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The accessory parotid gland (APG, Vth level) differs in histological structure from main parotid tissue. This gives rise to the hypothesis, mirrored in clinical observations, that the representation of tumours is different than in the rest of the gland. Aim To analyse the epidemiological and histological differences of parotid tumours located in regions I-V, with particular emphasis on the distinctiveness of region V. To define the epidemiological factors that will indicate the risk of histological malignancy from clinically benign appearance. Material and Method Multicentre prospective study conducted between 2017-2021 by five Head and Neck Surgery University Departments, cooperating within the Polish Salivary Network Database 1929 patients (1048 women and 881 men) were included. The age, gender, patient occupation, place of inhabitation, tumour size, clinical features of malignancy, histology, facial nerve (FN) paresis were analysed for superficial lobe (I_II), deep lobe (III_IV) and with special regard to the tumours affecting region V. Results 28 tumours were located exclusively in region V (1.45% total) and 72 tumours in region V with extension to neighbouring regions (3,7% total), characterized by significantly younger age and less frequent in retirees. In I-IV regions approximately 90% of tumours were benign, pleomorphic adenoma (PA) and Whartin tumour (WT) predominance. In region V PA exceed 75% but TW were casuistic (2/28). Incidence of malignancies in region V was 40% but clinical signs of malignancy were evident only in tumours>4 cm or in the presence of FN paresis. In 19% of patients with a benign appearance, imaging revealed malignancy, however in 38% of patients, the result remained false negative both in terms of clinical and radiological features of malignancy. Logistic regression models in 28 patients with tumour located exclusively in region V vs 1901 other patients and the in 100 patients with V extension vs 1829 other patients showed no clinical symptoms of malignancy bind with final malignant tumor histology as a single variable or in combination with other variables. The logistic regression models obtained in this study shows strong linkage between tumor location and predictors (age, male gender and tumor diameter) and aimed to act as a good classifier. Conclusion Despite the very clear image of the mid-cheek tumour, easily accessible in palpation and ultrasound examination, it is necessary to improve the oncological vigilance and preoperative patient preparation.

Recurrent laryngeal nerve injury is an important complication following thyroid and parathyroid surgery. Recently, Transcutaneous laryngeal ultrasound (TLUSG) has emerged as a non-invasive alternative to laryngoscopic examination for vocal cord (VC) assessment. The aim of the systematic review and meta-analysis was to determine its diagnostic accuracy in reference to laryngoscopy. It was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Scopus, Cochrane library and Web of Science databases were searched to identify relevant articles. Sixteen studies were included in the review. Pooled diagnostic accuracy was calculated based on weighted arithmetic mean and plotting forest plot. The pooled visualization rate was 86.28% and 94.13% preoperatively and postoperatively, respectively. The respective pooled sensitivity and specificity was 78.48% and 98.28%, and 83.96% (CI 95%: 77.24–88.50%) and 96.15% (CI 95%: 95.24–96.88%). The diagnostic accuracy improved if transverse and lateral approaches, and valsalva maneuver were utilized. Male gender and older age were the most crucial risk factors for VC non-visualization. TLUSG is an efficacious screening tool for vocal cord palsy due to its high sensitivity. It is likely to prevent unnecessary laryngoscopic examination in around 80% of patients, with the potential for becoming a gold standard for specific (female/young) patient cohort through assimilative modifications use, increasing expertise and development of objective measurements in the future.

Ectopic thymic carcinomas are rarely diagnosed in the thyroid gland, let alone in extrathyroid tissues. In the currently available literature, only five cases of extrathyroidal malignancies with thymic differentiation have been reported as arising in the major salivary glands. A 69-year-old female presented with a slow-growing palpable mass in the left parotid gland. Fine needle aspiration biopsy suggested metastatic cancer, whereas core needle biopsy revealed high-grade squamous cell carcinoma. The patient underwent left radical parotidectomy with selective ipsilateral lymph node dissection and subsequent radiation therapy. The surgical specimen was taken for histopathological examination. Microscopically, the tumor resembled thymic carcinoma. It was composed of large nests of squamoid cells with smooth contours, focally with a syncytial growth pattern, and accompanied by abundant lymphocytes with reactive lymphoid follicles. This appearance resembled a micronodular thymic carcinoma with lymphoid hyperplasia. Moreover, the tumor displayed expression of squamous markers (p40 and p63) and markers of thymic carcinoma (CD5 and CD117). Therefore, the final diagnosis of intrasalivary thymic carcinoma was rendered. The molecular analysis including next-generation sequencing demonstrated no variants of the strong, potential, or unknown clinical significance. The patient remains disease-free at 1-year follow-up. In the current case, we comprehensively present a clinical, microscopic, molecular, and radiological picture of CD5-positive squamous cell carcinoma of the parotid. We postulate that similar cases should be designated as intrasalivary thymic carcinoma analogically to similar thyroid tumors. Our case and the limited literature data indicate they should be distinguished from conventional squamous cell carcinoma of major salivary glands due to their rather favorable prognosis.

