclusions: 18F-FDG PET/CT is a useful diagnostic tool for staging of head and neck cancer, identifying residual and recurrent disease and detecting the occult primary tumour. It also allows the visualization of other lesions suspected for malignancy, localized outside the head and neck region.

Introduction: Temporal bone paragangliomas are rare, benign neuroendocrine tumors. Depend on their location at skull base, they can extend intracranially and extracranially. They characterize by slowly growth and late nonspecific clinical manifestation. Location of tumor and anatomical condition require suitable operational technique and cause related complications., Aim: The aim of this study was analysis of surgical procedure and evaluation of treatment results of patients with paragangliomas of the temporal bone hospitalized in Department of Otolaryngology of Warsaw Medical University in years 2000-2010., Material and Methods: 34 cases of patients were retrospectively studied. Clinical data, level of tumor advancement according to Glasscock & Jackson and Fisch classification were analyzed. Intraoperative and imaging studies data were used to evaluate extent of lesions. Suitable operative approaches and outcome of treatment were also analyzed., Conclusion: In group of 34 patients 26 of them had monocentric and 8 multicentric neoplasms. Age ranged 15-73-years-old. Most common symptoms were: loss of hearing, tinnitus and headache. Preoperative embolization was carried in 10 cases. Most common surgery technique: tympanotomy and hypotympanotomy posterior and infratemporal fossa of Fisch type A approaches. Radiotherapy was used in 2 cases and surgery with radiation therapy in 7 cases. Most commonly observed complication in surgical treatment was intermittent paresis., (Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.)

Aim: The aim of this study is to present indications, surgical technique and first results of fully implantable middle ear implant (Otologics Carina), first time in Polish clinical practice., Material and Methods: 24-years-old patient with bilateral moderate sensorineural hearing loss. The surgery with fully implantable middle ear implant was performed on November 11th, 2008 (implant device Otologics Carina). Two months after the surgery the patient was admitted to hospital for the first fitting. Audiological tests were performed before the surgery and after on every fitting visit (4 fitting visits so far)., Results: Postoperative bone and air conduction thresholds confirmed no cochlear damage due to the surgery. Free field pure tone and speech audiometry proved better results in aided conditions compared to unaided. Further fitting sessions are planned in 6-8 weeks intervals in order to improve hearing thresholds along with anti-feedback adjustments., Conclusions: Our results confirm that fully implantable middle ear implant is a viable treatment for adult patients with moderate sensorineural hearing loss. In selected cases it may become an alternative to conventional hearing aids.

Introduction: Idiopathic facial nerve paresis still remains a challenge for laryngologists and neurologists. The etiology of idiopathic peripheral facial nerve paresis has not been explained so far. There is a group of patients that complain about coexisting hearing abnormalities., Aim: Analysis of audiological abnormalities in patients with idiopathic peripheral facial nerve paresis on the basis of pure tone audiometry and auditory brainstem responses., Material and Methods: The retrospective analysis of 35 patients, aged under 40 years, with idiopathic peripheral facial nerve paresis hospitalised in Department of Otolaryngology of Warsaw Medical University-Poland (2004-2009). Control group consisted of age-matched, 23 healthy subjects. Each patient underwent audiometric evaluation that included pure tone audiometry and auditory brainstem responses. Statistical analysis was performed with Student's t-test., Results: In the analysed group of 35 patients (17 male + 18 female), age ranged 13-40 years (mean 26.7 +/- 7.1) significantly prolonged latencies of wave III and V and III-V and I-V intervals in comparison with control group where observed (p < 0.05). We found also that 48.6% patients with idiopathic peripheral facial nerve paresis had high-frequency hearing loss., Conclusions: The auditory brainstem responses in this study showed an association between retrocochlear pathology of the auditory system and idiopathic peripheral facial nerve paresis. Further investigations are necessary to estimate the etiopathology of these coexisting abnormalities.

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: 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.

Introduction: The main tumor of cerebellopontine angle are vestibular schwannoma (80-90%). According to National Institute of Health Consensus Development Conference the best treatment method is microsurgery. There are three principal surgical approaches: translabyrinthin, retrosigmoid and middle fossa. Only the latter two approaches provide the possibility of hearing preservation., Aim: Technique of surgery and postoperative morbidity after MFA., Material and Methods: 39 patients (40 tumor) suffered from tumor of cerebellopontine angle, operated by using middle fossa approach in years 1998-2007. We evaluate hearing preservation and function of facial nerve and others postoperative morbidity., Results: 22.5% of patients has hearing impairment and 32.5% has facial weakness. By individual cases we observed: CSF leak, meningitis, corneal ulceration, ischialgia, wound bleeding and venue thrombosis. 1/3 of patients suffered from headache and disequilibrium and 1/6 suffered from tinnitus., Conclusion: According to NIH middle fossa approach is one of three possible approaches in microsurgery of cerebellopontine angle tumors. There is possible total tumor removal with hearing preservation. Monitoring of facial and cochlear nerve during operation is recommended.

