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Nasal obstruction caused by adenoid hypertrophy can lead to malocclusion. The research material consisted of children aged 7-12 years with adenoid hypertrophy qualified for adenoidectomy. On the basis of the conducted tests (laryngological, orthodontic, pediatric), the occurrence of open frontal bite in children with pharyngeal tonsil hypertrophy, in particular in boys, was confirmed in comparison to children without hypertrophy correctly breathing through the nose.

In about 3% of children, viral infections of the airways that develop in early childhood lead to narrowing of the laryngeal lumen in the subglottic region resulting in symptoms such as hoarseness, abarking cough, stridor, and dyspnea. These infections may eventually cause respiratory failure. The disease is often called acute subglottic laryngitis (ASL). Terms such as pseudocroup, croup syndrome, acute obstructive laryngitis and spasmodic croup are used interchangeably when referencing this disease. Although the differential diagnosis should include other rare diseases such as epiglottitis, diphtheria, fibrinous laryngitis and bacterial tracheobronchitis, the diagnosis of ASL should always be made on the basis of clinical criteria.

Bacterial lysates stimulate the general immunity of the body in a non-specific way. They act on non-specific defense mechanisms, leading to an increase in type A antibody in mucous membranes, phagocytic activity and INF-ƴ production. They can also stimulate the production of specific antibodies against the bacterial antigens that make up the preparation. The oral immunomodulatory preparations with the best documented clinical efficacy available on the Polish market are Ismigen, Broncho-Vaxom, Ribomunyl and Luivac. They are all lysates of bacterial strains that most often cause respiratory tract infections. In many clinical trials, oral bacterial lysates have been shown to minimize the risk of recurrent respiratory infections in children and adults and reduce the need for antibiotics.

Allergic rhinitis (AR) is the most common form of allergy, which - as epidemiological research has shown - applies to nearly 25% of the population. AR significantly affects the quality of life of the patient, and the more severe the disease, the greater the risk of developing bronchial asthma. One of the factors affecting the severity of symptoms and the degree of their control is air pollution. In some patients, despite proper treatment, persistence or only partial remission of symptoms (uncontrolled allergic rhinitis) is observed. This can lead to an increase in comorbidities - inflammation of the paranasal sinuses, otitis media and asthma - both in children and in adults. The treatment of allergic rhinitis, in accordance with the standards, consists in: education of the patient, elimination of the allergen from the environment and factors intensifying the course of the disease, selection of proper pharmacotherapy and specific allergen immunotherapy. Many factors influence the selection of the antihistamine used, e.g., the opportunity of safe increase of the dosage.

Objective: A tropism to epithelial cells and lymphocytes, an inhibition of apoptosis in host cells, an ability to occurrence in persistent form resistant to antibiotic treatment are the features of Chlamydia pneumoniae, which can have connection with chronic inflammation of an adenoid tissue and adenoid hypertrophy. This study aimed to (1) detect the C. pneumoniae in an adenoid in children undergoing adenoidectomy, (2) estimate a connection between C. pneumoniae occurrence and the size of adenoid, (3) demonstration in which of adenoid cells C. pneumoniae occurs most often., Material and Methods: The examined group consisted of 200 children aged from 2 to 16 years (mean age 6,4) undergoing adenoidectomy. In all children during qualification for adenoidectomy a fiberoscopic examination of the nasopharynx was performed. A part of removed adenoid tissue was analysed by real-time PCR for C. pneumoniae. Adenoids from children with positive PCR examination and from 10 children with negative PCR examination were examined using immunohistochemistry (IHC)., Results: C. pneumoniae in the adenoid was present in 5,5% children. Positive results were obtained most frequently (24,14%, 7/29) in the eldest group (10-16 years). A statistical analysis demonstrated the correlation between C. pneumoniae occurrence in an adenoid tissue and the size of adenoid. In immunohistochemistry C. pneumoniae was found the most frequently in lymphocytes and in epithelial cells., Conclusions: A presence of C. pneumoniae in lymphocytes and epithelial cells of the adenoid first of all in older children with adenoid hypertrophy confirms the participation of this bacteria in adenoid pathology.

Objectives: The role of pro-inflammatory cytokines in the course of chronic otitis media with effusion (COME) has been documented. However, there are fewer studies on the action of anti-inflammatory cytokines in the middle ear. We sought determine whether there is an association between COME and anti-inflammatory cytokines and whether there are any differences in the cytokine profile in COME children with and without atopy., Methods: Eighty-four children were divided into 3 groups: 32 nonatopic children with COME (group NA), 31 atopic children with COME (group A), and 21 children without COME and without atopy (control group C). Specimens from the middle ear were collected and evaluated by enzyme-linked immunosorbent assay for the cytokines interleukin-1 receptor antagonist (IL-1Ra) and immunoregulatory IL-10., Results: Significantly higher IL-10 concentrations were found in both nonatopic and atopic children with COME compared to controls. No significant differences in IL-1Ra levels were found between atopic and nonatopic children with COME and the control group., Conclusion: We found no differences in the levels of IL-1Ra in atopic and nonatopic children with COME compared to controls. However, we found elevated IL-10 levels in the middle ear effusions from children with COME, with or without atopy. These elevated immunoregulatory cytokine levels suggest a role for new immunomodulatory treatments to prevent disease progression in COME, regardless of atopy.