Background. The COVID-19 pandemic has altered all aspects of how the healthcare system is organized, and impacted patients with head and neck cancer (HNC), who delayed diagnosis and treatment. The result was the increased admission of patients with severe dyspnea and a need for tracheotomy due to extremely advanced HNC. The aim of this study was evaluate the characteristics of two multi-center cohorts of HNC patients admitted for dyspnea. Methods.. The therapeutic activity of four University Departments of Otolaryngology was studied over two time periods: September-February 2019/2020 and 2020/2021. Results. A group of 136 HNC patients who underwent tracheotomy in two time cohorts, pre-COVID-19 (N = 59) and COVID-19 (N = 77), were analyzed. The mean tracheotomy incidence proportion was 1.82% (SD: 1.12) for the pre-COVID-19 and 3.79% (SD: 2.76) for the COVID-19 period. A rise in emergency dyspnea was observed in the COVID-19 cohort. In the pre-COVID-19 period, 66% of patients presented with symptoms for more than a month in comparison to 78% of patients in COVID-19 times (p = 0.04). The number of tracheotomies performed under general anesthesia dropped in favor of local anesthesia during COVID-19 (64% vs. 56% respectively) due to extremely advanced HNC. In the COVID-19 cohort, most patients received a telemedicine consultation (N = 55, 71%) compared to the pre-COVID-19 period (N = 14, 24%). Conclusions. There should be a reorganization of the referral system, an adjustment of treatment capacity for an increased number of HNC patients, and a reserve for more extensive resection and reconstruction surgeries in ENT departments to not hamper future HNC treatment if there is another pandemic wave.

The aim of this study was to compare the health-related quality of life (HRQoL) of patients treated for parotid carcinoma (PC) and parotid adenoma (PA). The impact of demographic, treatment, and pathological factors was analyzed within the PC group. The EORTC QLQ-C30 and QLQ-HN35 questionnaires were completed by 45 PC patients and 46 PA patients. A number of HRQoL domains were significantly worse in the PC group than in the PA group: global health status, pain, insomnia, loss of appetite, mouth opening, swallowing problems, dry mouth, sticky saliva, problems with senses and speech, social eating, and cognitive functioning (P0.05). In the PC group, significantly worse scores were found for age55years, radical parotidectomy, neck dissection, radiotherapy, recurrence of the disease, pT3/T4 stage, pN+ status, and high-grade tumour (P0.05). Worse results were related to global health status, social contact, mouth opening, weight and appetite loss, physical, role, emotional, and social functioning, fatigue, speech problems, social eating, and financial difficulties. The study results demonstrate worse HRQoL in PC patients in comparison to PA patients. Older age, radical parotidectomy, neck dissection, radiotherapy, T3/T4 stage, pN+, high-grade tumours, and recurrence had a significant influence on HRQoL in PC patients.

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a noninflammatory disease and is characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. Although, usually, DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor. In differential diagnosis of upper respiratory tract symptoms, we should consider DISH. We present case of 82 years old male patient with acute dyspnea, who was diagnosed with osteophytes of C4-C7 vertebral bodies. In this case conservative therapy was not efficient, therefore successful surgical treatment was performed.

Purpose To verify if differential diagnostic algorithms based on selected parameters of dynamic and diffusion-weighted MRI, clinical and demographic variables are accurate enough to differentiate between parotid malignancies, pleomorphic adenomas and Warthin tumors. Materials and methods The study included 84 patients, among them 19 (23%) with postoperative diagnosis of a parotid malignancy, 37 (44%) with Warthin tumors and 28 (33%) with pleomorphic adenomas. Accuracy of dynamic and diffusion-weighted MRI parameters (Tpeak, Tmax, WR and ADC), clinical parameters of the tumor (location in the superficial or deep parotid lobe, single vs. multiple lesion, concomitant lymphadenopathy) and demographic characteristics of the patient (age, sex) was determined on ROC analysis. Results Compared to Warthin tumors, parotid malignancies showed higher Tpeak, Tmax and ADC, lower WR, were more often located in the deep lobe of the parotid and presented as single lesions with concomitant lymphadenopathy. Consideration of all these variables provided 100% sensitivity and 89.2% specificity of the differential diagnostic algorithm. Compared to pleomorphic adenomas, parotid malignancies presented with lower ADC and Tpeak, higher Tmax, were more often located in the deep lobe of the parotid, associated with concomitant lymphadenopathy, diagnosed in men and individuals older than 66 years. Consideration of all these variables provided 100% sensitivity and 96.4% specificity of the differential diagnostic algorithm. Conclusion Combined analysis of clinical data and results of dynamic and diffusion-weighted MRI may provide nearly ideal accuracy in differential diagnostics of parotid malignancies and the two most common histological types of benign tumors.

Purpose The role of dynamic magnetic resonance imaging (MRI) in the preoperative differential diagnostics of parotid tumors is unclear. The aim of this study was to compare the accuracy of dynamic MRI and routinely used fine needle biopsy examination in the preoperative differentiation of malignant and benign parotid tumors. Materials and Methods The study included 100 consecutive patients with parotid tumors treated surgically at the authors' center. Accuracy of dynamic MRI and fine needle biopsy examinations in the differential diagnostics of malignant and benign lesions was verified against the gold standard (ie, final histologic diagnosis). Results Based on histopathologic examination of surgical specimens, 19 tumors were eventually diagnosed as malignant lesions and 81 were diagnosed as benign. Preoperative fine needle biopsy examination yielded 9 true positive, 70 true negative, 11 false positive, and 10 false negative results, which corresponded to 47.4 and 86.4% sensitivity and specificity, respectively. The most commonly established preoperative diagnosis for 10 tumors that were misdiagnosed as benign based on examination of biopsy specimens was pleomorphic adenoma (n = 10). Dynamic MRI examination yielded 17 true positive, 81 true negative, 2 false negative, and 0 false positive results, which corresponded to 89.5% sensitivity and 100% specificity. Conclusions These results suggest that dynamic MRI is highly accurate in the detection of malignant parotid tumors. However, taking into account the high cost and limited availability of this examination, its logical application seems to be verification of preoperative diagnoses in patients whose fine needle biopsy examination turned out to be nondiagnostic or showed pleomorphic adenoma.

