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Introduction: IROS - the Cochlear Implanted Recipient Observational Study is an international, multicenter, prospective and long-term study and the main aim of it is to collect subjective data of auditory implant users at regular time intervals (at the time between surgery and the first fitting of sound processor; at 1, 2 or optional 3 years after implantation). The ENT clinic in Lodz participates in this project since June 2012. Methodology: To evaluate patients outcomes two self-assessment scales were used in the study: Health Utility Index Mark 3 (quality of life ) and Speech Spatial Qualities of Hearing questionnaire (hearing-disease specific). A demographic profile of patients was created by a general questionnaires for clinicians and for patients. Other data like the usage of device and mobile phone, tinnitus, employment or dizziness were also collected. Results: In the clinic in Lodz there are 19 patients with cochlear implant under observation (in Poland -- there are 189 subjects). An average age of implanted patients is 47 years (min 24, max 62). The etiology of hearing loss was most commonly unknown (9), there were 3 patients with sudden deafness, 2 subjects with chronic otitis media, and individual cases of Measles Rougeole, noise exposure, trauma, rubella and meningitis. Six patients were using their hearing aids on the left ear and 11 on the right ear before surgery. The results of follow up questionnaires show an improvement in each area: speech understanding, spatial hearing and quality of hearing. Conclusion: Cochlear implantation increases the ability and quality of speech understanding and spatial hearing already after 1 year of the implant device usage. This kind of database of all implanted patients is important and helpful for the clinic to manage the patients on the clinical, administrative and reimbursement level and also to see how effective a treating method like cochlear implantation is. [ABSTRACT FROM AUTHOR]

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Introduction: Cancers of the auricle and the external auditory canal (EAC) remain a relevant oncological problem., Aim: Presentation of the results after resections of conchal bowl and EAC carcinoma (with or without radical mastoid surgery) and after reconstructions (postauricular island flap - PIF)., Material and Methods: We analysed results of 37 patients with cancers of the auricular conchal bowl and EAC after tumour resection and reconstruction (2000-2017)., Results: The cancers were completely excised in all patients, with no recurrences within at least 5 years after surgery. We noted venous congestion in 22 (59.4%) cases, pinning of the operated ear in 18 (48.6%), prominent earlobe in 14 (37.8%), and EAC constriction in 6 (16.2%) cases treated without radical mastoid surgery., Conclusions: Retroauricular approach in cancer of the auricular concha and EAC allowed for accurate evaluation of the tumour extent and proper surgical access, which facilitated complete removal of the tumour. Use of radical mastoid operation with conchal bowl resection and PIF reconstruction in patients with aquamous cell carcinoma or infiltrating basal cell carcinoma of auricular concha and osseous EAC resulted in cancer extirpation and good aesthetic outcomes, despite minor functional consequences. In these cancers mastoidectomy offered a wider access to determine the radicality of oncological resection., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2022 Termedia Sp. z o. o.)

Older adults with mild or no hearing loss make more errors and expend more effort listening to speech. Cochlear implants (CI) restore hearing to deaf patients but with limited fidelity. We hypothesized that patient-reported hearing and health-related quality of life in CI patients may similarly vary according to age. Speech Spatial Qualities (SSQ) of hearing scale and Health Utilities Index Mark III (HUI) questionnaires were administered to 543 unilaterally implanted adults across Europe, South Africa, and South America. Data were acquired before surgery and at 1, 2, and 3 years post-surgery. Data were analyzed using linear mixed models with visit, age group (18-34, 35-44, 45-54, 55-64, and 65+), and side of implant as main factors and adjusted for other covariates. Tinnitus and dizziness prevalence did not vary with age, but older groups had more preoperative hearing. Preoperatively and postoperatively, SSQ scores were significantly higher (Δ0.75-0.82) for those aged <45 compared with those 55+. However, gains in SSQ scores were equivalent across age groups, although postoperative SSQ scores were higher in right-ear implanted subjects. All age groups benefited equally in terms of HUI gain (0.18), with no decrease in scores with age. Overall, younger adults appeared to cope better with a degraded hearing before and after CI, leading to better subjective hearing performance., Competing Interests: CJ is an employee of Cochlear, manufacturer of Nucleus cochlear implants. PG and DM are paid consultants for Cochlear Europe. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 James, Graham, Betances Reinoso, Breuning, Durko, Huarte Irujo, Royo López, Müller, Perenyi, Jaramillo Saffon, Salinas Garcia, Schüssler, Schwarz Langer, Skarzynski and Mecklenburg.)

A series of five excited-state intramolecular proton transfer (ESIPT) emitters based on a 2-(2'-hydroxyphenyl) benzoxazole (HBO) scaffold, functionalized with a mono-or bis-(trialkylsilyl) acetylene extended spacer are presented. Investigation of their photophysical properties in solution and in the solid-state in different matrix, along with ab initio calculations gave useful insights into their optical behavior. Random lasing studies were conducted on a series of PMMA doped thin films, showing the presence of stimulated emission above the threshold of pumping energy density (ρth ≈ 0.5-2.6 mJ cm -2 ). In this work, the similarity of four level laser systems is discussed in light of the ESIPT photocycle.

Introduction: Despite the recent advances in otosurgery diagnosis of cholesteatoma and qualification for surgery remains an issue in contemporary laryngology. In cases of cholesteatoma recidivism, it is of utmost importance to properly locate the pathology in the middle ear to plan surgical approach. Magnetic Resonance imaging in diffusion-weighted non-echoplanar sequences (non-EPI DWI) enables cholesteatoma detection as small as 2 mm and could potentially prevent unnecessary second-look surgery. Computed Tomography of the temporal bone allows precise visualization of bony structures and topographical landmarks of the middle ear. A fusion of both imaging modalities combines the advantages of these techniques., Material and Methods: Five patients treated in the Department of Otolaryngology, the Medical University of Lodz for probable cholesteatoma recidivism were included in this study. A high-resolution CT scan of the temporal bone and an MRI scan including non-EPI sequences was obtained in all patients. A fusion of CT and MRI studies was conducted using OsirixMD software. Fist, CT studies were fused with MRI BFFE sequences, then non-EPI sequences were added. Finally, if the patient qualified for surgical treatment histopathological diagnosis was compared with MRI results., Results: CT scans were analyzed to establish the extent of previous surgical interventions and anatomical landmarks preservation. In all cases, MRI results were suspicious of cholesteatoma recidivism. Four cases were confirmed in postoperative histopathological evaluation, there was one false positive case when intraoperatively scar tissue was identified, which was later confirmed as connective tissue upon histopathological evaluation., Conclusions: CT and MRI fusion provides a helpful diagnostic tool in preparation for surgery in patients with suspected cholesteatoma recidivism.