Chronic otitis media with effusion (OME) is associated with irreversible changes in the middle ear, sometimes leading to hearing loss and abnormal language development in children. While the pathogenesis of OME is not fully understood, inflammatory and allergic factors are thought to be involved. The study aimed to investigate the role of cytokines in the local development of chronic OME, and assess differences in the cytokine profiles between atopic and non-atopic children. 84 atopic and non-atopic children with chronic OME (mean age of 6 years 7 months) were studied. Age-matched children with hypertrophy of the adenoids and Eustachian tube dysfunction served as the control group. The number of past acute otitis media (AOM) episodes, their age, and the type of effusion were recorded for all children. Pro-inflammatory cytokine concentrations (TNF-α, IL-1β, IL-6 and IL-8) were determined and the presence of pathogenic bacteria in the patients' effusions was examined. High concentrations of TNF-α, IL-1β, IL-6 and IL-8 were found in the effusions in all children with chronic OME, with the highest levels observed in the non-atopic group. The atopic group showed persistently high IL-1β levels, while in the non-atopic children, IL-1β and TNF-α levels positively correlated with the patient's age and the number of past AOM episodes. Pathogenic bacteria were more frequently isolated from effusions in non-atopic children. In both atopic and non-atopic children, pro-inflammatory cytokines are found at high concentrations. This argues in favor of instituting anti-inflammatory management for treating OME, regardless of atopy.

Objectives: The emergence of antibiotic-resistant bacteria is a major cause of treatment failure in children with acute otitis media (AOM). This study aimed to analyze the types of bacterial strains in fluid isolated from the middle ear of children with AOM who did not respond to oral antibiotic treatment. We also determined the antibiotic resistance of the most frequently isolated bacterial strain (Streptococcus pneumoniae) found in these children., Methods: This was a prospective study of 157 children with AOM aged from 6 months to 7 years admitted due to unsuccessful oral antibiotic treatment. All children underwent a myringotomy, and samples of the middle ear fluid were collected for bacteriological examination., Results: Positive bacterial cultures were obtained in 104 patients (66.2%), with Streptococcus pneumoniae (39.69%), Haemophilus influenzae (16.03%) Staphylococcus aureus (16.03%), Staphylococcus haemolyticus (6.9%) and Streptococcus pyogenes (5.34%) found most frequently. The majority (65.4%) of S. pneumoniae strains were penicillin-intermediate-resistant or penicillin-resistant, and 67.2% strains of S. pneumoniae were multidrug-resistant., Conclusions: We identified S. pneumoniae as the most frequently isolated pathogen from the middle ear in children with AOM treatment failure and determined that the majority of strains were antibiotic-resistant. We propose that the microbiological identification of bacterial strains and their degree of antibiotic resistance should be performed prior to therapy in order to choose the most appropriate antibiotic therapy for children with AOM treatment failure., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Eleven out of 40 children with adenoiditis were colonized with multiple genotypes of Haemophilus influenzae. Heterogeneous antibiotic susceptibility to ampicillin and cotrimoxazole was observed in 6 children. A multiple-colony methodology may potentially help to find the resistant strains of H. influenzae in patients who do not respond to the antibiotic treatment., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Haemophilus influenzae is one of the major pathogenic bacteria in upper respiratory tract of children. In this study, the presence of various H. influenzae genotypes were followed-up for at least 13 weeks, starting from one week before surgery. Forty-one children with chronic adenoid hypertrophy were prospectively enrolled to the study. The consecutive swabs of adenoid and tonsils, two before adenotonsillectomy and two after the surgery together with homogenates of adenotonsillar tissues and lysates of the CD14(+) cells fraction were acquired from 34 children undergoing adenotonsillectomy. Up to ten isolates from each patient at each collection period were genotyped using a PFGE method and their capsular type and antibiotic susceptibility was determined. Of the 1001 isolates examined, we identified 325 isolates grouped into 16 persistent genotypes, which colonized throats for more than seven weeks and were not eliminated by the surgery. The other 506 isolates grouped into 48 transient genotypes that had been eliminated by the surgery. The resistance to ampicillin were found in 23.8% of the transient strains, and 4.7% of the newly acquired strains following the surgical intervention. In contrast, none of the persistent strains were resistant to ampicillin; however, these strains showed apparently higher level of resistance to co-trimoxazole when compared to transient strains. The transient and persistent strains did not significantly differ in bacterial viability in the biofilms formed in vitro. Some of the strains were identified in two or three different patients and were considered as the strains circulating in the region between 2010 and 2012., (Copyright © 2014 Elsevier GmbH. All rights reserved.)

