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Background: The study evaluates clinical features of vocal fold (VF) leukoplakia in predicting its benign or malignant nature., Materials: 57 patients with 84 lesions were evaluated before undergoing laryngeal microsurgery. The texture, color, thickness and size of the leukoplakia, along with an assessment of the surrounding mucosa vascularization using narrow-band imaging (NBI), and VF vibratory function were analyzed. Receiver-operating characteristic curves were constructed to determine the predictive value of each feature and area under the curve (AUC) was calculated., Results: Histopathological examination revealed high-grade dysplasia or invasive cancer in 13 of VF leukoplakia. Seventy-one lesions were nondysplastic or low-grade dysplasia. Nonhomogenous color, irregular texture, and prominent thickness predicted malignancy with statistical significance (P < 0.05). AUC was 0.793, 0.793, and 0.679, respectively. Absence of a mucosal wave on laryngovideostroboscopy was significant for the detection of malignancy (P < 0.001) with an AUC of 0.927. The NBI diagnosis of horizontal vessel loops was significant with the highest AUC of 0.993., Conclusions: The comprehensive clinical evaluation of VF leukoplakia with laryngovideostroboscopy and NBI creates the opportunity to differentiate between low- and high-risk malignancy lesions. The perpendicular vascular pattern and the limited or absent mucosal wave appear to be the most powerful indicators of malignancy., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF). An improvement in mean value of LVS ratings was obtained in all three groups; however, only in benign lesion group was it consistently statistically significant for each time period (P < 0.001). Perceptual evaluation revealed significant improvement of G, R, and B parameters in benign lesions for each time period. In malignant neoplasms R and B parameters improved 3 and 6 months post microsurgery. In patients with benign lesions the maximum phonation time increased, but the improvement was significant only after 3 months. The acoustic parameters improved in all three groups. VHI significantly improved in patients with benign lesions after 3 and 12 months. VHI in the malignant neoplasm group significantly worsened on the first follow-up visit. Considering quality of life (QoL) results, only in patients with benign lesions was there a significant improvement in overall assessment of their QoL and general health., (Copyright © 2019 The Voice Foundation. All rights reserved.)

Background: This study investigates relevance of narrow band imaging (NBI) in stratifying risk of malignant transformation within leukoplakia., Methods: We conducted a prospective analysis that included 62 patients with 91 changes of leukoplakia on vocal folds. The NBI was obtained before microsurgery. Categorization of the lesion as benign was made when vessels of surrounding epithelium were classified as type I, II, or IV according to Ni classification. If there were visualized intraepithelial papillary capillary loops of type V, the lesion was classified as malignant. Results were compared to the histopathological diagnosis., Results: The NBI assessment classified 75 lesions (82.4%) as benign and 16 (17.6%) as malignant. Histopathological results revealed the diagnosis of no dysplastic changes or low grade dysplasia in 77 cases (84.6%). Another 14 cases (15.4%) occurred with high-grade dysplasia, carcinoma in situ, and invasive cancer. Sensitivity, specificity, and accuracy of NBI in predicting malignancy within leukoplakia were 100%, 97.4%, and 97.8%, respectively. The kappa index was 0.92 (95% confidence interval 81.1%-100%)., Conclusion: The noninvasive procedure of an NBI endoscopy may be recommended as an accurate method in predicting the risk of malignant transformation within the vocal fold leukoplakia and, therefore, would be useful in the clinic for planning the patient's therapy., (© 2018 Wiley Periodicals, Inc.)

Background: This is a comparative analysis of the diagnostic accuracy of narrow band imaging (NBI) and laryngovideostroboscopy (LVS) in the assessment of premalignant and malignant vocal fold lesions., Methods: A prospective analysis was performed on 105 consecutive patients with vocal fold lesions. The NBI and LVS were obtained before the microsurgery., Results: The NBI and LVS showed no significant differences in identifying premalignant and malignant pathologies. However, in analysis restricted to identification of only malignant lesions, the specificity (88.9% vs 20.6%), accuracy (90.5% vs 51.4%), and positive predictive value (PPV; 84.8% vs 45.1%) were significantly higher for NBI (P value < .001; .015; and .045, respectively). A comparison of LVS scored results relative to each NBI type revealed statistically significant differences (P < .001). A moderate positive correlation between NBI and LVS was demonstrated (P = .54)., Conclusion: The NBI and LVS are useful, complementary tools in evaluating early potential vocal fold malignancies. The NBI was superior to LVS on several statistical analyses., (© 2018 Wiley Periodicals, Inc.)