An original molecular fluorophore displaying single keto (K*) excited-state intramolecular proton transfer (ESIPT) emission is presented in this article. Substitution at the 3 and 5 positions of the phenol ring of a 2-(2'-hydroxyphenylbenzoxazole) (HBO) dye by triethylsilyl-ethynyl fragments leads to a drastic enhancement of fluorescence in the solution-state as compared to unsubstituted analogues. This intense fluorescence emission is also retained in a protic solvent like ethanol and in the solid-state as embedded in a potassium bromide pellet or as 1% doped in a poly(methyl methacrylate) (PMMA) film. The experimental optical properties were confirmed by ab initio calculations. Random lasing (RL) studies performed on this ESIPT emitter show the presence of stimulated emission occurring above the threshold level of pumping energy density (ρth ≈ 300 μJ cm-2) in the PMMA matrix. To the best of our knowledge, this study constitutes the first observation of RL based on ESIPT fluorescence.

Aims: Presenting our clinical experience with the postauricular island flap (pif) and estimation of the results following partial external auditory canal (eac) and/or auricular conchal bowl reconstructions with the pif in patients after carcinoma resections., Methods: We have analyzed postoperative results of 19 patients after auricular conchal bowl (11), or auricular conchal bowl and eac (8) reconstructions with pif, following malignant tumor resections, between 2000-2015. The patients were followed-up and evaluated in respect of early and long-term results after surgical treatment considering plastic surgeon's and patient's opinion., Results: The cancers were completely excised in all patients, and there were no recurrences within at least 2 years of follow-up. The observed complications after reconstructions comprised venous congestion in five cases (26.3 %), pinning of the operated ear in four patients (21 %), prominent earlobe in three (15.8 %), and eac constriction in three cases (15.8 %). Postoperative result was very good in all cases (both in the opinion of plastic surgeon and patients), except patients with pinning of the operated ear, prominent earlobe (moderately satisfied). Conclusions 1. Combined operations involving postauricular island flap reconstructions after partial (external auditory meatus and/or auricular conchal bowl) resections allowed for complete removal of malignant tumors with no evidence of recurrence, and also preservation of proper conchal shape in the reconstructed ear. 2. Retroauricular approach in cases with cancer involvement of the external auditory meatus allowed for proper visualization and estimation of lesions extent, as well as adequate surgical access.

Objective: To present outcomes of extensive surgery: lateral, subtotal, total petrosectomies in patients with temporal bone invasion resulting from specific primary cancers., Study Design: Retrospective case review., Setting: Four tertiary referral centers., Material: 89 patients with cancer of the temporal bone treated between January 2006 and December 2010., Intervention: Multidisciplinary team approach including surgical resection, reconstruction, and postoperative radiotherapy., Main Outcome Measure: Disease-specific survival, overall survival., Results: In 27.0% of the patients, relapse was reported, with an average of 6.3 months after surgery; 31 patients (34.8%) died during the follow-up. The average mortality was 22.1 months. Fifty-four patients (58.7%) stayed alive during the time of observation. The average survival time was 42.0 months. The median time of survival with relapse was 12 months (range: 1-51 months). The three-year disease-free rate was 38.0% and the overall survival rate was 58.7%., Conclusions: Petrosectomy is an effective treatment for malignant temporal bone invasion. The probability of a good outcome was statistically decreased with a high T grade, positive margins, and salvage surgery. Younger age is connected with better prognosis. One of the major tasks remains to improve detection and to shorten the time to diagnosis, keeping in mind that symptoms are insidious and in younger people, the time before diagnosis was longer.

Objectives: To assess subjectively perceived, real-world benefits longitudinally for unilateral cochlear implant (CI) recipients in a multinational population treated routinely. To identify possible predictors of self-reported benefits., Design: This was a prospective, multicenter, repeated-measures study. Self-assessment of performance at preimplantation and postimplantation at 1, 2, and 3 years using standardized, validated, local language versions of the Speech, Spatial, and Qualities of Hearing Scale (SSQ), and the Health Utilities Index Mark 3 (HUI3) was performed. Outcomes were analyzed using a longitudinal mixed-effects model incorporating country effect. Patient demographics were explored for associations with change over time., Subjects: Two hundred ninety-one routinely treated, unilateral CI recipients, aged 13-81 years, from 9 clinics across 4 countries., Results: Highly significant improvements were observed for all outcome measures (p < 0.0001). Postimplantation, mean outcome scores remained stable beyond 1 year, with notable individual variability. A significant association for one or more outcomes with preimplantation contralateral hearing aid use, telephone use, age at implantation, implantation side, preimplantation comorbidities, dizziness, and tinnitus was observed (p < 0.004)., Conclusions: Longitudinal benefits of CI treatment can be measured using clinically standardized self-assessment tools to provide a holistic view of patient-related benefits in routine clinical practice for aggregated data from multinational populations. Self-reported outcomes can provide medical-based evidence regarding CI treatment to support decision-making by health service providers., (© 2017 The Author(s) Published by S. Karger AG, Basel.)