Objective: The ability to occur in a persistent form and to inhibit apoptosis in host cells are the features of Chlamydia pneumoniae which may be associated with adenoid hypertrophy. This study aimed to (1) demonstrate the presence of C. pneumoniae DNA in the adenoid in children qualified for adenoidectomy, (2) evaluate the correlation between the presence of C. pneumoniae in the adenoid and the child's age, the size of adenoid, the incidence of recurrent respiratory tract infections, (3) demonstrate the co-occurrence of C. pneumoniae and typical bacteria in the adenoid tissue., Methods: A group of 200 children aged from 2 to 16 years (mean age 6.4) undergoing adenoidectomy from February 2010 to May 2011 were enrolled to the study. Adenoid tissue removed during planned adenoidectomy was analyzed for the presence of C. pneumoniae by real-time PCR and for the presence of typical bacteria by bacteriological culture. Statistical analysis was conducted using SPSS PASW Statistics 18 software., Results: C. pneumoniae was detected in the adenoid in 5.5% of the 200 children. Positive results were obtained most frequently (24.1%, 7/29) in the eldest group (10-16 years). In PCR positive children the degree of choanal narrowing by an adenoid tended to be larger than in PCR negative children. The occurrence of C. pneumoniae in the adenoid was not associated with a presence of a specific typical bacterium., Conclusions: The presence of C. pneumoniae in an adenoid was most frequently detected in the children of 10-16 years qualified for adenoidectomy., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: The research determining odors recognizable by children from Poland and Eastern Europe has not been widely described in the literature. The aim of the study was to determine the odors recognizable by Polish children which could be used in a screening olfactory test., Methods: The study was performed in Children's Hospital in Warsaw. Ninety-one children aged from 2.9 years to 10 years (SD=5.6 years) were examined, 85 (93.4%) of which completed a full olfactory test. Children were separated into three age groups. The olfactory test consisted of 21 odors., Results: The analysis of the results of all children's examinations showed statistically significant influence of age on the number of odors identified (p=0.0001; r=0.676). The olfactory test score enabled identification of 6 odors to be included in the screening test: bubble gum, lemon, cola, mint, toffee, fish. Correct identification of at least 4 out of them was accepted as a norm and was achieved by 96.5% of children., Conclusions: Olfactory evaluation is possible for children as young as 3 years old. Child's age influences the number of odors recognized and the specific odors recognition depends also on the home place geographic location and eating habits. Eastern European children most often recognized the following odors: bubble gum, lemon, cola, mint, toffee and fish, as so these odors were considered for olfactory screening test. The 6 odors test has good ability to generalize performance to olfactory status, has normative data and good validity and reliability, is fast, easy and inexpensive to administer., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The development of medicine, in this the new techniques and antibiotic therapy enlarged the survivability of patients in hospital. Applying antibiotics caused breakthrough in treatment stepping out in ill's group infections treated in hospital, however enlarging resistance is natural this effect, resulting from: the selection of resistant strains, the formation of new mechanisms of resistance, and/or the spreading of gene of resistance. Multidrug-resistant strains were included to emergence-pathogens group: MRSA, penicillin-resistant Streptococcus pneumoniae, VRE, Gram-negative producing beta-lactamase of type the ESBL and/or resistant to carbapenems. Emergence-pathogens occurrence leads to: therapeutic failures, the use extorts in therapy of dear medicines or with possibility of workings undesirable. The multidrug-resistant strains spread in hospital environment easily, especially on departments about high waste of medicines with the patients' simultaneously large susceptibility on infection, resulting mainly with state of reduced resistance of organism. The control of hospital infections recognize by present hospitality for the most important criterion of quality of work., Aim: Analysis of the emergence-pathogens isolated during treatment in hospital in 2005-2008, from special regard the ENT Department., Material and Methods: 50586 children treated in this period in hospital in which was executed 39386 bacteriological investigations, in this 6528 (12.9%) children in ENT Department in which was executed 1566 bacteriological investigations (3.98%). The diagnostics were executed according to routine microbiological procedures with qualification of resistance to antibiotics., Results: Emergence-pathogens infection was confirmed at 2369 children's (4.68%) treated in Hospital, in this in ENT Department at 84 children (1.29%). The most frequent emergence-pathogens in ENT Department were Streptococcus pyogenes, Streptococcus pneumoniae penicillin-resistant and average sensitive on penicillin, Staphylococcus aureus methicillin-resistant and Rotavirus., Conclusions: Streptococcus pneumoniae penicillin-resistant and average sensitive to penicillin and Rotavirus infections are the most frequent hospital infections. The systematic microbiological supervision is indispensable in prevention the spreading of infections of the emergence-pathogens in hospital.

Unlabelled: It encounters despite solid progress in development of diagnostic methods diagnostics the diseases of upper respiratory tract and ears in children called out by atypical bacteria's on the ground clinical symptoms and their treatment is difficulty still., Aim: The performance of accessible review of current literature was on the aim of work opinion of the atypical bacteria's part in evocation the infections the upper respiratory tract and ears in children, and performance of characteristic symptoms of clinical diseases these organs the bacteria's also., Conclusions: The quoted in work results of investigations do not it let on the unambiguous opinion the atypical bacteria part in contagions of infections the upper respiratory tract and ears in children. It seems however, that Mycoplasma pneumoniae answers first of all for evocation the acute infections of upper respiratory tract; however Chlamydophila pneumoniae plays the larger part in illnesses chronic as well as co-existent pathogen in illnesses sharp. Atypical bacteria can cause upper respiratory tract infections significantly more often than previously thought. These infections often occur in patients with history of respiratory recurrences.

Atypical bacteria, including Mycoplasma pneumoniae, Chlamydophila pneumonia and Legionella pneumophila play significant role in respiratory tract infections and account for 40% of all cases of community acquired pneumonia (CAP). These organisms also commonly occur as co-pathogens in mixed infections with mortality rates as high as 25%. The biological mechanisms and diagnosis of atypical infections is presented in this study.

Objectives: Estimation of the treatment of the nasal septal hematoma and abscess after injury was performed., Material and Methods: In 1998-2005 in Department of Otolaryngology Children's Hospital in Warsaw 2500 children after nasal injury were examined. Nasal septal hematoma and abscess were diagnosed in 22 (0,9%). They were reviewed retrospectively and some of them were examined 1-8 years after., Results: In 22 children with nasal septal hematoma and abscess no complication were observed during treatment. In 12 children examined 1-8 year after treatment 1 child developed saddle nose deformity (qualified to observation) and 1 child developed nasal septum deformities with nasal obstruction (qualified to septoplasty)., Conclusions: Complex treatment of nasal septal hematoma, drainage of the hematoma with septoplasty and reduction of fracture of the nose, makes good functional and cosmetic effect. Drainage of the nasal septal abscess with antibiotic prevent the early complications but it isn't enough functional and cosmetic effect in the future.