Introduction: Certain problems in ear surgery are caused by temporal bone cholestetoma and chronic otitis media complicated by deafness, facial nerve dysfunction, vertigo or meningcephalocele. Lateral petrosectomy offers possibility of radical treatment and prevention of temporal bone destruction and following complications., Aim of Study: It is an analysis of indications for lateral petrosectomy and it's results as a treatment of otitis media and temporal bone cholesteatoma. The possibility of synchronous cochlear implantation is noted., Material: Retrospective analysis of 62 patients after lateral petrosectomy, operated in the Department of Otolaryngology at the Medical University of Warsaw in 2001-2009. The group consisted of thirty one men and thirty one women., Results: Thirty two patients suffered from chronic granuloma or chronic choleateatoma otitis media or temporal bone cholesteatoma. Seventeen patients suffered from deafness prior surgery. Cochlear implantation was possible in five patients: two of them after cranium fracture, two with deafness caused by chronic otitis media and one with deafness caused by osteoradionecrosis. Intraoperative CSF leak was observed of eight patients. In one case lateral perosectomy was used as a treatment of CSF leak after removal of cerebellopontine tumor. There was no evidence of CSF leak after surgery. Facial nerve dysfunction was observed in fifteen cases., Conclusions: Lateral petrosectomy offers possibility of radical treatment in same patients with chronic otorrhea. The total removal of cholesteatoma prevents intracranial and intratemporal complications in case of chronic otitis media. Patients after lateral petrosectomy require systematic ENT and radiological (CT, NMR) examination.

Unlabelled: Paragangliomas are rare neoplasms of neurological origin and account for 0.012% of all tumors. Only 10% of them have extraadrenal localization. Head and neck paragangliomas account for 0.33% neoplasms of that localization. Typically paragangliomas are benign tumors, but even 19% cases may have malignant potential. On the neck they are located typically closely to carotid artery bifurcation, jugular bulb and along the course of vagus nerve. Laryngeal localization is very rare. Nonspecific manifestation and wide spectrum of symptoms cause difficulty in diagnosis of paragangliomas., Aim: Presentation of the diagnostic process, performed treatment and obtained results of neck paragangliomas in the material of the Department of Otolaryngology of Warsaw Medical University in years 2001-2010., Material and Methods: There was performed retrospective analysis, based on the medical documentation of 14 patients with neck paragangliomas (9 women and 5 men), age range 25-62 years, hospitalized in the Department of Otolaryngology of Warsaw Medical University during the last 10 years. The date from the history, physical examination, radiological evaluation and the method of performed treatment and post-treatment complications were studied., Results: Out of 14 patients with neck paragangliomas, there were 9 cases of isolated tumors and 5 cases of synchronic, multicentric neoplasms. The most common and single symptom was nonspecific neck mass. Doppler ultrasonography was adequate diagnostic tool in carotid artery paragangliomas. To diagnose mulicentric paraganglioma, vagal or laryngeal paraganglioma more thorough radiological examination was necessary, including computed tomography, magnetic resonance and angiography. All patients had performed surgical treatment. There were observed very good results in patients with isolated paragangiomas of carotid artery or larynx. Surgical management of multicentric and vagal paragangliomas was exposed to higher risk of cranial nerve paresis., Conclusions: (1) Paragangliomas are rare tumors of nonspecific clinical manifestation, making the early diagnosis very difficult. (2) Precise radiological evaluation is necessary taking into consideration quite high incidence of multicentric paragangliomas. (3) There is higher risk of cranial nerve paresis after surgical treatment of multicentric paragangliomas, neoplasms larger then 5 centimeters in diameter and vagal paragangliomas then in isolated carotid artery paragangliomas.

Unlabelled: Round window's movability measurements with helping of LDV in evaluation of ossicular chain functioning., Aim of Study: Quantitive evaluation of round window movability in normal conditions and after malleus stapes assembly reconstruction were aims of the study., Methods and Materials: In the experiment there were taken 10 non-frozen temporal bones harvested within 48 hours. Temporal bones specimens were prepared like in closed technique with antromastoidectomy and large posterior tympanotomy. Hearing system before and after MSA reconstruction were evaluated by measurement of round window movement. Measurements were performed at four frequencies: 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz., Results: In the normal ossicular chain the biggest movability were stated at frequency of 1 kHz. After reconstruction at all frequencies measurements were significantly worse. In reconstructed ears the highest movabilities were stated at frequencies 2000 Hz and 4000 Hz., Conclusions: Round window movability could be measured by Laser Doppler Vibrometry in posterior tympanotomy approach. Before reconstruction the biggest movability were evaluated at 1000 Hz and after MSA at 2000 Hz