Objectives (1) To verify whether appropriate selection of cutoff values for dynamic and diffusion-weighted magnetic resonance imaging (MRI) parameters optimizes the accuracy of preoperative differential diagnosis of parotid malignancies and pleomorphic adenomas. (2) To define the role of preoperative MRI in the differential diagnosis of parotid tumors. Study Design The retrospective analysis included 221 surgical patients with parotid tumors. Aside from ultrasonography-guided fine-needle biopsy, the preoperative protocol included dynamic and diffusion-weighted MRI. Final diagnoses were based on histopathologic examination of surgical specimens. Receiver operating characteristic analysis was conducted to determine the sensitivity and specificity of preoperative MRI with various combinations of cutoff values. Results Twenty-four patients with parotid malignancies (10.8%) and 57 with pleomorphic adenomas (25.8%) were identified. Parotid malignancies had significantly lower values of apparent diffusion coefficient and Tpeak, as well as significantly higher values of Tmax and washout rate. An apparent diffusion coefficient ≤1.267 × 103 mm/s2 yielded optimum accuracy in identification of parotid malignancies (95.8% sensitivity and 93% specificity). Conclusion Diffusion-weighted MRI is effective in differential diagnosis of parotid malignancies. Optimization of preoperative diagnosis of parotid tumors should include preselection identification of Warthin tumors on the basis of dynamic MRI, followed by identification of pleomorphic adenomas based on diffusion-weighted MRI and cytologic examination of the remaining lesions.

Aim The aim of the study was to assess the watch&wait strategy for management of patients with close surgical margin after conservative parotidectomy due to early low/intermediate grade parotid carcinoma. Patients and methods Out of 78 patients operated on due to primary parotid gland cancer we selected 32 patients with a history of parotidectomy, and preservation of 7th nerve, with negative (≥1 mm), but close (≤5 mm) surgical margin and who did not receive supplementary radiotherapy due to other indications. Margins ranged from 1 to 3 mm (in 27 cases it was 1 mm, in 3 cases – 2 mm and in 2 cases – 3 mm), average 1.2 mm. The patients underwent further clinical-histological analysis. Results 3 of 32 (9.38%) patients experienced a local recurrence 36, 53 and 56 months post-surgery. The 5-year disease-free survival (DFS) was 90.6%. Recurrences were treated surgically, followed by radiotherapy, which resulted in an overall survival of 107, 104 and 104 months. One patient died 72 months after surgery due to non-oncological causes. The 10-year disease-free survival (DFS) was 96.3%. The 3 patients with recurrence of cancer had histological diagnosis of epithelial-myoepithelial carcinoma LG, with a margin of 2, 1 and 3 mm, respectively. There were no other distinctive features. Conclusion The watch&wait strategy with intensive follow-up seems justified in cases of close margin after excision of I/LG T1/T2 parotid tumors. EMC should be considered as a neoplasm associated with higher risk of recurrence.

Not required for Clinical Vignette.

The present study was undertaken to evaluate real probability and pattern of cervical occult lymph node metastases (OLNM) in primary parotid carcinoma (PPC). We carried out a retrospective analysis of 66 patients treated in years 1992–2010 due to PPC, who underwent elective neck dissection (END). In search of risk factors for OLNM, we analysed the following parameters: age, sex, pT-Status, tumour size, skin invasion, facial nerve palsy, tumour fixation, extraparotid extension, localization, grade, histology, intra/periparotid LN metastases (IPLNM). OLNM was observed in 30.3% of patients. In a univariate analysis statistical significance was found for IPLNM, extraparotid extension and high risk histology. A multivariate analysis showed statistical significance only for the first variable. The most common location of cervical OLNM was level II (80%), then III (45%) and V (30%). In a compilation of our own material with data from the literature (5 series), we obtained a group of 80 patients with OLNM, selected out of 650 patients with cN0 (12.3%). The proportion of metastases to particular levels was the following: 69%—II, 22.5%—III, 20%—I,16%—V, 7.5%—IV. END should be carried out in case of all T3/T4a carcinomas with minimal range of levels II and III. Removal of levels Ib and Va is recommended as well. In the T1/T2 carcinomas with high grade/high risk histology, END should be performed including levels II and III.

Conclusion: At least two groups of parotid malignancies exist, including one whose parameters of dynamic MRI closely resemble those of pleomorphic adenomas. Also tumors with long time to peak enhancement after administration of a contrast agent (Tpeak) and low washout rate (WR) should be considered malignant, especially single masses with concomitant lymphadenopathy located within the deep parotid lobe.Objective: To verify if malignant tumors of the parotid are homogeneous in terms of parameters of preoperative dynamic MRI: Tpeak and WR.Methods: The retrospective analysis included 221 surgical patients with parotid tumors. Aside from fine needle biopsy, pre-operative examination included dynamic and diffusion-weighted MRI. Final diagnosis was based on histopathological examination of the surgical specimen.Results: Twenty-four of 221 (10.8%) malignant lesions were identified. Using k-means clustering based on Tpeak and WR values, two distinct clusters of parotid malignancies were identified. The cu...

Pleomorphic adenoma is the most frequent benign tumor of the salivary glands. It is characterized by a tendency to recur, which is determined by the biological characteristics of the tumor as well as the mode of its treatment. Recurrence of the tumor is associated with a high risk of postoperative facial palsy, risk of subsequent recurrence after revision surgery, and an increased risk of malignant transformation. Knowledge of the recurrence risk factors could allow selection of treatments that minimize the risk. Among the factors in this study the most important are: incomplete excision, intraoperative capsule rupture, myxoid subtype, presence of the satellite nodules and tumor extensions (pseudopodia), lack of the glandular tissue margin and the experience of the surgeon. The possible factors are: the female sex, young age, location and size of the tumor, and the duration of the tumor growth. The technique of tumor enucleation of pleomorphic adenoma carries a high risk of recurrence and should be replaced by parotidectomy. In cases of recurrence the treatment is individually tailored and may: further follow up, limited resection of the tumor, lateral parotidectomy or extended radical parotidectomy with concurrent reconstruction of the facial nerve. The role of radiotherapy is discussed.