The influence of chemical substances (feromones) on human emotional and physical condition has fascinated psychologists, sexuologists and laryngologists since centurie. Literature conveys inconsistent information on vomeronasal organ (VNO) occurrence in humans. This organ is often called Jacobson's, and 2 symmetrical openings leading into it, located on both sides of septum, are called Ruyasch's ducts. The aim of the study was to analyze vomeronasal organ occurrence in humans in relation to age and sex. The study was conducted in a group of 634 patients, aged 18-80 years. All patients underwent routine ENT examination including rhinoscopy, nasal cavity examination with usage of 2.5x magnification lens (surgical glasses) and surgical microscope with 10x magnification. All persons had nasal cavities examined endoscopically. Every time presence of vomeronasal organ openings, along with localization, size and symmetry of these was noted. Subjects, who presented Jacobson's organ, were asked to fill a questionnaire concerning influence of smells on erotic sensations. Vomeronasal organ was fund in 312 persons, that is 49.21%. In 83.65% of cases vomeronasal organ opening size was smaller than 0.2 mm, what restricted its visibility to usage of magnifying lens, microscope, or endoscope. In 16.34% of cases only vomeronasal organ ducts openings were well visible in routine rhinoscopy without magnification. Vomeronasal organ was found more often in men than women. VNO was significantly more rare in patients with nasal septal deviation. In these cases, vomeronasal organ was usually found unilaterally, in all the cases on the concave side of deviated nasal septum.

Introduction: An increasing antibiotic resistance of pathogens is the main cause of failures during treatment of acute otitis media (AOM). Aim. A qualitative and quantitative bacteriological analysis of material isolated from the middle ear in children with AOM treated with antibiotic without improvement., Material and Methods: This is a prospective study performed in Department of Otolaryngology in Warsaw between 2005 and 2007. An examined group consisted of 72 children aged from 6 months to 17 years, admitted to Department of Otolaryngology because of failure of antibiotic therapy of AOM, severe course of this disease and complications of AOM or persistent AOM. In all children were performed the myryngotomy and/or ventilatory tube insertion and/or mastoidectomy and the material from the middle ear was collected to bacteriological examinations., Results: The positive cultures were obtained in 63.9% patients. Streptococcus pneumoniae (40.4%), Staphylococcus aureus (14%), Haemophilus influenzae (10.5%) and Pseudomonas aeruginosa (10.5%) were the most frequently found bacteria in the culture of middle ear. beta-lactamase producing bacteria were isolated in 12 children (21.1% of isolated bacteria). Staphylococcus aureus (7 children, 12.3% of positive cultures) was the bacteria most frequent producing beta-lactamase. The most of organisms were susceptibility to amoxicillin/clavulanate--56.1% of bacteria from the middle ear. The most of organisms presented resistance to penicillin--63.9% of bacteria from the middle ear., Conclusions: Microbiological identifications and antibiotic resistance determination of pathogens isolated from the middle ear in children with AOM not responding to empirical antibiotic treatment gives possibility of the choice of an effective antibiotic and its proper dosage. The pathogenic bacterial flora isolated from the middle ear in children with AOM shows evidence to accomplishing changes in the most frequent pathogens causing acute otitis media in children.

We describe children with orbital complications of acute sinusitis and analyse symptoms, diagnostic procedure and treatment options. We used X-ray and/or CT of paranasal sinuses to make diagnosis. The most frequent presenting orbital and occular symptoms are preseptal cellulitis and orbital cellulitis. Management of these children included intravenous antibiotic and we made maxillary sinus puncture with drainage. Proper recognition and treatment lead to total recovery.

Objective: The final shape of the nasal septum deformities is a result of irregular development of the nasomaxillary complex or of a nasal injury. Nasal septum deformities reveal in childhood. The aim of this study is to estimate the prevalence of the particular types of the septum deformities in children according to Mladina's classification, analysis of the correlation between types of deformities and age and sex and checking if nasal injury influences the occurrences of nasal septum deformities and determines the particular type of it., Methods: The nasal septum morphology was examined in 288 children aged 3-17. The investigation was performed in kindergartens and schools in Warsaw. The study population was divided into three groups. Anterior rhinoscopy without nasal vasocontrictive drugs was performed. A questionnaire was included. The nasal septum deformities were qualified according to Mladina's classification. Analysis of variance (ANOVA) and Wilcoxon's test were used to performed statistical significance., Results: Deviation of the nasal septum was diagnosed in nearly 34% of the sample population. The nasal septum deformities occurred in 29% of girls and in nearly 37% of boys. The prevalence of septum deformities in group 1 aged 3-7 years was 35.23%, in group 2 aged 8-13 years was 27.97% and in group 3 aged 14-17 years was 40.24%. We observed statistically significant correlation between age of patients and type of nasal septum deformities (F=3.65, p=0.000876). In children with nasal injures, 66.66% had nasal septum deformities while in group without injuries there was about 31.69%. We observed statistically significant correlation between type of nasal septum deformities and nasal injuries (Z=7.67, p<0.0000001)., Conclusions: The percentage of the nasal septum deformities change with age. Deviation of the nasal septum was more prevalent in boys. The risk of occurrence of the nasal septum deformities increases after nasal injury. Type 1 and type 5 according to Mladina's classification dominates in study population. Type 1 decreases with age, while type 5 increases with age.