Introduction: An assumption was taken that in central nervous system (CNS) in patients above 15 years of age there are possible mechanisms of neuronal changes. Those changes allow for reconstruction or formation of natural activation pattern of appropriate brain structures responsible for auditory speech processing., Aim: The aim of the study was to observe if there are any dynamic functional changes in central nervous system and their correlation to the auditory-verbal skills of the patients., Material and Methods: Nine right-handed patients between 15 and 36 years of age were examined, 6 females and 3 males. All of them were treated with cochlear implantation and are in frequent follow-up in the Department of Otolaryngology at the Medical University of Warsaw due to profound sensorineural hearing loss. In present study the patients were examined within 24 hours after the first fitting of the speech processor of the cochlear implant, and 1 and 2 years subsequently. Combination of performed examinations consisted of: positone emission tomography of the brain, and audiological tests including speech assessment. In the group of patients 4 were postlingually deaf, and 5 were prelinqually deaf., Results: Postlingually deaf patients achieved great improvement of hearing and speech understanding. In their first PET examination very intensive activation of visual cortex V1 and V2 (BA17 and 18) was observed. There was no significant activation in the dominant (left) hemisphere of the brain. In PET examination performed 1 and 2 years after the cochlear implantation no more V1 and V2 activation region was observed. Instead particular regions of the left hemisphere got activated. In prelingually deaf patients no significant changes in central nervous system were noticeable neither in PET nor in speech assessment, although their hearing possibilities improved., Conclusions: Positive correlation was observed between the level of speech understanding, linguistic skills and the activation of appropriate areas of the left hemisphere of the brain in postlingually deaf patients treated with cochlear implants. No such correlation was noted in prelingualy patients treated with the same method.

Unlabelled: 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 Kennedy's 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.

Aim: The study aimed to assess the auditory skills in multi-handicapped children with cochlear implants., Material and Methods: The study assessed 34 children, who were implanted due to the bilateral profound sensorineural hearing loss. Apart from the hearing loss, all of the subjects suffered from additional impairments (mild motor disabilities, cerebral palsy, cognitive disability, specific learning disability, behavioral disorders, sight impairment), 29 (85.29%) from more than one. Cochlear implantation took place in the Department of Otolaryngology at the Medical University of Warsaw in Poland. The age at implantation ranged from 1.3 to 7.5 years old (mean 3.2 years, SD 1.64). The retrospective review of medical charts, audiology and speech pathology records was based on Champions profile with evaluation at 6, 12, 18-24 months, and 3 years after implantation. When a patient had been referred for developmental evaluation by psychologist, this source of information was also used., Results: All of the subjects suffered from additional impairments, and most of them presented more than one additional disability. Individually and as a group, these patients respond well to cochlear implantation. The study population showed improvement in communication code in 31 patients (91.18%), and no improvement in 3 patients (two of them had 6 months follow up and one 12 months follow-up). Also progress in auditory skills was noted in the study population, which was measured as the awareness in environmental sounds--Categories of Auditory Performance (CAP)., Conclusions: Multi-handicapped children receive benefit from cochlear implantation. The rate of this improvement is slow but offers better quality of life due to better auditory-communication skills, better self-independence and social integration. The results of implantation in presented group of patients is encouraging.

The main tumor of cerebellopontine angle are vestibular schwannoma (80-90%). Most of them are unilateral lesion but 5% of them are bilateral pathological mass. There are genetic disease like neurofibromatosis type 1 and 2. According to National Institute of Heath Consensus Development Conference the best treatment method is microsurgery. The possibility of hearing preservation surgery give middle fossa approach and suboccipital approach, radiotherapy or auditory brainstem implants and cochlear implants. The aim of the study is case report of the patient suffered from bilateral vestibular schwannoma. Early diagnosis and therapy enable hearing preservation and good facial nerve function.

Introduction: Chondromyxoid 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.

Mucocele, though is a common lesion, rarely penetrates to the surrounding intra- and extracranial spaces. We describe the case of 45-year-old male with 2 years history of a chronic left nasal obstruction and a concentric visual field deficit in the left eye as the only manifestations. Diagnostic CT and MRI imaging revealed a mucocele originating from the posterior ethmoid and sphenoid sinuses and penetrating intracranially to the anterior and middle cranial fossae and extracranially to the pterygopalatine fossa and the parapharyngeal space. This extensive localization appears to be an extremely rare entity, which, to our knowledge, has not been described in the English literature yet. The clinical features and a literature review are also presented.