Purpose Operative treatment is the main treatment option for parotid gland tumors. The purpose of this study was to present the authors' experience in the operative treatment of parotid gland malignant tumors, especially regarding feasibility and techniques in the most advanced cases. Materials and Methods This is a retrospective cohort study of parotid malignancies. The study included patients treated at the authors' university clinic from 2000 through 2010. The primary predictor variable was stage of disease. The primary outcome variables were 3- and 5-year overall and disease-free survival rates. The secondary predictor variables were nodal status, distant metastases, status of the facial nerve (FN), tumor diameter, extraparotid tumor extension, histology, and surgical procedure. The outcome variable was survival rate. Data were analyzed by χ2 tests. Results Of 867 parotid tumors, 103 patients with malignancies (47 female, 56 male; 12 to 88 yr old) underwent 24 partial lateral, 34 lateral, 39 total, and 6 extended parotidectomies. The 3- and 5-year overall survival and 3- and 5-year disease-free survival rates for stages T1 and T2 were 100, 99, 91, and 85%, respectively, and those for stages T3 and T4 were 100, 70, 48, and 34%, respectively. Overall and disease-free survival rates were influenced by FN paralysis and histologic type. Conclusions Final oncologic outcomes, recurrence, and survival rates in parotid malignancies are considerably affected by local tumor stage, malignancy, and FN paralysis before treatment. Infiltration of adjacent structures is not connected with a poorer prognosis as long as an extended parotidectomy is performed.

Background: To verify the usefulness of a new algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion- -weighted magnetic resonance imaging (MRI). Materials and methods: The retrospective analysis included 158 consecutive surgical patients with parotid tumours. Aside from ultrasound-guided fine needle biopsy, the protocol of preoperative evaluation included dynamic and diffusion-weighted MRI. According to the new diagnostic algorithm, the result of fine needle biopsy was considered only in the case of lesions with time to peak enhancement (Tpeak) > 60 s and washout rate (WR) ≤ 30% on dynamic MRI and apparent diffusion coefficient (ADC) ≤ 1.7 × 103 mm/s2 on diffusion-weighted MRI, or those presenting with concomitant lymphadenopathy. The accuracy of this algorithm was verified against final histopathological diagnoses. Results: The new algorithm gave 10 true positive and 2 false positive results, as well as 132 and 14 true and false negative results, respectively. Its sensitivity and specificity (41.7% and 98.5%, respectively) were the same as in the case of fine needle biopsy alone. None of the 59 tumours that were qualified as benign solely on the basis of preoperative MRI turned out to be malignant on postoperative histopathological examination. Conclusions: Interpreted together, dynamic and diffusion-weighted MRIs provide the same accuracy in preoperative differential diagnostics of parotid tumours as fine needle biopsy. This substantiates the use of diagnostic algorithms in which biopsy would serve mostly as a secondary test to verify selected ambiguous radiological diagnoses. (Folia Morphol 2018; 77, 1: 29–35)

The aim of this study was to analyse signs and symptoms present in patients with parotid gland carcinoma and to assess their prognostic value. A retrospective study of data from 131 patients who were treated surgically was performed. Evaluation of prognostic factors was possible in 109 patients who completed a minimum 5 year follow up. The most common sign and symptoms were parotid mass (96.9%), pain (40.4%), enlarged cervical lymph nodes (32.0%), facial nerve palsy (20.6%) and overlying skin infiltration (19.8%). In 20% of all cases there were no symptoms of tumour malignancy. The average duration of symptoms suggesting malignancy was 4 months. In univariate analysis, the strongest prognostic value was found for facial nerve palsy; it reduced nearly tenfold (9.7) the 5-year disease-free survival. The subsequent poor prognostic factors were: skin infiltration, enlarged cervical lymph nodes, tumour fixation and tumour size (>4 cm). Pain and the dynamics of tumour growth were not statistically significant for survival rate. Significant difference in 5-year disease free survival rate was found between the groups of patients, according to the number of symptoms suggesting malignancy. The multivariate analysis showed that only facial nerve palsy and skin infiltration were independent prognostic factors.

Summary Bone destruction in chronic otitis media with cholesteatoma is a common phenomenon. Expanding growth of cholesteatoma in the middle ear causes ischemia of the mucosa and bones with granulation tissue production. The aim of this study was to assess the expression and distribution of the key regulators of bone destruction: osteoprotegerin (OPG), Receptor Activator for Nuclear Factor κ B Ligand (RANKL) and tumour necrosis factor α (TNF-α) in chronic otitis media with cholesteatoma and their role in the pathomechanism of bone resorption. Material and methods We performed immunohistochemical study of the cholesteatoma tissue collected from 21 patients suffering from chronic otitis media with cholesteatoma and 16 samples of normal external auditory meatal skin. This material was analysed histopathologically and by means of immunoperoxidase immunohistochemical technique with the use of antibodies against OPG, RANKL and TNF-α and their quantitive evaluation. Results In all patients with cholesteatoma, features of auditory ossicles and temporal bone destruction were demonstrated. We found that cholesteatoma and granulation tissue cells release factors of the OPG/RANKL/RANK system and TNF-α. In cholestatoma a higher expression of RANKL, OPG and TNF-α positive was demonstrated when comparing to the skin of external auditory meatus. These factors were relatively higher expressed in the stroma rather than in the epithelium of cholesteatoma. RANKL-positive cells were demonstrated mainly in the stroma cells, whereas OPG-positive ones in the cholesteatoma epithelium. The reaction with the antibodies against OPG, RANKL and TNF-α was weak in the external auditory meatal skin. Conclusions Bone destruction in chronic otitis media with cholesteatoma is a common process dependent on osteoclast activating factors. OPG/RANKL/RANK system and TNF-α play a key role in the process of osteolysis in otitis media with cholesteatoma. We found no positive correlation between bone destruction advancement and the level of examinated proteins.