Introduction: Otitis media with effusion is a common problem in childhood. The tympanostomy tubes is a standard treatment of persistent otitis media with effusion in children which improves hearing level. However some pathological changes of the tympanic membrane and middle ear few years after treatment are observed. The aim of the study was prevalence of middle ear sequelaes in children with persistent otitis media with effusion treated by tympanostomy tubes 4-10 years after treatment., Material and Methods: The group of 61 patients aged between 1-13 with otitis media with effusion treated by tympanostomy tubes in Department of Otolaryngology Childrenís Hospital in Warsaw between 1994-2001 were controlled. 113 ears treated with tympanostomy tubes were examined 4-10 years after treatment. At the examination otomicroscope, pure-tone audiometry and tympanometry were used., Results: Out of the 113 ears after ventilation tubes insertion as a method of otitis media with effusion treatment in 83 (73%) developed one or more middle ear sequelaes. Myringosclerosis in 47 ears (41,59%), segmental atrophy in 19 ears (16,81%), atrophy in 14 ears (12,38%), disfunction of Eustachian tube in 8 ears (7,07%), otitis media with effusion in 7 ears (6,19%), perforation of tympanic membrane in 6 ears (5,3%), chronic otitis media in 2 ears (1,76%), retraction pocket in 2 ears (1,76%) and tympanostomy tube in the middle ear cavity in 1 ear (0,88%) were found. No cases of cholesteatoma were found. In 22 ears (19,46%) the conductive hearing loss was greater than 20 dB. In 4 ears (3,5%) mixed hearing loss and in 3 ears (2,6%) receptable hearing loss was diagnosed. Tympanogram type A was in 86 ears (76,1%), tympanogram type B was in 11 ears (9,7%) and tympanogram type C was in 12 ears (12,6%)., Conclusions: In children with otitis media with effusion treated with tympanostomy tubes the amount of sequelaes increased with time. In children with otitis media with effusion who started treatment with tympanostomy tubes in age to 4 years old the amount of sequelaes is less. The follow-up is recommended up to 8 years after the treatment.

Aim of the Study: Evaluation of effectiveness of immunostimulating treatment with Broncho-Vaxom and his influence on concentration of proinflammatory cytokines in children with recurrent upper respiratory tract infection., Material and Methods: The study comprised 32 children (the average age 8 years and 4 months) with recurrent upper respiratory tract infection received immunostimulating treatment with Broncho-Vaxom. 20 children (the average age 7 years and 8 months) with recurrent upper respiratory tract infection which did not receive treatment with Broncho-Vaxom consisted the control group. In all children clinical state and concentration of cytokines TNF-alpha and, IL-1beta, IL-6, IL-8 in serum was examined. Period of observation in both groups carried out 24 months. Follow-up was executed after 6 months., Results: In children treated with Broncho-Vaxom statistically significant (p<0.01) decrease in frequency of occurrence as well as shortening of duration of upper respiratory tract infection were observed. In children treated with Broncho-Vaxom statistically significant (p<0.01) decrease of serum concentration of TNF-alpha and in time of observation. The statistically significant changes were not observed in serum concentrations IL-1beta in time of observation. It was statistically significant (p<0.01) affirmed the rise of serum concentration of IL-6 in time of observation, the largest growth of concentration this cytokine stepped out in 1 year of treatment. The statistically significant (p<0.01) increase of concentration cytokine IL-8 in the first year of treatment as well as statistically significant (p<0.05) decrease of concentration this cytokine after end of treatment., Conclusion: The treatment with Broncho-Vaxom shows the high effectiveness in prevention of recurrent upper respiratory tract infection in children as well as the influences of profitable changes in profile of serum cytokines which can impact on limitation the inflammation process in the upper respiratory tract.

Unlabelled: The aim of this study was to inquire whether it has got an influence on the number and activity of peripheral blood T and NK cells., Material and Methods: The examined group consisted of 51 children with adenoid hypertrophy. The first group consisted of 17 children with only one episode of otitis media with effusion (ome). The second group consisted of 14 children with more than 4 episodes of ome and the third group consisted of 20 children with adenoid hypertrophy without ome. Evaluation of percentage of CD4+, CD8+ and NK subsets with co-expression of CD69, HLA-DR molecules in peripheral blood was performed by flow cytometry method. In examined groups with ome the decrease of CD4 number was compensated by increase of the number of NK and CD19 cells. In these groups the increase of CD69 and HLA-DR expression on the examined subsets was observed. The results suggest that in recurrent otitis media with effusion may be one of the factors causing T lymphocytes deficiency. Obtained results might be one of the criteria of using adenoidectomy.