The aim of the study was to estimate voice defect and the quality of life deterioration in patients with different laryngeal pathologies qualified for microsurgery treatment. The results of videolaryngostroboscopy (VLS), perception, aerodynamics, acoustics, Dysphonia Severity Index, Voice Handicap Index (VHI), and the World Health Organization Quality of Life Scale Brief Version before microsurgery were analyzed. There were 151 patients enrolled in the study. There were 86 patients in group 1 (benign lesions), 34 in group 2 (premalignant conditions), and 31 in group 3 (malignant neoplasms). Significant differences were found in the mean values of VLS between group 1 and group 3 (P = 0.001), maximum phonation time between group 1 and group 2 (P = 0.001), and between group 2 and group 3 (P = 0.04), men's fundamental frequency between group 1 and group 2 (P = 0.03), and between group 1 and group 3 (P = 0.01), and shimmer between group 1 and group 3 (P = 0.01). The correlation between the methods was analyzed, and there was a strong to moderate correlation between VLS and perception (r = 0.57-0.73) in group 1 and group 2. The jitter and shimmer correlated moderately with perception in group 1: grade of hoarseness (G) (r = 0.52 and r = 0.57, respectively), breathiness (B) (r = 0.58), and asthenia (A) (r = 0.57 and r = 0.53, respectively). In group 3, the strongest correlation was observed between maximum phonation time and phonation quotient and G (r = 0.52; 0.58), B (r = 0.54; 0.55), and strain (S) (r = 0.63; 0.72). The VHI results and life quality outcomes were not significantly different between the groups. The VHI did not correlate with any voice measure method., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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

Wstęp: Cel badania stanowi ocena efektów długoterminowych augmentacji krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia. Materiał i metody: W badaniu wzięło udział 17 pacjentów, którzy z powodu niewydolności szpary głośni (z powodu jednostronnego porażenia krtani oraz niewydolności mięśni wewnętrznych krtani) zostali zakwalifikowani do przeprowadzenia augmentacji krtani (10 kobiet i 17 mężczyzn), w wieku: 57,6±17,7 lat, mediana 61 lat, z zakresem: 32-83 lata. U wszystkich pacjentów wykonano augmentację krtani w znieczuleniu miejscowym, przez jamę ustną, podając bocznie od fałdu głosowego/ fałdów głosowych hydroksyapatyt wapnia (preparat Radiesse). W celu oceny efektów długoterminowych augmentacji krtani - przeprowadzano ocenę jakości głosu pacjenta przed augmentacją, a następnie 3 i 12 miesięcy po augmentacji krtani, przy pomocy oceny videolaryngostroboskopowej krtani, oceny odsłuchowej, analizy akustycznej, oceny aerodynamicznej oraz samooceny głosu dokonanej przez pacjenta przy pomocy kwestionariusza VRQoL. Wyniki: Uzyskano istotną statystycznie poprawę w ocenie odsłuchowej głosu dla parametrów G i A, po 3 miesiącach, dobre wyniki utrzymywały się w czasie 12-miesięcznej obserwacji. W ocenie akustycznej MDVP&#95;Jitt, MDVP&#95;Shim i MDVP&#95;NHR poprawiły się odpowiednio do wartości: 2,5; 5 oraz 0,1 (3 miesiące po augmentacji) i 1,9; 3,6 oraz 0,1 (12 miesiące po augmentacji). MPTa wydłużył się do 12,2 i 11,9 s., odpowiednio po 3 i 12 miesiącach od augmentacji. Natężenie głosu poprawiło się z 67 do 68 oraz 71 dB(A), odpowiednio po 3 i 12 miesiącach. Wyniki: VRQoL poprawiły się do wartości 19,5 i 20, odpowiednio 3 i 12 miesięcy po augmentacji. Dyskusja Augmentacja krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia daje długotrwałe, dobre efekty leczenia.