Objectives: We investigated prognostic factors in sudden sensorineural hearing loss (SSNHL). Methods: Our study group consisted of 133 patients with SSNHL who were treated at our department between 1980 and 2000. Eighty-one of them (group B) were treated between 1980 and 1996; they received vasodilators and small doses of steroids. The others (52 patients; group A) were treated between 1997 and 2000; they received vasodilators, steroids at high doses, and hyperbaric oxygen. A multivariate stepwise linear regression was used to identify the prognostic factors that were related to hearing improvement as measured by objective change of gain in the overall average (0.5, 1, 2, 4, 6, 8 kHz), the pure tone average (0.5, 1, 2 kHz), the high tone average (4, 6, 8 kHz), and the pure middle tone average (0.5, 1, 2, 4 kHz). The following factors were included in the analysis: group (method of treatment), age, gender, seasonal occurrence of disease, presence of tinnitus and vestibular symptoms, time delay before first visit, type of initial audiogram, and type of caloric reaction. In group A, an additional analysis was conducted to include the results of certain laboratory tests: blood morphology parameters, erythrocyte sedimentation rate, glucose level, coagulogram, lipidogram, thyroid-stimulating hormone, autoantibodies (antimitochondrial antibodies, smooth muscle antibodies, and anti-brush border antibodies), and immunoglobulins G, A, and M. Values for p of less than .05 were considered significant. Results: Our analysis suggests the presence of the following prognostic factors for SSNHL: method of SSNHL treatment (better results in group A); time delay before the start of treatment (better results when treatment started within 10 days of the first symptoms of SSNHL); and type of caloric reactions (worse results in patients with canal paresis). In group A, the factors for poor prognosis for absolute hearing improvement were as follows: delayed treatment, labyrinth responsiveness disorders, and decreased level of thyroid-stimulating hormone. In group A, better hearing improvement was observed in those patients in whom SSNHL was diagnosed in the spring. Conclusions: A short time delay before starting treatment (within 10 days), treatment with high doses of steroids and hyperbaric oxygen, preserving complete caloric function of the labyrinths, normal function of the thyroid, and seasonal occurrence of the disease in the spring were positive prognostic factors for hearing recovery in SSNHL.

Aim: To evaluate the immunohistochemical and molecular presentation of protein p27 in cholesteatoma. Methods: 42 cholesteatoma samples and 6 external ear canal skin (EECS) specimens were investigated and analyzed taking into consideration congenital, acquired, recurrent cholesteatoma, and EECS. Results: The expression of p27 was found in 16 (38.1%) out of 42 specimens of cholesteatoma and in 5 (83.3%) out of 6 specimens of EECS. There was a significant difference in p27-positive staining rate between EECS and cholesteatoma epithelium (p < 0.008). The presence of p27 was detected in 10 cases of acquired cholesteatoma, 2 cases of congenital and 3 cases of recurrent cholesteatoma. There was no significant difference between the presence of p27 in cholesteatoma and EECS (p = 0.01). Conclusion: The down-regulation of p27 is a key player in cell cycle control and plays an undefined role in the pathogenesis of all types of cholesteatoma.

The immune response plays a main role in disregulation of epithelial growth in chronic otitis media (COM). Immunohistochemical study was performed on 11 specimens of human tympanic membranes (TMs) with COM correlated with 11 normal human TMs from cadavers. The specimens of TM near perforation expressed high intensity of TGFβ1 and HLA-DR antigen. TGFβ1 expression was observed in the lamina propria of perforated TM. Expression of EGF-R was various, more intensive in the margin tissue of TM perforation. The fragments of TM showed the highest staining of tenascin- and S-100-positive cells. The expression of S-100-positive cells in the TMs and granulation tissue indicated the presence of dendritic cells, which are the part of immunity. These data support the hypothesis, that epithelial cells in the COM are activated through the growth factors.

Dysfunction of the facial nerve is a common complication of parotidectomy. The functional deficit may be total or partial, and may include all or a single branch of the nerve. Despite a wide variety of the facial nerve grading systems, most of them have a limited utility in patients after parotidectomy. Therefore, existing scales assessing facial nerve function are compared to describe facial nerve outcomes after parotidectomy. The regional House–Brackmann, Sydney, and Yanagihara classification systems were utilized. The post-parotidectomy facial nerve grading system (PPFNGS) was created based on these three grading systems and also used for this study. The facial nerve function was assessed and recorded on the first postoperative day following conservative parotidectomy in 200 patients using all 4 scales by 3 otolaryngologists. The validity of the PPFNGS and existing facial nerve grading systems was examined by assessment of interrater agreement, intraclass correlation coefficient, internal consistency and construct validity. A deficit in the facial nerve function was found in 54 patients (27 %). Although results were consistent in all tested scales, the PPFNGS had a higher interrater agreement than the other three scales. PPFNGS is a new grading system designed for assessing the facial nerve function after parotidectomy in a quantitative and qualitative way and has a higher interrater agreement than other scales used to examine function of the 7th nerve. Electronic supplementary material The online version of this article (doi:10.1007/s00405-014-3196-y) contains supplementary material, which is available to authorized users.