Unlabelled: Acute otitis media is very general disease and concerns every child practically. The shortening the time of treatment as well as quick decrease of symptoms, and mainly the pain have large meaning in treatment of this disease. Combined treatment of fenspiride and typical treatment of otitis media permits as our investigations show on quicker and observed at children's larger number decrease of symptoms in children with acute otitis media. The aim of the study was to observe effectiveness of combined treatment with antibiotic and fenspiride in children with acute otitis media., Material and Methods: The study comprised 40 children (mean age 8.2 years). The diagnosis of acute otitis media based on medical history data, otolaryngological examination and audiometry (tone and impedance). Children with GERD, hypersensitivity to amoxicillin and fenspiride as well as hypertrophy of adenoid were excluded from the study. Children were divided in two equal groups randomly. All children received amoxicillin in dose 80 mg/kg/day in three partite doses (Amotaks, Polfa Tarchomin Poland) as well as oxymethazolin 0.05% nasal drops 3 x day 1-2 drops (0.05% Nasivin, Merck Germany). In children from second group fenspiride was applied in dose 2 ml/kg/day in three divided doses (Eurespal, Servier Francja) additionally. Treatment was provided by 10 days. During the treatment parents made record of recession in 10 point scale, estimating following parameters: the pain of ear, bother, raised the temperature of body, loss of appetite, vomiting, diarrhea, otorrhea and crying. After end of treatment control otolaryngological and audiological examinations were performed., Results: In studied children symptoms were similar, and the pain of ear was in both groups main suffering. Vomiting and diarrhea the most seldom were observed. In children with acute otitis media treated additionally with fenspiride statistically significant (p<0.01) quicker recession of clinical symptoms was observed. Statistically significant (p<0.01) reduction was observed of such symptoms as the pain of ear, bother, raised of body temperature as well as crying in children treated additionally with fenspiride in comparison to children treated only with antibiotic. Earlier return of hearing and state of middle ear was observed in children from group II than in children from group I (p<0.01). We observed also statistically significant (p<0.01) improvement of hearing estimated in tonal audiometry and impedance in this group. The undesirable symptoms during the treatment were not mentioned., Conclusion: Our study show that combined treatment with fenspiride and antibiotic in the treatment of acute otitis media in children causes quicker reduction of symptoms as well as improvement in audiological parameters (tone and impedance).

The aim of the study was to identify microorganisms and antimicrobial susceptibilities of pathogens from middle ear in children with recurrent acute otitis media and acute otitis media. The study comprised 83 children--42 with recurrent acute otitis media and 41 with acute otitis emdia classified for paracentesis. Agar, chocolate, blood and Chapman plates were inoculated for isolation of bacteria. The plates were incubated at 37 degrees C and examined at 24 hours. The susceptibility of bacteria was determined by disk diffusion technique containing concentration gradients for following antibiotics: penicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefaclor, cefprozil, cefuroxime, erythromycin, azithromycin, clinadamycin and trimethoprim/sulfamethoxazole. 217 organisms from middle ear in children with recurrent acute otitis media and 131 organisms from middle ear in children with acute otitis media were isolated. Most frequent cultured bacteria were: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis--71.4% in recurrent acute otitis media and 47.3% in acute otitis media. We observed statistically significant (p < 0.05) increased of Moraxella catarrhalis in specimens from the middle ear in children with recurrent acute otitis media older than 2 years. The best susceptibility was observed to amoxicillin/clavulanate (79.7% of bacteria in children with recurrent acute otitis media and 83.2% of bacteria in children with acute otitis media). The most of organisms presented resistance to trimethoprim/sulfamethoxazole--65.9% of bacteria in children with recurrent acute otitis media and 62.6% of bacteria in children with acute otitis media. Our investigation showed that resistance to bacteria increase in children with recurrent acute otitis media, most frequent appear in children older than 2 years and depend on number of episodes of acute otitis media and day care.

The aim of this study is to assess the impact of some selected bacteriological factors on the occurrence of subglottic laryngitis in children. The research covered 72 children hospitalized in the Children's Hospital in Warsaw with the following symptoms: dry barking cough, stridor, inspiratory dyspnoea with the participation of auxiliary respiratory muscles, agitation and change of colour of skin. Subglottic laryngitis is one of the acute children's diseases, directly caused by a violently growing odema of the subglottic area. The disease constitutes 5-8% of all severe airways inflammations and states that subglottic laryngitis is responsible for 6.5% off all lower airways inflammation cases. Based on preliminary examinations, the patients were divided into two groups--one of them composed of 41 patients with simultaneous atopy, the other--of 31 patients with no atopy symptoms. The examination of each patient included subjective, objective (pediatric and laryngological) and auxiliary (primary-blood cell count, OB and specialized-bacteriological tests) examinations. Own research showed that out of 72 patients with subglottic laryngitis 56.95% had bacterial symptoms. 90.32% in non atopic group have higher NBT test, in atopic children it was 39.02%. We observed that 50.51% of the patients suffering from subglottic laryngitis had an inflammation of upper airways (otitis media, rhinitis, pharyngitis) and 13.89% of lower respiratory tract (bronchitis, pneumonitis). Many authors incline to say that bacteria may be a conductive factor for subglottic laryngitis to develop. However, many factors seem to suggest that the occurrence and symptoms of subglottic laryngitis are primarily caused by the reaction to an infection. The impact of bacteria onto the etiopathogenesis of subglottic laryngitis has been discussed for many years. Some experts are of the opinion that the disease develops on the bacteriologic background.

We report on 34 children with acute lymphadenitis of the neck at the age between 10 months to 12 years who were admitted in our Department of Otolaryngology Children Hospital in Warsaw between 2001-2003. In a retrospective study we evaluated clinical features and diagnostic impact of ultrasonography, white blood cell count, C-reactive protein as well as bacterial etiology of children treated surgically for bacterial cervical lymphadenitis. Leukocytosis and elevated concentrations of C-reactive protein occurred in the majority of patients in 32 children (94.12%). 24 children (70.59%) we treated conservatively. Clinical appearance and the result of ultrasound examination were relevant for diagnosis of suppurative inflammation. Treatment included antibiotic therapy in all cases and incision and drainage in 10 cases (29.4%). A positive culture grew in 20% of children treated surgically and of these isolates we found Streptococcus pyogenes and Streptococcus species. In these cases surgical drainage is a key to appropriate resolution. USG diagnoses were retrospectively correlated with clinical and surgical findings or with the outcome of treatment in 87.5% of children.