The aim of the study was to present our experience with the postauricular island flap (pif) and clinical evaluation of the results following auricular conchal bowl reconstructions with the pif in patients after carcinoma resections., Material and Methods: We analyzed results in 13 patients who underwent auricular conchal bowl reconstructions with pif following malignant tumor resection between 2000-2013. The patients were followed-up. We estimated early and long-term results after surgery including plastic surgeon's and patient's opinion., Results: The malignancies were completely excised in all patients, and there were no recurrences within 2 years of follow-up. Observed complications of conchal bowl reconstructions were venous congestion in two cases (15.3 %), and pinning of the operated ear in two patients (15.3%). Postoperative result was very good in 11 cases (both in the opinion of plastic surgeon and patients), whereas in two patients with pinning of the operated ear was satisfied., Conclusions: 1. Postauricular island flap reconstructions after auricular conchal bowl resections allowed for complete removal of malignant tumors with no evidence of recurrence, and also preserved proper conchal shape in the reconstructed ear. 2. Reconstructions of auricular conchal bowl with the postauricular island flap resulted in very good postoperative results, which confirms the efficiency of the applied technique. 3. Reconstructive surgery with postauricular island flap of individuals with partial auricular conchal bowl defects contributed to postoperative satisfaction in both patients and doctors' estimations.

Objective: Multicenter evaluation of the quality of life and quality of hearing after Nucleus® cochlear implant placement in patients over 60 years of age., Reference and Method: Evaluation was performed in patients receiving cochlear implants after the age of 60 years as a part of the Cochlear-Implanted Recipient Observational Study (Cochlear-IROS). This study is a prospective, international and long-term assessment which enables observation of recipients for up to three years after implantation. Data regarding subjective evaluation of the quality of life and quality of hearing were gathered before the first switch-on of the sound processor and one year afterwards. Standardized questionnaires were used in this evaluation, including Health Utility Index (HUI mk. III) and Speech, Spatial and Qualities of Hearing (SSQ) Scale. Data were also gathered regarding the aetiology of hearing loss, hearing aid usage, tinnitus and vertigo, as well as on the telephone usage and the professional status of recipients., Results: Included in the evaluation, were 20 subjects who were over 60 years old at the moment of the cochlear implant surgery. The study group consisted of 12 men and 8 female patients. The average age of CI recipients at the moment of implantation was 67.8 years (min. 60, max. 80 years). The SSQ questionnaire outcomes regarding self-assessment in the field of ability to hear in everyday situations one year after the surgery indicate that speech understanding increased by 180%, spatial hearing increased by 135 % and quality of hearing increased by 98%. Overall quality of life before the first sound processor switch-on as assessed using the HUI questionnaire was at the level of 0.38 (on 0-1 scale, where 0 equals death, and 1 equals full health). One year after the implantation, this assessment increased by 33% (up to 0.5 on the scale)., Conclusion: The effectiveness of the cochlear implantation in patients with severe hearing loss after 60 years of age with respect to the quality of life and hearing was confirmed. Statistically significant improvement was demonstrated in the self-assessment of patients in relation to the speech understanding, spatial hearing and quality of hearing, as well as quality of life.

Deregulation of mechanisms that control cell motility plays a key role in tumor progression by promoting tumor cell dissemination. Secreted netrins and their receptors, Deleted in Colorectal Cancer (DCC), neogenin, and the UNC5 homologues, regulate cell and axon migration, cell adhesion, and tissue morphogenesis. Netrin and netrin receptor expression have previously been shown to be disrupted in invasive tumors, including glioblastoma. We determined that the human glioblastoma cell lines U87, U343, and U373 all express neogenin, UNC5 homologues, and netrin-1 or netrin-3, but only U87 cells express DCC. Using transfilter migration assays, we demonstrate DCC-dependent chemoattractant migration of U87 cells up a gradient of netrin-1. In contrast, U343 and U373 cells, which do not express DCC, were neither attracted nor repelled. Ectopic expression of DCC by U343 and U373 cells resulted in these cells becoming competent to respond to a gradient of netrin-1 as a chemoattractant, and also slowed their rate of spontaneous migration. Here, in addition to netrins' well-characterized chemotropic activity, we demonstrate an autocrine function for netrin-1 and netrin-3 in U87 and U373 cells that slows migration. We provide evidence that netrins promote the maturation of focal complexes, structures associated with cell movement, into focal adhesions. Consistent with this, netrin, DCC, and UNC5 homologues were associated with focal adhesions, but not focal complexes. Disrupting netrin or DCC function did not alter cell proliferation or survival. Our findings provide evidence that DCC can slow cell migration, and that neogenin and UNC5 homologues are not sufficient to substitute for DCC function in these cells. Furthermore, we identify a role for netrins as autocrine inhibitors of cell motility that promote focal adhesion formation. These findings suggest that disruption of netrin signalling may disable a mechanism that normally restrains inappropriate cell migration.

Unlabelled: In otosclerosis patients the most common procedure followed at Otosurgical Dept. Medical University of Lodz is stapedotomy with insertion of teflon-piston prosthesis. When surgery is finished a whisper hearing test is done from the 1 meter distance for brief intraoperative hearing improvement assessment. There is a number of patient who report subjective intraoperative hearing improvement which is not confirmed by postoperative pure-tone audiometry (2-3rd post-op day)., The Aim of the Study: was the analysis of factors influencing stapedotomy (teflon-piston procedure) patients in which intraoperative hearing improvement was not confirmed by postoperative pure-tone audiometry., Material and Method: Retrospective analysis of postoperative hearing results in patients who underwent stapedotomy (teflon-piston operation) at the Otosurgical Dept. Medical University of Lodz from 2005 to 2009., Results: The total number of 142 stapedotomies were analyzed. In 27 ears no hearing improvement was reported (19.1%). Among them 18 reported intraoperative hearing improvement not confirmed on postoperative pure-tone audiometry and 9 cases intraopertively reported no hearing improvement. Patients in Group A (hearing improvement 1-2 month post stapedotomy)--12 cases (44.4%) with hearing improvement confirmed by pure-tone audiometry and Group B--5 cases (55.6%) in which no sign of hearing improvement in pure-tone audiometry was reported., Conclusion: In patients who intraopertively reported hearing improvement not supported by the pure-tone audiometry the following factors seem to play a vital role: a) strong suggestion and willingness of improvement after surgical treatment, b) specific condition of the whisper hearing test at the operating room environment, c) patient's stress during the surgery and strong fear of possible revision surgery.