Aim: Presenting and discussing the patient with intravestibular schwannoma of the vestibulocochlear nerve, the course of disease, audiologic and radiologic examination and treatment possibilities., Methods: Analysis of clinical presentation and treatment of the patient with intravestibular schwannoma and review of available literature on intralabyrinthine schwannomas., Results: A 34-year-old male was diagnosed with a tumor localized in the left vestibule and semicircular canals without accompanying vertigo at any time of the disease but with tinnitus and total deafness of the left ear. Preoperative diagnosis was established on the basis of MRI with contrast. Localization of the tumor laterally to the fundus of internal auditory canal was essential for the diagnosis. Surgical treatment was chosen via translabyrinthine approach. Postoperative course was uneventful., Discussion: Intralabyrinthine schwannoma are rare pathology. Their occurrence implies that schwannomas can originate at any segment of vestibulocochlear nerve. Most commonly intralabyrinthine schwannomas are observed at intracochlear or intravestibular localization. Present trials of these tumors classification were presented. The symptoms emerging in the course of disease are hearing loss, tinnitus, and vertigo, thus there were described patients with intralabyrinthine schwannomas diagnosed and treated as Meniere disease. Treatment depends on the intensity of symptoms and tumor expansion, while approach is dependant on its localization., Conclusion: Elaborate radiologic examination including MRI with contrast is essential in case of atypical course of disease with hearing loss, tinnitus and vertigo, or with early diagnosis of Meniere disease.

Aim of Study: Evaluation of usefulness new non-contact method--Laser Doppler vibrometry (LDV) in measurements of movability of ossicular chain during second look operation was aim of the study. We would like answer to questions: 1. Is LDV helpful in intraoperative conditions? 2. Which measurements points have the largest practical value? 3. Which measured parameters could be used to determination of effectiveness ossicular chain reconstruction?, Methods and Materials: In experiment there were taken 3 fresh temporal bones kept in 0,9% NaCl. In first stage were executed: antromastoidectomy with wide tympanotomy. The ossicular chain movability investigation was conducted on: back branch of stapes, front branch of stapes, round window, umbo of eardrum. Laser Doppler Vibrometer was used to measurement ossicular chain's movability. ER-2 loudspeakers were generated wave: 1000 Hz, 2000 Hz, 4000Hz. In second stage were executed: Malleus-Stapes Assembly (MSA) ossicular chain's reconstruction and repeated investigation in measured points., Results: The most convenient points to measurement were respectively: back branch of stapes, front branch of stapes, umbo of eardrum. In two cases round window was placed in deep niche and was partly covered by facial nerve. MSA performance didn't influence accessibility of measuring points. Theresholds of measured point's movability was useful to evaluation of reconstruction., Conclusions: Back branch of stapes, front branch of stapes and umbo of eardrum are useful to intraoperatve measurements ossicular chain movability. Delimitation thresholds of ossicular chain movability can help in reconstruction's evaluation. After next experiments LDV can be use in practice-intraoperative.

The Aim of the Study: to evaluate CSF leak as a complication of osteoplastic flap surgery of the frontal sinus., Material and Methods: Medical recordings of the patients that underwent osteoplastic flap surgery of the frontal sinus were analyzed., Results: among 62 patients operated between 2000 and 2007 there were 4 cases of intraoperative CSF leak (6.5% of cases). In all complicated cases indication for surgery was benign large tumor of the frontal sinus, among them there were two cases of osteoma, one cholesterol granuloma and ossifying fibroma. All CSF leaks were successfully closed with multilayer underlay or overlay graft. The technical aspects of the osteoplastic flap surgery of the frontal sinus are discussed.

Introduction: The main problem of a deaf patient is per se communication process. Some of the patients, who are candidates to cochlear implantation report vertigo or imbalance in some everyday situations. The relation of patients' complaints to vestibular loss was evaluated. The authors used electronystagmography which was realized in diagnostic process to cochlear implantation. The results come from the patients diagnosed in our department in 2006-2007. In accordance to the literature, the true vertigo, was rather rare., Material and Methods: Medical history, caloric tests as electronystagmography results were evaluated retrospectively in 47 patients qualified for cochlear implantation in 2006-2007., Results: In the study group, 25 patients did not complain of vertigo; with symmetrical calorics in 10 subjects (40%). The true vertigo reported 6 subjects; 8 subjects had imbalance and unsteadiness on walking. In the group of 47 subjects 8 of them complainted the both- vertigo and imbalance. In the ENG of this group the results of symmetrical responces were evaluated in 57% cases and vestibular hypofunction in 43% subjects. In the group with vertigo (6), 4 subjects (66%) had diagnosed unilateral hypofunction, 1 (17%) bilateral areflexion, 1 subject (17%) had symmetrical responses., Conclusions: The necessity of the confrontation ENG results to additional examination in audiological part of diagnostic process to cochlear implantation is underlined.

Introduction: Paragangliomas, in other words chemodectomas were bening tumors arising from the paragangliomas cells of the parasympathetic system. There are four kinds of paragangliomas: carotic artery baroreceptors (glomus caroticum), tympanic cavity (glomus tympanicum), internal jugular vein (glomus jugulare) and placed along vagal nerve (glomus vagale). Overall 5-10% of all paragangliomas are malignant. The bening lorms paragangliomas, of the originally numerous location are rare described., Material and Methods: The authors describe the rare case of 24 yrs old male, of the bening form paraganglioma of the originally numerous location - glomus tympanicum on the left site, glomus caroticum on the right site., Results: The patient was successfuly treated surgicaly., Conclusions: The first choice of treatment is surgery. The diagnosis of a suspected paraganglioma can be confirmed with USG, CT, Angio CT, Angiography and MRI. Radiation therapy may be usefull in those cases in which the residual tumor was known to be left.