Bone destruction in chronic otitis media with cholesteatoma is a common phenomenon. Expanding growth of cholesteatoma in the middle ear causes ischemia of the mucosa and bones with granulation tissue production.was to assess the expression and distribution of the key regulators of bone destruction: osteoprotegerin (OPG), Receptor Activator for Nuclear Factor kappa B Ligand (RANKL) and tumour necrosis factor alpha (TNF-alpha) in chronic otitis media with cholesteatoma and their role in the pathomechanism of bone resorption.We performed immunohistochemical study of the cholesteatoma tissue collected from 21 patients suffering from chronic otitis media with cholesteatoma and 16 samples of normal external auditory meatal skin. This material was analysed histopathologically and by means of immunoperoxidase immunohistochemical technique with the use of antibodies against OPG, RANKL and TNF-alpha and their quantitive evaluation.In all patients with cholesteatoma, features of auditory ossicles and temporal bone destruction were demonstrated. We found that cholesteatoma and granulation tissue cells release factors of the OPG/ RANKL/RANK system and TNF-alpha. In cholestatoma a higher expression of RANKL, OPG and TNF-alpha positive was demonstrated when comparing to the skin of external auditory meatus. These factors were relatively higher expressed in the stroma rather than in the epithelium of cholesteatoma. RANKL-positive cells were demonstrated mainly in the stroma cells, whereas OPG-positive ones in the cholesteatoma epithelium. The reaction with the antibodies against OPG, RANKL and TNF-alpha was weak in the external auditory meatal skin.Bone destruction in chronic otitis media with cholesteatoma is a common process dependent on osteoclast activating factors. OPG/ RANKL/RANK system and TNF-alpha play a key role in the process of osteolysis in otitis media with cholesteatoma. We found no positive correlation between bone destruction advancement and the level of examinated proteins.

The purpose of this study was to evaluate the expression of proinflammatory and immunoregulatory cytokines in chronic otitis media. The expression levels of TNF-α, IL-1α, IL-6 and IL-10 were determined by Western blot analysis of tissue samples obtained during ear surgery. The expression levels of TNF-α, IL-1α and IL-6 in cholesteatoma tissues were substantially higher compared to those determined in the granulation tissue. The highest levels of TNF-α, IL-1 and IL-6 proteins were observed in patients with bone destruction. There were no significant differences in the expression of IL-10 levels in cholesteatoma and normal skin, but in the granulation tissue its level was substantially higher. The level of IL-10 in cholesteatoma tissues inversely correlated with the expression of proinflammatory cytokines, the degree of bone destruction and cholesteatoma invasion. Increased expressions of TNF-α, IL-1α and IL-6 in chronic otitis media and a strong positive correlation between these cytokine levels and the degree of bone destruction indicate the destructive behavior of cholesteatoma or granulation tissue.

Telomerase is an enzyme responsible for maintaining the constant length of chromosomal telomers, which are necessary for normal function of eucaryotic cells. Presence of active telomerase in neoplastic cells prevents shortening of telomers what makes this cells immortal. Telomerase plays an important role in carcinogenesis. Aim of this study was to investigate the activity of telomerase in head and neck tumors and assess its diagnostic and prognostic value.Material consisted of 30 head and neck tumors treated surgically and 9 samples from healthy skin and mucous membranes. Telomerase activity was investigated using TeloTAGGG Telomerase PCR ELISA method.Telomerase activity was found in 24 (80%) malignant tumors. Relative activity of telomerase in neoplasms was from 16.9 to 766,2 RTA. Telomerase expression was much lower in samples of healthy skin and mucous membrane (RTA5). Statistically significant difference was proven for T1 and T2 tumors, comparing to T4 tumors (p0.05). No statistically significant difference in telomerase activity for G1 and G2 differentiation tumors comparing to G3 and for tumors without lymph nodes metastases comparing to tumors with metastases.Malignant head and neck tumors show high activity of telomerase comparing to healthy tissue. Detection of telomerase activity in head and neck malignant neoplasms can be a useful marker for cancer assessment. The quantification of telomerase activity has clinical diagnostic value for head and neck malignant neoplasms. To make a convenience of telomerase as a marker for diagnostic and prognosis in patients with malignant head and neck tumor needs further investigations.

BACKGROUND Keratinocytes in cholesteatoma demonstrate uncoordinated hyperproliferation, migration, and invasion properties. There is a controversy regarding the impact of Ki-67 and telomerase activities on cellular proliferation in cholesteatoma. We studied expression of Ki-67 protein and telomerase activity in cholesteatoma and its relationship with clinical findings. METHODS The expression level of Ki-67 protein was examined by immunohistochemical analysis of 51 cholesteatomas and 6 skin tissues obtained from patients during ear surgery. Telomerase activity was determined in 23 samples of cholesteatomas and 6 skin samples by polymerase chain reaction-based telomeric-repeat amplification protocol assay. RESULTS The presence of Ki-67 protein was observed in 21 (41.2%) of 51 samples of acquired cholesteatoma. The average Ki-67 labeling index in the cholesteatoma group was 28.9 +/- 9.2 and was higher than that in the skin group (18.2 +/- 6.1). Telomerase activity was detected in 2 (8.7%) of 23 samples of cholesteatoma (21 of them were Ki-67 staining positive and 2, negative) and in 3 (50%) of 6 of control skin samples (p < 0.05). CONCLUSION This study showed increased expression of Ki-67 in cholesteatoma, whereas there was no significant difference in rate of Ki-67 positive staining between skin and cholesteatoma (p = 0.066). Telomerase activation is a rare event in cholesteatoma. We assume that the absence of telomerase may lead to generation dysfunctional telomeres what in turn may impair the proliferative capacity of cholesteatoma.