Duchenne muscular dystrophy is a genetic muscle disease characterized by the absence of sub-sarcolemmal dystrophin that results in muscle fibre necrosis, progressive muscle wasting and is fatal. Numerous experimental studies with dystrophin-deficient mdx mice, an animal model for the disease, have demonstrated that extrasynaptic upregulation of utrophin, an analogue of dystrophin, can prevent muscle fibre deterioration and reduce or negate the dystrophic phenotype. A different approach for ectopic expression of utrophin relies on augmentation of CT-GalNAc transferase in muscle fibre. We investigated whether CT-GalNAc transferase overexpression in adult mice influence appearance of utrophin in the extrasynaptic sarcolemma. After electrotransfer of plasmid DNA carrying an expression cassette of CT-GalNAc transferase into tibialis anterior muscle of wild type and dystrophic mice, muscle sections were examined by immunofluorescence. CT-GalNAc transgene expression augmented sarcolemmal carbohydrate glycosylation and was accompanied by extrasynaptic utrophin. A 6-week time course study showed that the highest efficiency of utrophin overexpression in a plasmid harboured muscle fibres was 32.2% in CD-1 and 52% in mdx mice, 2 and 4 weeks after CT-GalNAc gene transfer, respectively. The study provides evidence that postnatal CT-GalNAc transferase overexpression stimulates utrophin upregulation that is inherently beneficial for muscle structure and strength restoration. Thus CT-GalNAc may provide an important therapeutic molecule for treatment of dystrophin deficiency in Duchenne muscular dystrophy.

Unlabelled: Abnormalities in the ocular-motor reflex recorded in electronystagmography may indicate central vestibular system impairment. Multiple sclerosis (MS) is the most common chronic, debilitating disease characterized by focal demyelinization that develops throughout the central nerves system at varying time. The aim of the study was to apply the quantitative analysis of ocular-motor tests to evaluation degree of the central system impairment in MS patients., Material and Methods: The study was carried on 60 MS patients consulted in Balance Division, Otolaryngology Clinic, Medical University of Lodz, from 2002 to 2004, and 50 healthy persons as the control group. Clinical otoneurolaryngological examinations and electronystagmography tests (smooth pursuit, optokinetic, saccades) were performed in all patients. We apply the quantitative Z score analysis for gain in smooth pursuit test, slow phase velocity in optokinetic, maximal velocity of the saccades. Depending on Z score value the patients were qualified into one of three scale dysfunctions., Results: Statistical correlation were found between results of all ocular-motor tests outcome in MS patients and control group. In smooth pursuit test most often second degree (35.0%), in OKN test first degree (28.3%) and in saccades the third degree (31.6%) of dysfunction was observed. The higher the values of Z score, the more abnormal results of ocular-motor reflex were observed., Conclusion: Application of the quantitative Z score analysis of the ocular-motor tests results demonstrating the degree of central ocular-motor system dysfunction in MS patients. This method may assist in monitoring the central vestibular system impairment and in evaluation course of the disease and degree of neurological disability.

Unlabelled: Otoneurologic bedside examination with testing eye movements gives valuable information about static and dynamic properties of balance system and may give topodiagnostyc information about the side of lesion in patients with vertigo, dizziness and disequilibrium., The Aim of the Study: was to present the scheme of otoneurological bedside examination and usefulness of ocular motor disturbances index in evaluation of Multiple Sclerosis patients status., Material and Methods: Sixty patients with diagnosis of MS, seen in outpatient neurology clinic, Medical University of Lodz, from 2002 to 2004, were enrolled into the study. Patient's history of vertigo, dizziness, hearing loss and vision disturbances were evaluated. The clinical bedside ocularmotor examination was performed in all patients. It was composed of seven tests on the basis on which we introduce ocular motor disturbances index--IRZ., Results: The most frequent abnormalities were found in clinical saccadic test in 30% and smooth pursuit in 22%. MS patients who had in clinical eye movements examination IRZ bigger than 3 point formed the abnormal clinical examination group' (ACE)-- 31.7%. In u 68.3% the index was less than normal clinical examination group' (NCE). The longer duration of the disease was observed in ACE group. Comparisons of functional neurological score EDSS and for cerebellar and brainstem subscale were significantly greater in ACE group., Conclusion: Otoneurological bedside examinations with dynamic tests and introducing quantitative the ocular motor disturbances index is a valuable method of evaluation of visual-ocularmotor reflex and may be used in monitoring MS course of disease.

Introduction: Results of studies analyzing the role of immunocompetent cells in tumor environment and whole peripheral blood indicate their responsibility for aggressiveness of neoplasm, prognosis and therapeutic effect. Atcivation of lymhocytes T is connected with expression the markers (antigens) on their surface. The aim of this study was the analysis of activation antigens expression on lymphocytes T in patients with laryngeal carcinoma and the connection with clinicomorphological features., Material and Methods: Analysis of activation antigens expression CD69, CD71 and CD25, CD26, HLA/DR on lymphocytes T CD4+ i CD8+ in 33 patients with squamous cell carcinoma of the larynx was performed. Flow cytometry-based analysis of activation antigens in T cell cultures with and without PHA stimulation was used. The connection of these molecules and clinicomorphological features was examined (pT, pN, G, Anneroth, Batsakis and Lunas' classification)., Results: The significant correlation between chosen markers of activation and tumor features were noted: pT with HLA/DR/CD4, CD69CD8, CD71CD8, pN with CD26CD8, G with CD25CD8, CD71CD8, ABL score with CD25CD4., Conclusion: Our data indicated the connetion of immunocompetent cell activity and spread of neoplasm in patients with laryngeal carcinoma.

Introduction: Papilloma of the nose and paranasal sinuses is a benign tumor originated from nose mucosa. Especially inverted papilloma tumor has a significant recurrence and malignancy potential rate. The aim of the study was the analysis of clinical and treatment outcomes of patients with papilloma of the nose and paranasal sinuses., Material and Methods: The retrospective analysis was curried out on 41 patients--16 with papiloma of the nasal vestibule and 25 with inverted papilloma the nose and paranasal sinuses surgically treated in I ENT Clinic Medical University in Lodz between 1998-2004 years. We analyzed patient's complains, clinical data and surgical follow-up results., Results: The most frequent complains was increasing unilateral nasal obstruction and rhinorhea. Nasal vestibule papilloma were intranasal removed in all cases. In extended tumor nose and paranasal sinuses in 14 cases intranasal procedures, in 7 sublabial approached, in 4 lateral rhynothomy were performed. In 5 patient local recurrences was observed and in 3 neoplasmatic transformation., Conclusion: The choice of surgical management should be individual with respect to tumor localization and extension of neoplasmatic process. The treatment result depends of radical tumor resection.