Objective: To investigate the use of transtympanic electrocochleography (TT-ECochG) analyzed on-line by a detector strategy software that made possible automatic extraction of TT-ECochG components intraoperatively in real-time domain., Patients: Fifteen patients with cerebellopontine angle tumor among 50 patients were included in this study., Intervention: All subjects were operated on via middle fossa or retrosigmoid approach. Pure-tone average (PTA) was measured at 0.5, 1.0, and 2.0 kHz, and calculations were performed before and after surgery. Auditory function was monitored intraoperatively via TT-ECochG, and analyzed data were displayed on-line., Main Outcome Measures: TT-ECochG changes in morphology were described. Postoperative PTA elevation level correlated with TT-ECochG morphology changes occurring intraoperatively., Results: Analyzed on-line, TT-ECochG data were displayed as first negative peak of compound action potential amplitude and latency in time domain every 3 to 5 seconds. A good correlation between postoperative PTA elevation and TT-ECochG morphology changes was showed (Spearman rank test, R = +0.93; t(N-2) = 9.00; p < 0.0001)., Conclusion: TT-EcochG seemed to effectively mirror even minimal changes in auditory function during intraoperative monitoring in real-time domain. Developed strategy of on-line analysis makes the intraoperative hearing status assessment faster and easier.

Posttransplantation lymphoproliferative disease (PTLD) is a well-known complication of solid organ and bone marrow transplantation. It is agreed that the main causes of PTLD are chronic infection with Epstein-Barr virus (EBV); the intensity, rather then the type, of immunosuppression used; and underlying recipient disease. Hepatitis C virus (HCV) and cytomegalovirus, as cofactors of EBV infection, have been suggested to increase the risk of PTLD. Use of calcineurin inhibitors, anti-CD3 monoclonal antibody (OKT3), and antithymocyte globulin may increase the risk of PTLD. On the other hand, mycophenolate mofetil, sirolimus, and the anti-interleukin-2 receptor monoclonal antibodies Daclizumab and basiliximab have not been demonstrated to increase the risk of PTLD. The incidence of PTLD after liver transplantation (LT) is estimated to be 1.5-3%, but a tonsillar location is extremely rare in adults. Thus, little is known about the best diagnostic tools for and treatment by LT recipients with tonsillar PTLD. Here, we report 2 cases of adult LT recipients with tonsillar PTLD. Tonsillectomy was used as a diagnostic tool and treatment option and resulted in complete remission for >2 years. Considering the high mortality and diagnostic difficulties of PTLD, together with the relatively low risks of tonsillectomy, we recommend tonsillectomy for treating tonsil enlargement of unknown cause and suspected PTLD in LT recipients. A larger series of patients and prospective studies comparing different treatment options will be needed to substantiate our recommendation.

Aim of the Study: We report 2 cases (52 and 29-year-old men) of CG in the petrous apex we treated in 2004-2006. We also review the literature and discus the mechanism of development of CG and the treatment of this lesion., Material and Methods: Cholesterol granuloma (CG) is a chronic inflammatory process with associated foreign body reaction to hemorrhage-related cholesterol crystals. Although CG is found in various organs the temporal bone is the most common site of detection. Numerous ethiopathological hypotheses have been proposed but most authorities support the concept of air cell tract blockage in well pneumatized petrous apex. Obstruction of the air cells leads to rupture of blood vessels and hemorrhage. Red blood cell degradation into cholesterol crystals produces a foreign body giant-cell reaction with progressive accumulation of typical brownish glistening fluid. Clinically, this lesion can produce sensorineural hearing loss, tinnitus, hemifacial spasm, facial numbness and trigeminal neuralgia. Cholesteatoma is the main lesion to distinguish from CG. On MRI studies, CG appears with a high signal on both T1- and T2-weighted sequences, cholesteatoma appear bright only on T2-weighted ones. Goal of the surgery is to create a drainage and ventilation of the affected area to prevent recurrence. Several alternative approaches to the petrous apex have been described., Results: 12-18 months follow up shows no clinical signs of recurrence.

Introduction: Nasal obstruction is widely mentioned among the factors influencing pathophysiology of obstructed breathing disorders during sleep. However numerous observations confirms 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 live at least in patients self estimation. Furthermore, an improvement of nasal patency diminishes the side effects of nCPAP therapy and provides lower therapeutic pressure.