Objective: To translate and adapt the original Singing Voice Handicap Index (SVHI) for the Polish population and to evaluate the psychometric properties of the Polish SVHI version, such as internal consistency, reliability and construct validity in different groups of dysphonic singers., Study Design: Prospective case-control study., Setting: Patients treated at a single institute., Participants: Sixty singers with voice disorders and 57 healthy singers completed the SVHI and the Voice Handicap Index (VHI). Thirty singers completed the SVHI twice within a 2- to 4-week interval., Main Outcome Measures: Internal consistency, test-retest reliability, discriminant validity, criterion-related validity RESULTS: A strong Cronbach's alpha coefficient (0.96) indicates that the SVHI items are measuring the same construct. Evaluating the test-retest reliability, the r-Spearman correlation coefficient was r = 0.797 for the total score of SVHI, which shows a good level of reproducibility. There were significant differences between the control group (CG) and patients with benign vocal fold lesions (P < 0.001), CG and singers with muscle tension dysphonia (P < 0.001), CG and coexistence of muscle tension dysphonia and chronic laryngitis (P < 0.001). There was a positive statistically significant correlation between SVHI and VHI (r = 0.753, P = 0.000*)., Conclusions: The Polish version of SVHI serves as a valid health status instrument, as well as discriminating between singers with voice disorders and singers without voice problems. The SVHI is easy to perform in clinical practice., (© 2017 John Wiley & Sons Ltd.)

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

The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). Seventy-two consecutive parotid gland tumors were analysed with high-resolution ultrasonography (12 MHz) with color Doppler imagining. The histopathological diagnosis was confirmed after parotidectomy for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for the US were established. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. Area under the curve (AUC) was calculated for each parameter considered. The analysed material included 27 MA, 26 PA, 1 basal cell adenoma, 8 inflammatory conditions, and 10 malignant neoplasms. The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The predictive values were: PPV 66.8% and NPV 93.6%. Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. The predictive values were: PPV 50% and NPV 68.8%, respectively. For distinguishing malignant from benign tumors, the highest AUC values noted were for heterogeneity and vascularization (0.8 and 0.743, respectively). The AUC values were the highest for hypoechogenicity and vascularization in separating PA from MA (0.718 and 0.685, respectively).

Objectives: The purpose of this study was to evaluate vocal tract function and the voice quality in singers with muscle tension dysphonia (MTD) after undergoing combined functional voice therapy of the singing voice., Design: This is a prospective, randomized study., Methods: Forty singers (29 females and 11 males, mean age: 24.6 ± 8.8 years) with MTD were enrolled in the study. The study group consisted of 20 singers who underwent combined functional voice therapy (10-15 individual sessions, 30-40 minutes each). Singers who did not opt for vocal rehabilitation consisted of the control group. Effects of rehabilitation were assessed with videolaryngostroboscopy, palpation of the vocal tract structures, flexible fiberoptic evaluation of the pharynx and the larynx, perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, and the Voice Handicap Index., Results: After combined functional voice therapy in the study group, great improvement was noticed in palpation of the vocal tract structures (P < 0.001), perceptual voice assessment (P < 0.001), phonetograms (P = 0.002), and singing range obtained from acoustic analysis of glissando (P < 0.001). In the control group, no statistically significant differences were found between the first and the second assessments., Conclusions: Combined functional voice therapy proved to be an efficacious treatment method in singers with MTD in singing. Development of palpation and perceptual singing voice examination protocols enables one to compare results before and after rehabilitation in clinics., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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