Aim: Retrospective analysis of the post-op hearing results in stapes surgery using different types of materials for stapes prosthesis after 12 months follow up., Material and Methods: The total number of 350 otosclerosis patients who underwent surgical treatment at the Otosurgery Department, Medical University of Lodz from 1980-2002. All patients included in the study were divided into 4 groups: group 1 (N=54)--Portmann's method interposition, group 2 (N=160)--stapes replaced with the Shea-type prosthesis, group 3 (N=60)--platinum wire prosthesis (Zini-type), group 4 (N=76)--teflon-piston operation (Fisch-type)., Results: The 12 months post-op mean value for air-bone gap (500, 1000, 2000 Hz) presented the following values: group 1-19 dB, group 2-15.9 dB, group 3-18.4 dB, group 4-13.5 dB. The percentage of patients with the mean air-bone gap value of 15 dB or less (500, 1000, 2000 Hz) has the following values in each group: group 1-75%, group 2-81.3%, group 3-83%, group 4-85%., Conclusions: 12 months post-op hearing results compared between the 4 studied groups showed statistically not significant differences. Our experience with teflon-piston prosthesis shows the lowest post-op mean value of the air-bone gap.

Introduction: Acoustic neuroma usually presents as an unilateral tumor, seldom - bilateral and rarely in coexistence with other central nervous system neoplasms. The following paper reports such a case of a 21-year-old male patient presented with sudden deafness in left ear accompanied with tinnitus and vertigo. Symptoms started 4 weeks prior hospitalization. Their aggravation has been observed 7 days before admission to the hospital. Audiometry revealed moderate sensorineural hearing loss in left ear (for low and middle frequencies), brainstem auditory evoked potentials were absent on the left side and ENG examination showed left peripheral vestibular impairment. Initially patient received i.v. vasodilatators showing 20-25 dB improvement in low frequencies after 3 days of treatment. MRI study revealed in the left internal acoustic meatus mass (7 x 7 x 14 mm) suggesting acoustic neuroma and an oval mass (7 x 9 x 14 mm) in the pineal gland presenting radiological features of pinealoma. Patient has been qualified for neurosurgical treatment. Acoustic neuroma has been removed by suboccipital approach and pinealoma has been left for further observation as it was found incidentally. Histopathological examination confirmed diagnosis of left VIII nerve schwannoma. The left facial palsy (House-Brackmann III/IV grade) and profound hearing loss appeared after surgery. The postoperative course shows no evidence of acoustic neuroma recurrence.

Aim: Analysis of indications for stapes revision surgery in patients qualified for the secondary procedure at the Otosurgery Dept. Medical University of Lodz., Material and Methods: 25 cases of stapes revision surgery out of the 385 total treated surgically otosclerosis cases are discussed., Results: In group A (patients after total stapedectomy) the following indications for the secondary surgical procedure were observed: 12 cases--platinum wire prosthesis displacement with ossicular chain discontinuity; 3 cases--perichondrium or adipose tissue atrophy; 2 cases of incudo-stapedial joint luxation. Group B was composed of 8 patients after stapedotomy (teflon piston operation, 0.6 mm)., Conclusions: (1) The most common indication for the stapes revision surgery in patients after total stapedectomy were prosthesis displacement and necrosis of the long crus of the incus. (2) Obliteration of the stapes footplate after small fenestra operation was observed in our material to be the most frequent indication for the secondary stapes procedure.

Introduction: In studied analyzed role of the cytokines in pathology of neoplasms of various origin the importance of these proteins in regulation of immunocompetent cells function has been described. The aim of this study was to estimate of cho sen cytokines concentration produced by peripheral blood mononuclear cells and in whole blood in patients with laryngeal carcinoma and to analyze the connection of cytokines profile with clinicopathological features. MATERIALA AND METHODS: 55 patients with squamous cell carcinoma of the larynx treated at ENT Department Medical University of Lodz between 2003-2007 were analyzed. For estimation of cytokine secretion the cultures of isolated peripheral blood mononuclear cells (T lymphocytes) and the whole blood were established. Production of cytokines in supernatants was detected by Elisa. Connections with clinicomorphological features (pT, pN, Anneroth, Batsakis i Lunas' classification) were analyzed., Results: Authors reported statistical correlation between chosen cytokines concentration and clinicomorphological parameters: pT and IL-2, IL-6, IL-8, TNFalpha produced by isolated cells and IL-2, IL-6, TNFa and IFNgamma in whole blood, pN and IL-8, IL-10, IFNgamma; ABL score and IL-6, TNFalpha, IFNgamma produced by isolated cells and IL-2, IL-6, IL-10, TNFalpha, IFNgamma in whole blood., Conclusion: Our studied indicated the important influence of proinflammatory and regulatory cytokines produced by immunocompetent cells for course of neoplasm disease, aggressiveness and advance in laryngeal carcinoma.

Introduction: Occult foci of neoplasm cells in lymph nodes (referred to as micrometastases) in various squamous cell carcinomas may be discovered by immunohistochemistry by using anti-CKs (cytokeratine filaments) policlonal antibodies which reactive with epithelial cells. Matrix metalloproteinases (MMPs) are proteolytic family enzymes represent a group of endopeptidases which are capable to degrading components of the extracellular matrix and have been implicated as playing an important role in cancer invasion and metastases. The purpose of this study was to analyze the morphological parameters and to investigate MT1-MMP expression in laryngeal carcinoma to relate the expression to CKs in pN0 lymph nodes., Materials and Methods: To presented the direct correlation between the morphological features of tumor front and the probability of micrometastases and prediction of prognosis we have analyzed 22 patients operated for squamous cell carcinoma of the larynx. The total score of TFG classification, tumor clinicomorphological features and grade of matrix metalloproteinase membrane type 1 staining in tumor front were analyzed to predict the presence of micrometastases and prognosis. Immunohistochemical methods with a panel of CKs antigens in lymph nodes and MT1-MMP expression in tumor tissue were performed., Results: Our study showed that the total morphologic score TFG is very useful in the prediction of micrometastases in patients with laryngeal squamous cell carcinoma. The statistical analysis has revealed a significant correlation between the total TFG score and the depth of invasion and the presence of micrometastases. Positive MT1-MMP expression in 68.2% cases was observed. There was no significant relationship for immunoexpression of MT1-MMP in examined group of patients with advanced laryngeal carcinoma and positive poliCKs stain in lymph nodes., Conclusions: The results of study suggest that extended traditional pathologic evaluation by features from the TFG classification, especially the depth of invasion, could aid in diagnosis of micrometastases. The positive expression of poliCKs in the conventional pathological examination of pN0 lymph nodes appears to play an important role in determining prognosis in patients with carcinoma of the larynx.