The aim of this study was to investigate the utility of distortion product otoacoustic emissions (DPOAEs) in intraoperative monitoring (IM) of cochlear ischemic episodes in animals during internal auditory artery (IAA) compression. The IAA was exposed using the posterior fossa approach and then compressed for 3 and 5 min intervals to effect ischemia. DPOAE amplitudes and phases were measured at 4, 8, and 12 kHz geometric mean frequency (GMF). In each monitored ear, laser-Doppler cochlear blood flow (CBF) was measured. All IAA compressions resulted in rapid decrease of DPOAE amplitude and CBF, with simultaneous DPOAE phase increase. DPOAE phase changes were found to increase consistently within several seconds of IAA compression, while corresponding DPOAE amplitudes changed more slowly, with up to 30-40 s delays. Following IAA release, DPOAEs at 12 kHz GMF were characterized by longer delays in returning to baseline than those measured at lower frequencies. In some cases, CBF did not return to baseline. In this animal model, DPOAEs were found to be sensitive measures of cochlear function during transient cochlear ischemic episodes, suggesting the utility of DPOAE monitoring of auditory function during surgery of cerebello-pontine angle tumors.

Sudden deafness (SD) is thought to be a heterogenic group of disorders as to etiopathogenesis. Acoustic neuroma should always be considered in the differential diagnosis. The authors analysed symptoms occurring in the group of 89 patients, diagnosed with acoustic neuroma. A special attention was paid to the role of sudden deafness as a clinical manifestation of the VIIIth nerve pathology. Progressive hearing loss, tinnitus, headache and sudden deafness were the most common complaints. Sudden deafness was developed by approximately 1 of the investigated patients (24.7%). Progressive hearing loss, tinnitus and sudden deafness were also dominating initial signs. The sudden deafness onset was preceded by the period of progressive hearing loss in 3 patients. In one case episode of SD occurred twice.

In 52 patients with Obstructive Sleep Apnea Syndrome (OSAS) and nasal obstruction due to nasal septum deformation, hypertrophy of inferior nasal concha or posttraumatic external nose deformity the evaluation of the day somnolence using the Epworth Scale was carried out. The patients were randomly divided in to two groups. The first group consisted of 40 patients who were subjected to appropriate corrective surgery of the nasal obstruction. The remaining 12 patients constituted the control group. After 3 month each of the patients was asked to fill in the same questionnaire. Among the patients who underwent the surgical procedure day somnolence intensity was decreased approximately 2 times whereas in the control group no significant changes were observed. Results of this study could be crucial for the discussion concerning the complex influence of the nasal obstruction on the pathomechanism and symptomatology of obstructive breathing disorders during sleep.

Authors review the most important data about natural history, signs and symptoms and clinical stages of otosclerosis. Development of otosclerosis is long-lasting and involves several decades of lives. First symptoms already appear in teenagers in about 20% of cases. In advanced cases there are irreversible sensorineural hearing loss. When total deafness occurs cochlear implantation is nowadays the treatment of choice.

Otosclerosis is generally considered as a disease of adults, but the onset of hearing loss can occur in childhood. The purpose of this presentation is to show the effectiveness of stapedectomy in children. Both, short and long-term results are presented. Material is based on 14 pediatric patients, age 7-14 y. 12 of them had bilateral, 2 unilateral hearing loss. Together 26 ears. The diagnostic pattern was as follow: general pediatric and ENT examination, tuning fork testing, pure-tone audiometry (2x), recognition score test, tympanogram and acoustic reflex test, CT scan of the temporal bone. Particular attention was paid to the parents report concerning the episodes of otitis media or frequent upper respiratory tract infections and history of family hearing loss. Average time of hearing loss was noted 3 years before stapedectomy. Pure tone audiometry was performed on frequencies 500, 1000, 2000, 3000 and 4000 Hz. All children had hearing loss with air-bone gap 30 or more dB. 23 ears underwent stapedectomy for otosclerosis with teflon-piston prosthesis insert. Hearing level was based on PTA obtained in 2-3 weeks postoperatively and then 3 and 6 months. PTA hearing improvement was in 22 ears. No hearing loss was noted after operation. A total of 16 ears were available for long-term follow-up (up to 24 months after stapedectomy). The PTA hearing improvement was found to be permanent.

Introduction: Results of hearing perception with patient with auditory and visual neuropathy combined with peripheral polyneuropathy one year after cochlear implantation are presented in this article. Visual problems and hearing loss were progressing during recent years leading to social problems and communication disability. Speech discrimination was much worse than could be suspected based on pure tone audiometry. Lack of benefit from hearing aids was also stated., Methodology: As the examination method free field speech audiometry was used based on Pruszewicz word tests and set of modified speech therapy tests TAPS II. Simple sentences, monosyllables and polysyllables words as well as logotoms perception and identification of music instruments sounds were estimated., Main Result: Progress of speech intelligibility in monosyllables test according to Pruszewicz in free field speech audiometry was stated, as well as better understanding of sentences, monosyllables and polysyllables words, and more precise recognition of music instruments sounds., Main Conclusion: In many sensory-neural profound hearing losses as well as auditory neuropathy cases good results may be obtained by cochlear implantation. Early diagnosis of auditory neuropathy is important because of proper management. Lack of benefit from hearing aids in such cases seems to be indication to cochlear implantation. In described case cochlear implantation improved hearing perception one year after using speech processor.