Hypertophy of pharyngeal tonsil and palatine tonsils is the most common cause of nasal obstruction in children. When the obstruction of the nasopharynx causes recurrent infections of upper respiratory tract, chronic otitis media secretoria or sleep apnoea, then adenoidectomy with or without tonsillectomy is indicated. The purpose of the study was analysis of postoperative hemorrhage after adenoidectomy with or without tonsillectomy. The influent of frequent infections of upper respiratory tract, disorders of blood clotting, chronic diseases, seasons of the year, operation time and general anesthesia on postoperative hemorrhage was estimated. A group of 1184 children after adenoidectomy with or without tonsillectomy was studied. Postoperative hemorrhage occurred in 59 children (4.98%). Early bleeding was frequently occurred after adenotonsillectomy and late bleeding after adenoidectomy. There was relationship between the time of general anesthesia and incidences of postoperative bleeding. Food or inhalation allergy, recurrent infections of upper respiratory tract and male sex are risk factors of postoperative hemorrhage after adenoidectomy with or without tonsillectomy.

Otitis media with effusion and eustachitis occur very often in childhood. In dependence on advanced of otitis media with effusion and eustachitis, we use surgical and nonsurgical treatment. In short-term otitis media with effusion and eustachitis performs tympanotomy, insufflation of the Eustachian tube by Politzer and Valsava's methods and vibro-pressure massage AMSA. The aim of this study is estimation of efficacy vibro-pressure massage AMSA in otitis media with effusion and eustachitis in children. The study population consisted of 34 children and youth aged between 3-17 years with otitis media with effusion or eustachitis. In all people we performed 10 procedures of vibro-pressure massage AMSA administered 4 mg dexamethasone in vibro-aerosol. Efficiency of treatment was estimated by comparison otolaryngology examination, pure tone audiometry and tympanometry. In 76.7% ears with eustachitis we observed correct results of examinations of hearing acuity after treatment. It was more two times better then in children with otitis media with effusion. Vibro-pressure massage AMSA 10 times with 4 mg dexamethasone in vibro-aerosol is good method in treatment of eustachitis. In otitis media with effusion isn't efficacious enough. In this case we recommended tympanostomy tube.

Nasal provocative test (NPT) can be defined as a method for recreating upper respiratory tract response to natural allergens or irritants. It can be used in solving nasal patophisiology problems: establishing whether and how the patient's nose is sensitive to antigens or irritants; quantitative evaluation of sensitivity; establishing factors influencing sensitivity. This method is employed to confirm clinical diagnosis in cases where difficulties arise in interpretation of diagnostic tests. The study based on nasal provocative tests establish an allergy to pollen in cases of pollinosis, and select appropriate components for the desensitising vaccine. Sample group included 53 patients, 29 were females and 24 were males, aged 15-42 years, selected from 1,021 patients diagnosed between 1999-2002 in the Allergology Department of the ENT Department of the MMI. The sample patients were diagnosed based on additional tests with allergic inflammation of the nasal mucosa caused by allergy to pollen of such plants as birch, grass, rye, mugwort and plantain. Research methods included: subjective physical examination, prick tests, total and specific IgE levels in serum, nasal provocative tests and rhinomanometric examination. Allergen solution was administered onto the mucosa with a calibrated atomiser. NPT solutions containing pollen of birch, grass, rye, mugwort and plantain were used. Provocative test was considered positive if, following allergen provocation, rhinomanometric examination revealed an increase in respiratory resistance by at least 40 % in comparison with the control test. On the basis of the study, 2 conclusions were drawn: 1) Nasal provocative test is an essential element in diagnostics of allergic nasal obstruction. 2) Rhinomanometry, as an objective method of examining nasal patency, is crucial for evaluating the nasal provocative test.

We report a case of nasal septal abscess and palatine process of the maxilla abscess secondary to acute rhinosinusitis in an 12-year-old boy. Rare complication of acute sinusitis is the nasal septum abscess; even rarer is the abscess of the palatine process of the maxilla, which our patient presented. Nasal septum abscess is an reservoir of suppurative secretion between cartilage or bone of the septum and their periostium or perichondrium. Nasal septum abscess is most often bilateral, causing nasal cavities obstruction. Other symptoms are: nasal pain, fever, headache, nasal tenderness, bad general feeling. Spontaneous abscesses of nasal septum are rare and occur due to acute ethmoid or sphenoid sinusitis and inflammations originating from teeth. Patophysiology of nasal septum abscess depends on its etiology. The isolated acute sphenoid sinusitis may lead to occurrence of nasal septum abscess by spreading of inflammatory changes under periostium along the anterior surface of sphenoid bone and damaging the periostium of vomer and perpendicular lamina of ethmoid bone into subperichondrial space of quadrangular cartilage. Inflammation of inferior wall of sphenoid sinus located over fornix of nasopharynx might have lead to appearance of the palatine process of the maxilla abscess. We consider this mechanism of abscess creation occurred in our patient. Another possible mechanism comprehends spreading of inflammatory process through bone fissures, congenital bone malformations of due to thrombophlebitis. Recommended procedure in cases of confirmed nasal septum abscess is surgical decompression from semitransverse incision of the column and abscess drainage. Aspiration and bacteriological culture allow for exact establishment of proper antibiotic treatment. Antibiotic therapy should be conducted for 2-3 weeks according to bacterial sensitivity to chemotherapeutics. In reexamination of our boy's nasal septum cavity of abscess was assessed and a small cartilage defect was noted. Necrotic changes in nasal septum cartilages arise due to ischemia and compression by residual pathological contents between perichondrium and cartilage. Proper recognition and surgical and preservative treatment lead to total recovery. In our boy, control examinations after 2 and 6 months confirmed recovery without recurrence and later complications.