Authors present a case of a female patient surgically treated for chronic otitis media (radical middle ear surgery) in which basing on postoperative pathology report a specific inflammatory process (tuberculosis) has been diagnosed. It is pointed out that in this patient there is a history of malignant neoplastic process (rhabdomyosarcoma embryonal) treated previously at the contralateral middle ear.

The diagnosis and treatment of laryngeal premalignant lesions has been frustrated because of failure to adequately define the histologic changes that may help in prediction of irreversible neoplastic transformation. To assess the grading of laryngeal hyperplastic epithelial lesion it was used a Ljubljana classification of histologic changes. It was done a retrospective study of 104 laryngeal hyperplastic lesions biopsies that were classified according to the Ljubljana classification comprising benign spinous layer augmentation (simple hyperplasia), benign basal and parabasal layer augmentation (abnormal hyperplasia), alteration of epithelial cells towards malignancy (atypical hyperplasia) and carcinoma in situ. One hundred and four biopsies with preneoplastic changes were reevaluated and classified according to Ljubljana classification. It was found 42 cases (40.4%) which showed simple, 38 (36.5%) abnormal, 21 (20.2%) atypical hyperplasia and 3 (2.9%) carcinoma in situ. Three cases of atypical hyperplasia (2.9% of all investigated cases) and one of abnormal (0.96%) progressed to invasive carcinoma during the observation ranging from 5 to 9 years (median 8.1). None of the cases classified as simple hyperplasia showed progression to malignancy. The Ljubljana classification focuses on the important clinical decision involving benign looking hyperplastic lesion that do not require strict follow-up (simple and abnormal hyperplasia); and "risky" epithelium that require close follow-up with repeated histologic assessment to recognize any malignant progression (atypical hyperplasia); and carcinoma in situ that requires fast and complete treatment. We suggest that the Ljubljana classification may give a reliable assessment of laryngeal hyperplastic epithelial lesions and can help in monitoring all those patients.

Unlabelled: Vascular malformations are the most common anomalies appearing from birth to any adulthood. They are not clinically and morphologically homogenous group. They may occur at different place but most often in the subcutaneous or submucous space in the oral cavity, pharynx, the paranasal sinuses and nose. The aim of this study was to present the difficulties in diagnosis and treatment of head and neck vascular malformations in patients hospitalized in ENT Department University of Lodz from 2001 to 2006. From 17 patients with vascular malformations we choose four to careful evaluation. Two patients had neck vascular malformation, two had the paranasal and nose sinuses tumors. Presented lesions were categorized as "low-flow" vascular malformation. In two cases there was vascular and lymphatic malformation, deeply located in the neck. In two cases arisen in the nose and the paranasal sinuses, there were capillary and cavernous types. We pointed out the clinical signs and diagnostic problems in deep vascular tumors and bleeding risk concerning treatment procedure. Even a needle biopsy and radiological imagining did not confirm the preoperative diagnosis. CT and MRI is recommended to delineate the extend the lesion, and evaluation of its special anatomical location, surrounding arteries, vessels and important neck structure prior to surgery. In the paranasal and nose tumor CT could show bone destructions as well., Conclusions: Surgical careful excision has been favorable in depth neck laying and extended paranasal and nose vascular malformation. Because of the risk of bleeding careful hemostasis are important challenges in the surgical removal, so embolization is preferred in some cases.

In cell cycle, most of the regulatory actions occur at the so-called restriction point (R) in the late G1 phase. Tumor suppressor genes; Rb, p53 and p21 are among the most important of the agents suppressing transition through R point. Changes in the expression of Rb (retinoblastoma) gene correlate with the presence of Rb protein and they are believed to be an early event in carcinogenesis. This issue seems to be not plainly defined in laryngeal cancer. P21 with p16, cyclin D1 and Rb genes that play a critical role in the regulation of the G1-S transition of the cell cycle, are frequently altered in several neoplastic entities. Our purpose was to investigate the possible prognostic value of p21, p16 and Rb proteins in patients with laryngeal cancer. 67 patients with laryngeal cancer was multi-variously analysed. Paraffin-embedded tissue sections were immunohistochemically stained with a monoclonal antibody raised against p21, p16 and Rb proteins using standard immunohistochemistry techniques. Low intensity (< or = 10%, 7/67) of p21 protein expression was significantly correlated with histological grading (p < 0,01) and overall and disease free survival (p < 0,05). We did not observed any correlation between p21 expression and T, N and M status and local or nodal recurrences. Absence of p16 protein expression was observed in 35/67 (52,2%) cases and was significantly correlated with N status (p = 0,03) and nodal recurrences (p = < 0,01). By univariate analysis expression of p16 protein was related with quicker relapse. Rb protein was absent in 7/67 cases (10,4%) and was related to T3 and T4 primary tumour size (p < 0,05). We did not observed any correlation between Rb and other clinocopathological features (p > 0,05). Our study has identified p21 protein expression as important biological marker which may indicate the progression of laryngeal squamous cell carcinoma. P16 protein has a prognostic value in assessment of disease free survival. Based on this findings it can be deduced that investigation of Rb, p16 and p21 proteins makes it easier to understand the process of cancerogenesis in laryngeal cancer and to establish its prognostic value further research and observations need to be attempted.