The incidence of intracranial complications of acute otitis media (AOM) has decreased and the need for operative and medical treatment is declined during the antibiotic era. To describe pathognomonic signs, evaluation management, operative findings, clinical course and outcome of otitic hydrocephalus and lateral sinus thrombosis as complications of AOM and mastoiditis in pediatric patients. Two children, 9 and 13 years old, with the diagnosis of OH and TK and MRI findings are presented. Intracranial complications in children resulted from unsuccessful treatment of AOM, which led to acute mastoiditis and lateral sinus thrombosis. Both of the presented children had thrombus in their sigmoid sinus preoperatively, demonstarated by MRI, causing decreased blood flow. Both patients underwent a mastoidectomy and delamination of sigmoid sinus with puncture of sinuses. After medical and surgical treatment, blood flow through the sinus increased significantly. In both cases signs of increased intracranial pressure ceased. The clinical presentation of otogenic lateral sinus thrombosis (LST) as a complication of acute otitis media (AOM) can be masked by antibiotic treatment. The episodes of vomiting, headache, visual impairment and a history of AOM seem to be indicative for otitic hydrocephalus. MRI scans of patients with similar symptoms should be carefully studied to facilitate the early diagnosis of dural sinus thrombosis with increased intracranial pressure. Contrast-enhanced computed tomography scan and magnetic resonance imaging play a major role in determining diagnosis and treatment plans in this intracranial complications. Management included systemic antibiotics, short-term heparin anticoagulation and surgical decompression. In our patients intensive i.v. antibiotic treatment, steroids, anticoagulants and surgery led to a significant improvement in the clinical condition.

A retrospective review of children diagnosed and treated for suppurative complications of paranasal sinusitis was undertaken to describe clinical presentation, microbiology, and treatment. This review includes children with subgaleal abscess and osteomyelitis of the frontal bone, subdural empyema, frontal lobe abscess, meningitis, and encephalitis. Staphylococcus aureus and group C β-hemolytic Streptococcus were isolated agents. All children were treated with intravenous antibiotics with drainage of both the sinus and extracranial and intracranial suppurations. Results of treatment in the series support the opinion that combined aggressive surgical and antibiotic treatment is a preferred method in complicated sinusitis in children.

Malignant external otitis (MEO) is an invasive, morbidity, even mortality, mainly pseudomonal infection of the external auditory canal, frequently involving the base of the skull, multiple cranial nerve and the meninges. In many cases conventional therapy has been prolonged, intensive and relatively ineffective, especially in infections other than bacterial (mainly fungal). We presented theoretical principles of hyperbaric oxygen (HBO) treatment in MEO, our own experience and others' experience in applying this treatment method. We treated eight patients with MEO applying pharmacotherapy, topical management, surgery in one case and also adjunct HBO. In six patients, infection was caused by Pseudomonas aeruginosa, in one by Staphylococcus sp. and in one by Aspergillus sp. Complete recovery was achieved in seven patients. In the patient with MEO caused by Aspergillus sp., intracranial complications developed and the patient died. Our experiences in employing HBO in bacterial-caused MEO have confirmed the role of HBO as a valuable, beneficial, supporting classical treatment method. Small number of patients with MEO, especially with non-bacterial infection, and unforeseen clinical course of disease make our experience difficult to objectivize.

The authors described the medical achievements of Jan Antoni Mikulicz-Radecki--a famous surgeon and laryngologist of Polish origin, belonging to the Viennese surgical school of Prof. Theodor Billroth at the turn of the 20th century. His scientific and clinical activity in Vienna, Cracow, Konigsberg, and Wroclaw resulted in 232 publications and several new surgical methods. He changed the opinion on scleroma and described benign lymphoepithelial lesions. He was one of the authors of modern aseptics, antisepsis in surgery, and is regarded as a pioneer of endoscopic procedures. He was interested mainly in thoracic surgery, surgery of the abdomen, orthopedics, and laryngology. Mikulicz was the first to describe the method of surgical treatment of the maxillary sinus, osteoplastic surgery of the nose, esophagoscopy, and lateral pharyngotomy in tonsil carcinoma. Prof. Mikulicz was the first to perform thoracic surgery; he performed the first pyloroplasty, the first partial esophagectomy and gave rise to antiseptic procedures and general surgical management. He described many modifications of surgical operations and he constructed the esophagoscope, scoliozymeter, and many other useful surgical devices.

Molecular and cellular mechanisms in chronic otitis media (COM) with cholesteatoma have not been clearly enough known so far. Investigations on cholesteatoma are focused on its immunological and morphological status. The authors presented the results of immunomorphological evaluation of 31 patients with COM with cholesteatoma, divided into three groups. In the first group there were 4 patients with congenital cholesteatoma, in the second group 19 patient with primary acquired cholesteatoma and in the third group 8 patient with secondary acquired cholesteatoma. Immunohistochemical investigations were performed using antibodies for identification the tenascin, S-100 protein, antigens Ki 67, CD 31, FVIII, HLA-DR, and growth factors TGFbeta1 and EGFR. The immunological activity was assessed for three types and matrix and perimatrix of cholesteatoma. High expression of tenascin was proven in the perimatrix of cholesteatoma and protein S-100 was highly expressed in the cholesteatoma matrix. Ki 67 antigen was seen rarely and mostly was present in basal cells of the matrix. The presence of endothelial cells was proven mainly in the connective and vascular tissue of perimatrix (CD 31, FVIII). The high expression of HLA-DR in matrix confirms the presence of Langerhans cells. The presence of growth factors TGFbeta1 and EGFR was observed in peribasal layer of the epithelium and keratinocytes of cholesteatoma matrix. Activity of immunological processes in COM with cholesteatoma confirms their important role in pathophysiology of chronic otitis media with cholesteatoma.