Objectives/hypothesis: This study investigated vocal function knowledge and vocal tract sensorimotor self-awareness and the impact of functional voice rehabilitation on vocal function knowledge and self-awareness., Study Design: This is a prospective, randomized study., Methods: Twenty singers (study group [SG]) completed a questionnaire before and after functional voice rehabilitation. Twenty additional singers, representing the control group, also completed the questionnaire without functional voice rehabilitation at a 3-month interval. The questionnaire consisted of three parts. The first part evaluated the singers' attitude to the anatomical and physiological knowledge of the vocal tract and their self-esteem of the knowledge level. The second part assessed the theoretical knowledge of the singers' vocal tract physiology. The third part of the questionnaire assessed singers' sensorimotor self-awareness of the vocal tract., Results: The results showed that most singers indicated that knowledge of the vocal tract's anatomy and physiology is useful (59% SG, 67% control group). However, 75% of all participants defined their knowledge of the vocal tract's anatomy and physiology as weak or inadequate. In the SG, vocal function knowledge at the first assessment was 45%. After rehabilitation, the level increased to 67.7%. Vocal tract sensorimotor self-awareness initially was 38.9% in SG but rose to 66.7%., Conclusions: Findings of the study suggest that classical singers lack knowledge about the physiology of the vocal mechanism, especially the breathing patterns. In addition, they have low sensorimotor self-awareness of their vocal tract. The results suggest that singers would benefit from receiving services from phoniatrists and speech-language pathologists during their voice training., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of the study was to translate and adapt the original V-RQOL (Voice-Related Quality of Life) instrument into Polish and to evaluate the psychometric properties of the Polish version of the V-RQOL Measure such as internal consistency, reliability, and construct validity in different groups of dysphonic patients., Methods: A total of 214 patients with voice disorders were assessed using the V-RQOL Measure, the Voice Handicap Index, and the World Health Organization Quality of Life, short version., Results: The Polish version of the V-RQOL Measure showed strong internal consistency with the Cronbach alpha coefficient: 0.92 for the total score, 0.90 for the social-emotional domain, and 0.86 for the physical functioning domain, and a good test-retest reliability (r-Spearman correlation coefficient: r = 0.8852 for the total score of the V-RQOL Measure). Construct validity was demonstrated with a strong correlation to the Voice Handicap Index (r = -0.843, P = 0.000*) and a weak positive, statistically significant correlation between the V-RQOL-physical functioning domain, V-RQOL-social-emotional domain, and the Q1, Q2, and Domain 1-Domain 4 of the World Health Organization Quality of Life, short version (0.2 < r < 0.4)., Conclusions: The Polish version of the V-RQOL Measure is a valid and reliable instrument to evaluate the patient's perception of his or her own voice disorders and the impact it can have on the patient's life. The V-RQOL Measure is easy to perform in clinical practice., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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

Unlabelled: The aim was to identify the frequency of different causes of congenital hearing loss and to investigate the age of treatment intervention., Material: 197 children with hearing loss, hospitalized in the Department of Infant Diseases between 2007-2009., Methods: Three-level audiological examinations, clinical investigations, specific tests for selected congenital infections and GJB2 mutations, neuroimaging., Results: In 14 children with negative screening test hearing loss was confirmed; in 14 with positive was excluded; in 5 newborns screening test was not performed. In 179/197 the confirmation of hearing impairment was obtained up to 6 months (90%). Sensorineural (176/197), bilateral (157/197) hearing loss dominated; conductive and mixed was in 21/197. In 97/176 children with sensorineural hearing loss, congenital CMV infection was confirmed; in 47/176 - GJB2 mutations; in 21 simultaneous CMV infection and GJB2 mutation; in 26 the reason was not identified. The hearing aids were applied in 128, in 76 up to 6 months; the cochlear implants received 36, mainly in the 1st. and 2nd. year of life. The improvement of hearing was obtained in 33., Conclusions: 1. Early identification of infants with hearing loss allows for an earlier introducing of comprehensive treatment and improvement of hearing. 2. The significant proportion of children with hearing loss in the course of congenital cytomegalovirus infection indicates the need to carry out tests to identify infection in newborns with abnormal hearing screening test. 3. Cochlear implants are now in Poland the standard method of treatment in partial and complete deafness in children, also the youngest.

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

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