Unlabelled: Metalloproteinases are the proteolytic enzymes that digest components of the extracellular matrix in many physiological and pathological conditions. Their activity is regulated by their natural inhibitors: non-specific alpha2-macroglobulin and specific tissue inhibitors of metalloproteinases (TIMP). There are four TIMPs. TIMP-2 is the only enzyme that is expressed in constitutive manner and has the ability to inhibit activity of all metalloproteinases. TIMP-2 has been identified in many carcinomas including cancers of lung, oral cavity, breast and colon. There was correlation between TIMP-2 expression and clinical course of the disease observed in most of the neoplasm., Aim: The aim of the research was to evaluate the expression of TIMP-2 in laryngeal cancer and to assess the prognostic significance of this factor., Material and Method: 104 patients with laryngeal cancer, that underwent surgical treatment were included in the study. Only cases with at least a 5-year follow-up were included. Immunohistochemical studies were performed on formalin fixed, paraffin embedded sections by using monoclonal antibodies against TIMP-2 antigen and ABC detection system., Results: TIMP-2 expression was cytoplasmatic, mainly in cancer cells, but also in some stromal cells. There was correlation between TIMP-2 expression and tumor size and grading observed. We didn't find any correlation between TIMP-2 and nodal metastases, recurrence and survival., Conclusions: Our results don't suggest that TIMP-2 expression may be used as a prognostic factor in patients with laryngeal cancer. Nevertheless there are more researches needed to explain the role of TIMPs in growth and progression of neoplastic tumors.

Introduction: Nasal polyposis is a chronic inflammatory disease of the nasal mucosa. The prevalence of nasal polyps seems to vary between 1 and 4% of the population. The pathogenesis of nasal polyps is still not entirely known and has been debated for many years. The aim of the present study was to evaluate the expression of adhesion molecule ICAM-1 in patients with nasal polyps., Materials and Methods: 53 patients with nasal polyposis were selected and divided into two groups--allergic and non-allergic. Patients with allergy were distinguished from those without allergy on the basis of positive allergy skin tests to dust and serum levels of IgE. Immunohistochemical studies with monoclonal antibody against ICAM-1 antigen (NCL-CD54, Novocastra) using immunoperoxidase method were performed to evaluate expression of ICAM-1., Results: Immunoexpression of ICAM-1 was present on some epithelial cells and on fibroblast, inflammatory cells and endothelium in the submucosa. The mean +/-SD values of the immunoexpression of ICAM-1 were significantly increased in dust-sensitive patients compared with dust-tolerant patients (1.93 +/- 0.83 vs 0.83 +/- 0.73 (p < 0.001)., Conclusions: This research suggests that ICAM-1 plays an important role in the pathogenesis of nasal polyps and the allergic mechanism may play a fundamental role in this process. However, further examinations to confirm this need to be undertaken.

Fibronectin is one of the extracellular matrix glycoprotein, that plays an important role in cancer invasion and progression. Our purpose was to evaluate fibronectin expression and its possible prognostic value in laryngeal cancer. Forty-one patients (six female and thirty-five male) surgically treated for laryngeal cancer were included in the study. The expression and distribution of fibronectin was immunohistochemically determined by using monoclonal antibody against fibronectin. Low expression of fibronectin was detected around the individual carcinoma cells, but large amounts were present in the invasive tumour front and the cancer surrounding stroma was strongest positive for fibronectin. By univariate analysis the level of fibronectin expression on the border of the invasive tumour front was proved to be correlated with tumor stage (p = 0.03). There was a significant association between the defect of ECM and overall survival (p > 0.05). These observation indicates that testing the distribution and the expression of ECM seems to be useful to evaluate the histological grading of malignancy of laryngeal cancer and to be helpful to prognosticate the overall survival while measured on the border of tumour proliferative front in laryngeal patients. The results demonstrate that fibronectin amount may be useful in evaluating the invasion potential of the tumour.

Introduction: In chronic otitis media bacterial infection is often a cause of exacerbation in the clinical course and failure in treatment. The aim of the study was to investigate the incidence and profile of the aerobic bacterial flora in chronic otitis media and to determine the drug susceptibility of selected isolated bacteria., Material and Methods: The samples of 274 consecutive middle ear discharges taken from 228 patients with chronic otitis media were analysed (which constitutes 41.3% all bacteriological examinations made during 3 years). The smears were obtained using sterile cotton swabs, then incubated and identified. Drug susceptibility was determined by disc-diffusion method., Results: Monocultures were observed in 77% and mixed infections in 17.5% of smears, no growth was found in 5.5%. The 308 pathogen isolates were recovered, among them--273 bacterial (88.6%) and 35--fungal (11.4%). Twenty five species of bacterial microorganisms were found, among them the most common isolates were Staphylococcus aureus--42.9% and Pseudomonas aeruginosa---19.8%. Rarely were recovered Acinetobacter spp.--4.1%, Proteus mirabilis--37%, Proteus vulgaris--3.3% and methicillin-resistant Staphylococcus--1.5% of bacterial isolates. Among fungal pathogens (n=35) Aspergillus spp. was isolated in 37.1%, and Candida albicans--22.9% of cases., Conclusions: (1) Aerobic pathogens ---aphylococcus aureus and Pseudomonas aeruginosa were most frequently found microorganisms in chronic otitis media. (2) Mixed infections comprised only a 17.5% of all cultured cases of chronic otitis media. (3) Pseudomonas aeruginosa was highly susceptible in vitro to imipenem (100%), piperacillin-tazobactam (100%), ceftazidime (98%) and amikacin (89.7%), less susceptible to ciprofloxacin (77.6%) and much less susceptible to pefloxacin (33.6%) and cefotaxim (33.3%).

An exemplary classification of otolaryngological data with use of the Kohonen artificial neural network is presented along with an evaluation of grouping effectiveness. The study was based on 220 patients with otosclerosis, including 184 women and 36 men, aged 16-68, operated at the Otosurgery Department, Medical University of Lodz in 1984-1992. The neural network distinguished 3 clusters considerably differing in air and bone conduction preoperatively and as a result in the values of postoperative air-bone gap. The effectiveness of classification was also exhibited in congruent with previous knowledge differences between clusters in many other variables not presented to the neural network.