Chronic otitis media (COM) is an inflammatory process involving the middle ear mucosa and the tympanic membrane. The healing and epidermization is mostly impaired by immunological response of the host. Investigating the activity and the function of immunological response elements one can learn the immunological mechanisms taking place in chronic otitis media. The ultrastructural investigations of the tympanic membrane were done on its fragments obtained from 19 patients with COM during middle ear surgery, performed at ENT Department of Medical University of Gdańsk in the years 1997-1999. Immunohistochemical investigations were performed using monoclonal antibodies against tenascin, S-100 protein, Ki 67, CD 31, F VIII, HLA-DR, TGFbeta1 and EGFR. The control group was 11 healthy tympanic membranes from cadavers. The presence of tenascin was proven in all COM tympanic membranes and in 45.5% of those from control group. S-100 protein was present in 88.9% of the patients with COM and absent in control group. Ki 67 was observed in 44.4% of the patients with COM and in 27.3% of the healthy tympanic membranes. Angiogenesis factors (CD 31 and FVIII) were present in 77.8% of the investigated COM tympanic membranes, in control group in 45.5%. HLA-DR expression was observed in 90% COM patients, in control group in 72.7%. Growth factor TGFbeta1 was present in the all cases in mucous and fibrous layer and in 54.5% of healthy tympanic membranes. EGF receptor was present in 60% of COM patients, mainly in epithelial layer of tympanic membrane and in 54.5% of those from control group. The presented investigations confirm the immunological activity of tympanic membrane in chronic otitis media.

Acute mastoiditis is the most common complication of acute otitis media (AOM) and its early recognition and management still poses a challenge due to potentially serious consequences. The incidences of extracranial and intracranial suppurative complications of AOM in children have decreased significantly, yet they remain a serious clinical problem, especially when caused by bacteria resistant to antibiotics. The authors presented a case of rare AOM complication - zygomatic abscess with temporal myositis. A 6-year-old boy was admitted to the ENT Department with 4 weeks of ear pain, treated for AOM with cefuroxime axetyl and amoxicilline, with acute mastoiditis and subsequent abscess formation in zygomatic and preauricular region. The inflammatory process spread through anterior air cells to the zygomatic cells leading to a fistula formation in the zygomatic bone and breakthrough into the temporal muscle. The surgical procedures applied were: myringotomy with drainage, cortical mastoidectomy and revision of zygomatic area and treatment with antibiotics (ceftriaxon). Enterococcus faecalis and Streptococcus viridans were found in the culture of middle ear and mastoid effusion. After half a year of follow-up the child had a normal hearing. Severe complications of AOM are rare today. An early diagnosis in order to promote adequate management and prevent inherently suppurative complications is essential.

From 1948 to 1992, 14 patients with non-epithelial malignant neoplasm of the larynx were seen in the ENT Department of the Gdańsk School of Medicine. During this period, 2,249 patients with malignant laryngeal neoplasms were treated. The choice of therapy (laryngectomy, total or partial, excision by thyrotomy, irradiation or chemotherapy) depended on the size and location of the tumor and its histopathological nature. Significant for these tumors were: unchanged mucosa covering the tumor, rare metastases to the cervical lymph nodes, difficulties in estimating a histopathological diagnosis and determination, in certain types their unifocal nature.

Objective: The clinical picture of mastoiditis, sigmoid sinus thrombosis and brain abscess has changed with the advent of antibiotics. A delay in the recognition of intracranial complications in children and in the institution of appropriate therapy may result in morbidity and mortality. Increased mortality of the children has been correlated with the neurological status of the patient on admission to hospital. Method: A retrospective study was made of two children with acute mastoiditis and sigmoid sinus thrombosis and chronic mastoiditis with cerebellar abscess treated in 1997 in the ENT Department of the Medical University of Gdansk, Results: We present two cases of intracranial complications in children (13 and 11 years old) originating from acute and chronic otitis media. The first case, of a 13-year-old boy with sigmoid sinus thrombosis as a complication of acute otitis media took its course as a typical Symonds Syndrome. Mastoidectomy, thrombectomy and jugular vein ligation associated with antibiotics and edema-reducing drugs and anticoagulants proved to be successful. The second case of an 11-year-old boy with exacerbated chronic otitis media with cholesteatoma and mastoiditis, was complicated by suppurative meningitis. cerebellar abscess, perisinual abscess and sigmoid sinus thrombophlebitis. Neurosurgical approach by suboccipital craniotomy and abscess drainage was ineffective. Otological treatments of modified radical mastoidectomy, thrombectomy, jugular vein ligation, perisinual and cerebellar abscess drainage associated with wide-spectrum antibiotics and edema-reducing drugs were performed with a very good outcome. After 3 years of follow-up the patients remain without any neurological and psychiatric consequences. Conclusion: The authors show different courses of both presented complications and imaging techniques and surgical procedures performed in these children. The sigmoid sinus trombosis with Symonds Syndrome may be difficult to diagnose due to previous antibiotics valuable in establishing the diagnosis and the extent of disease. The successful therapy is based on understanding of pathogenesis of the intracranial complication and the cooperation of an otolaryngologist, a neurologist, a neurosurgeon and an ophthalmologist.