A case of the 17-years old girl with bilateral tumors of the neck due to neurofibromatosis type I has been described. Patient has been unsuccessfully treated conservatively for over two years prior to the admission to our department. The principles of diagnostics and surgical treatment of the patients with neurofibromatosis type I have been presented.

Auditory neuropathy, a disorder of neural synchrony, is a retrocochlear hearing disorder identified by absence of auditory brainstem responses (ABR) and presence of evoked acoustic otoemissions (EOA). Registration of emissions shows normal function of external cilliary cells. Patients with auditory neuropathy have difficulties to understand speech especially in presence of beckground noise. Normal conversation requires the support of orofacial reading. The authors presents electrophysiological and behavioral tests useful in diagnostic process. An option in treatment of auditory neuropathy is cochlear implantation. Such treatment is indicated when conventional hearing aids doe not help to improve speech understanding.

Objective: To determine the long-term hearing and vestibular outcomes in patients with intractable vertigo caused by unilateral Meniere's disease, who were treated with transtympanic injection of gentamicin., Study Design: the study was a long-term analysis of hearing and control of vertigo in patients with unilateral Meniere's disease who received transtympanic gentamicin., Methods: Pure-tone thresholds and ENG, along with the control of vertigo. Criteria described in 1995 by the American Academy of Otolaryngology - Head and Neck Surgery were used. Patients treated with transtympanic gentamicin had definite Meniere's disease and had intractable vertigo despite optimal medical therapy, no symptoms suggestive of Meniere's disease in the contralateral ear, and serviceable hearing in the contralateral ear. The study analyzed the outcomes of 9 patients for whom follow-up data were available for periods greater than 24 months after transtympanic gentamicin., Results: Complete control of vertigo was obtained in all 9 patients. Profound sensorineural hearing loss occurred only in 1 patient. Hearing was improved in 6 patients, and in 2 was unchanged., Conclusions: Transtympanic gentamicin therapy is a good method of controlling vertigo and the risk of hearing loss is low.

The treatment of total deafness using a cochlear implant has now become a routine medical procedure. The tendency to expand the audiological indications for cochlear stimulation and to preserve the remnants of hearing has brought new problems. The authors have studied the topographical anatomy of the internal structures of the ear in the area where cochleostomy is usually performed and an implant electrode inserted. Ten human temporal bones were obtained from cadavers and prepared in a formalin stain. After dissection of the bone in the area of round and oval windows, the following diameters were measured using a microscope with a scale: the transverse diameters of the cochlear and vestibular scalae at the level of the centre of the round window and 0.5 mm anteriorly to the round window, the distance between the windows and the distances from the end of the spiral lamina to the centre of the round window and to its anterior margin. The width of the cochlear scala at the level of the round window was 1.23 mm, and 0.5 mm anteriorly to the round window membrane it was 1.24 mm. The corresponding diameters for the vestibular scala are 1.34 and 1.27 mm. The distances from the end of the spiral lamina to the centre of the round window and to its anterior margin are 1.26 and 2.06 respectively. The authors noted that the two methods of electrode insertion show a difference of 2 mm in the length of the stimulated spiral lamina. The average total length of the unstimulated lamina is 2.06 and 4.06 in the two situations respectively.

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.

Summary Chondromas of the skull base are extremely rare cartilaginous tumors. Etiology of chondromas remains unknown. The clinical presentation and radiological findings are not unique and cannot reliably distinguish from other similar lesions in this area. The low frequency of patients with chondromas of the skull base makes it impossible to draw definitive treatment conclusions. Chondromas are benign tumors and have good clinical outcomes. However, follow-up depends on localization of the tumor and neighboring vital structures within a small area. The authors present a case of 16-year-old patient with chondroma of the skull base, followed by a diagnostic evaluation and surgical management. Clinical characteristics of the neoplasm was presented on the basis of literature.

A rare case of MALT lymphoma of the hypopharynx is presented. The study was focused on case history, symptoms and management. In the following paper the theories and classification of non-Hodgin's lymphoma are presented.

Searching for the methods, which may improve the visualisation of the membranous labyrinth, authors decided to evaluate autofluorescence of the membranous structures of the inner ear. The analysis of the inner ear autofluorescence parameters was performed. We assessed, whether the detected differences in autofluorescence between the bony elements and the membranous structures, allows the practical apply, owning to increased contrast in the operating microscope. The optimal wave length inducing autofluorescence of membranous labyrinth amounts to 465 nm. Obtained in these circumstances contrast of the membranous structures don't cause a significant improvement in their visualisation, comparing with the picture received in the traditional optical microscope.