The aim of the study was to find out the potential prognostic value of proliferation activity and apoptosis in cholesteatoma and granulation tissue removed during middle ear reoperation in recurrent middle ear inflammation. Granulation tissues and recurrent cholesteatoma were analysed after being surgically removed from the middle ear in a group of 25 patients qualified for middle ear reoperation procedure. Paraffin sections were stained with haematoxylin and eosin according to Mallory's method. Immunohistochemical reaction Anti-PCNA was performed. Apoptosis was evaluated using the TUNEL method. The percentage of PCNA-positive cells was 42-95% in the matrix of the cholesteatoma and 29-81% in the perimatrix. In the granulation tissue it was 35-75%. The percentage of apoptotic cells was 12-73% in the matrix of the cholesteatoma, 5-72% in the perimatrix and 1-65 % in the granulation tissue. The prognostic value of the parameters studied in the recurrent middle ear inflammatory process is questionable, probably due to the small number of cases under examination.

Unlabelled: Pure-tone audiometric examination and its thorough analysis is decisive in the most adequate choice of the future otosurgical procedure. The final outcome of the middle ear surgery for hearing rehabilitation is closely dependent on thorough patients' qualification for adequate type of surgery. To analyze the predictive value of the air-bone gap and hearing impairment level (HIL) average value in the preoperative cholesteatoma patients assessment. Two groups of patients: group A (n = 41) cholesteatomatous chronic otitis media and group B (n = 31) simple chronic otitis media (tympanic membrane perforation, no ossicular interruption, no cholesteatoma) underwent the observations of the average value of air-bone gap and hearing impairment level (HIL). A statistically significant difference between the average value of the air-bone gap in group A (27.7 dB) and group B (23.6 dB) has been observed. The difference of 4.7 dB between average value of air-bone gap for epitympanic cholesteatoma localization (group A1 29.5 dB) and mezo- and hypotympanic localization (group A2 24.8 dB) has been statistically not significant., Main Conclusions: 1. The average values of air-bone gap in cholesteatoma epitympanic localization (29.5 dB) and mezo/hypotympanic localization (24.8 dB) has not statistically significant (p < 0.2540; F = 1.42) predictive value in preoperative assessment. 2. Patients with cholesteatoma have 4.2 dB (statistically significant; F = 4.386311; p < 0.03985) higher values of the average values of air-bone gap than patient with chronic otitis media simplex.

Neurilemmoma is a mild tumor growing from the Schwann's cells of the external part of the nerve trunk. Authors, in their works describe a case of a 32-year-old man with a neck tumor on its right side. The tumor was identified as the neurilemmoma on the grounds of a postoperative histopathological examination. Thin-needle biopsy that was made twice during the history of the patient that lasted two years did not reveal the character of the tumor.

We previously reported that an elevated level of matrix metalloproteinase-1 (MMP-1) gene expression in patients with chondrosarcoma has a strong statistical correlation with recurrence and in vitro invasion. In the present study, we used an antisense RNA strategy for MMP-1 inhibition to determine if this would affect the invasive characteristics of the cells. We transfected a human chondrosarcoma cell line with a retroviral plasmid expressing a 770 bp genomic fragment of the human MMP-1 gene in the sense or antisense orientation. The results show that cells transfected with the MMP-1 antisense fragment had a significant decrease in both MMP-1 protein and enzyme activity (p<0.05) as compared to cells transfected with an empty plasmid or the parental cells. Cells transfected with the MMP-1 antisense fragment demonstrated a significant decrease in their ability to invade the collagen I barrier (p<0.05). The gene expression for MMP-8 and MMP-13 were unaffected in cells transfected with the MMP-1 antisense fragment, MMP-1 sense fragment, or empty plasmid. These results support the hypothesis that MMP-1 facilitates tumor cell egress from chondrosarcoma tissue and demonstrate the potential of MMP-1 as a promising target for a novel biologic therapy in chondrosarcoma.

Labyrinthine fistulas (l.f.) are reported to be diagnosed in 3-12.9% of the chronic otitis media patients. Their most frequent location is the lateral semicircular canal. The other locations include posterior semicircular canal, superior s.c. and vestibular window. Surgical removal of the cholesteatoma matrix brings a high risk of the complete hearing loss in the operated ear. Preoperative diagnosis of the l.f. is not always possible. Authors present the analysis of the group of 18 patients with l.f. treated at the Otosurgery Department, Medical University of Lodz. In all patients the radical modified surgery has been performed. Postoperative results are strictly correlated to the l.f location and size. As a conclusion authors present an algorithm of the l.f. surgical treatment based on their experience.

The amount of data in the field of otorhinolaryngology has rapidly increased in proportion to the growing number of patients. It is a very important issue to preserve their records and make them easily available. Authors present a computer-based system for monitoring audiometric data of hearing impaired persons named Audiobase. The main elements of this system as: the personal data, otoscopic and audiometric examination have been described. This system was created to be used by staff without computer skills and therefore is largely "icon-driven". The main functions include patient record creation, update, and retrieval, as well as the generating of reports and graphical presentations. The system has already provided useful research material and is now beginning to fulfill an even more important role in patient follow-up and in evaluation of alternative treatment protocols.

Previously we reported that suppression of type I collagenase synthesis in human melanoma cells with antisense RNA significantly reduced proteolysis of type I and type IV collagen matrices (Durko et al., 1997, Biochim. Biophys. Acta 1356, 271). Because plasmin is a major activator of the type I collagenase, we assessed the impact of type I collagenase suppression on the urokinase/plasmin system of proteolysis. Gel zymography revealed the appearance of two new caseinolytic bands of Mr 81-83000 in conditioned media of type I collagenase-depleted, but not of wild-type cells and these were identified as plasmin bands. This increased extracellular plasmin activity coincided with reduced membrane-associated plasminogen levels and decreased expression of the urokinase-type plasminogen activator receptor at both the mRNA (up to 83% reduction) and cell-surface (up to 48% reduction) levels, while urokinase mRNA levels remained unchanged. The results indicate that in these cells the urokinase/plasmin system is regulated by type I collagenase levels., (Copyright 1998 Academic Press.)