Merkel cell carcinoma (MCC) is a skin cancer arising from neurosecretory cells which take part in APUD system. In most cases it is locally growing tumor with significant tendency to local recurrences after surgery. The authors have described four cases MCC localised on the skin of the middle angle of the eye, lower eyelid, auricle and cheek, without nodal metastases. All patients have been surgery treated, in two cases reconstructive surgery was performed. Radiotherapy followed surgery was used for two patients. The authors have reported 5-year survival rate in 2 cases, 2-year disease-free rate and 18 month in other cases.

New methods of 3D visualization in operating field give better possibilities in different surgical specialties. Authors analyzed current optical systems for choosing assumption of the method to better visualize the inner ear intraoperatively. For practical clinical reasons optimal imaging of the inner ear is possible with additional digital processing on the display fitted to the head of the operating microscope.

The paper presents the results of transtympanic steroid therapy for sadden sensorineural hearing loss in 20 patients. All patients previously underwent a full conventional treatment, without the beneficial effect. Patients were classified into two groups: the first one consisted of 16 patients who received intratympanic Dexaven application just after termination of conventional treatment. The second group received intratympanic treatment 1 or more months after the conventional therapy had been finished. The pattern of intratympanic Dexaven application is presented. The results of treatment are promising (hearing improvement in 7 cases) and the method is both minimally invasive and inexpensive.

A case of 64 year-old man with middle ear carcinoma and temporal bone was described. He was treated by surgery and radiotherapy. Main symptoms communicated by the patients were discharge followed by pain of the ear. Further, diagnostic problems and methods of treatment are discussed as well as unsuccessful course of the disease, due to extension of the carcinoma, which caused the no total resection of tumour.

Cochlear implantation by facial recess is nowadays the approach of choice in normal anatomical conditions in the middle and inner ear. When deafness is coincident with chronic otitis media or partial obliteration of the cochlea, others approaches can be applied. Authors presented lateral petrosectomy as an approach for cochlear implantation in two cases. In both patients all the electrodes were inserted. There were any complications in postoperative period. Lateral petrosectomy is nowadays well codified technique. It is possible to apply this approach for cochlear implantation in cases with chronic otitis media. Good access to the cochlea especially to its basal turn allows for good insertion even in partial obliteration of the scala tympani.

The authors presented management rules and the results of surgical treatment in perilymphatic fistulas. Materials comprise 7 cases of cholesteatoma and 6 cases after previously performed so called conservative modified operation of the ear. In 3 cases cholesteatomas were destroying the membranous structures or were being adherent to them. In these cases labyrinthectomy was performed with partial conservation of hearing in one patient. In the remained 10 cases the fistulas were cleaned and sealed with 3 layers of tissues--fascia, cartilage and fascia. After the ossicular chain was reconstructed in one stage. Discharge, and vertigo were stabilised in all cases. It was stated that cleaning of the labyrinthine fistula during cholesteatoma removal does not influence on bone conduction thresholds.

Tympanic sinus is located at the medial wall of the tympanic cavity. It's visualisation is difficult from most of approaches. Tympanic sinus is often filled with cholesteatoma in course of chronic otitis. Intraoperative assessment of tympanic sinus was performed in 29 patients with facial recess cholesteatoma, and in 20 patients with acoustic neuroma operated with translabyrinthine approach. In the group of patients with cholesteatoma four patients underwent canal wall up tympanoplasty with posterior tympanotomy, 25 underwent canal wall down tympanoplasty. Tympanic sinus was assessed during surgery with 30 degrees endoscope. In all cases depth of the sinus was measured with the use of calibrated hook. In 11 patients depth of the sinus exceeded 4 mm. In 6 among these features of bone destruction was found.

30 temporal bones from adult cadavers of both sexes were examined. After the tympanic sinus was identified, its morphologic features were evaluated. Minimum distance from adjacent structures: lateral and posterior semicircular canal, facial nerve canal and jugular fossa were taken. Measurements were taken under operative microscope with eye-piece graduation of 0.05 mm accuracy. Four main morphologic types of entrance to the sinus and two main developmental forms--deep and shallow sinus were distinguished. Deep sinus coexisted with absence of bridge and conversely if bridge was seen sinus was shallow. Deep sinuses were located close to the facial canal, in some cases penetrating around the canal up to 2/3 of canal's circumference. This anatomical variation increase the risk of the facial nerve damage during the surgery. In most of cases tympanic sinus is oval in shape. It's long diameter lies in vertical plane. The mean distance between the sinus and adjacent structures were as following: facial nerve canal--1.5 mm, lateral semicircular canal--2.1 mm, posterior semicircular canal--1.59 mm, jugular fossa--5.5 mm. No differences dependent from gender and side were found.