Nasopharyngeal flora can be a reservoir of bacteria caused acute otitis media in children. The aim of the study was to identify microorganisms and antimicrobial susceptibilities of pathogens from the nasopharynx and middle ear of children with acute otitis media. The study comprised 128 children ages 1 year to 14 years with diagnosed of acute otitis media with purulent discharge. The nasopharyngeal and middle ear samples were collected at the same time. Agar, chocolate, blood and Chapman plates were inoculated for isolation of bacteria. The plates were incubated at 37 degrees C and examined at 24 hours. The susceptibility of bacteria was determined by disk diffusion technique containing concentration gradients for following antibiotics: penicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefaclor, cefprozil, cefuroxime, erythromycin, azithromycin, clindamycin and trimethoprim/sulfamethoxazole. 196 organisms from nasopharynx and 325 organisms from middle ear were isolated. Most frequent cultured bacteria were: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis--75.6% in nasopharynx and 77.8% in middle ear. We observed statistically significant (p < 0.01) increased of Moraxella catarrhalis in specimens from the middle ear than from nasopharynx. Most of the organisms were susceptible to amoxicillin/clavulanate--83.2% of bacteria from nasopharynx and 81.8% of bacteria from middle ear. Most organisms were resistant to trimethoprim/sulfamethoxazole--60.7% of bacteria from nasopharynx and 62.6% of bacteria from middle ear. Penicillin resistance was observed in 25.0% of bacteria from nasopharynx and 25.6% of bacteria from middle ear. The correlation in resistance of bacteria between trimethoprim/sulfamethoxazole and erythromycin (r = 0.4886) and between trimethoprim/sulfamethoxazole and penicillin (r = 0.5027) was observed. Nasopharyngeal and middle ear flora in children with acute otitis media is similar. In that case susceptibility of bacteria from the nasopharynx can be useful for empirical treatment of acute otitis media in children.

The palatine tonsils are cluster of lymphatic tissue located at the border of the respiratory system and the digestive system. Hypertrophy of palatine tonsils is the consequence of the stimulation of the children's immunological system by antigens of the breathing air and food intake. The aim of this study is the estimation of the size of the palatine tonsils depends on the age and the estimation of the correlation between size of the palatine tonsils and the frequency of otitis media and sinusitis in children, youth and young adults. 326 children divided into three groups: group I aged 3-6, group II aged 7-14, group III aged 15-22. We examined the oral cavity, the throat, the nose and the ears. The size of palatine tonsils was qualified according to Pirquet's classification. The questionnaire was included. The fifth degree of the size of the palatine tonsils observed more often in youngest group then in the other. Otitis media occurs in 80% children with fifth degree of the size of the palatine tonsils and in 50% children with I, II, III degree. The sinusitis was the most frequent in group of children with I and II degree of the palatine tonsils. In group of children with fifth degree sinusitis didn't occur. The size of the palatine tonsils can influence occurring and frequency of otitis media but it doesn't influence occurring and frequency of sinusitis.

In paper a case of pyogenic granuloma of the tongue in an 8-week-old child was presented. The signs and symptoms, etiological agents, surgical treatment, and complications are discussed. This case is the youngest case with an unusual location. The lesion was presented as sessile, soft, single and pink erythematous nodule with tendency to spontaneous hemorrhage, 3 cm in diameter. We performed conservative excision because of anaemia and not good condition of the child. We didn't observe recurrence of this lesion in follow-up after 2 weeks, 6 months and 3 years. We report this case to alert the otorhinolaryngologist of this rare condition. There have been very few reports in the literature of this condition.

Subglottic laryngitis is one of the acute children's diseases, directly caused by a violently growing edema of the subglottic area. Its symptoms generally appear very suddenly, when children seem to be in perfect health, at night, several hours after falling asleep. Their symptoms included barking cough, clear voice, stridor, inspiratory dyspnoea with participation of auxiliary respiratory muscles, excitation and anxiety of a child, changes in skin coloration. The movement of the wings of the nostrils is intensified. In especially severe cases, agitation, cyanosis, pallor of skin, obnubilation, apnea, loss of consciousness and circulatory failure may also occur. Subglottic laryngitis is a disease, which can threaten the life of a small child. The aim of this study was to observe efficacy of the treatment of the subglottic laryngitis with glucocorticoids, especially budesonide in nebulization. The research covered 169 children: 58 girls (34.31%) and 111 boys (65.69%) aged 9. months do 5. years (mean 3 years 6 months) hospitalized in the Children's Hospital in Warsaw with the following symptoms: dry barking cough, stridor, inspiratory dyspnoea with the participation of auxiliary respiratory muscles, agitation and change of colour of skin. The examination of each patient included subjective, objective (pediatric and laryngological). Disease severity was assessed by a clinical croup score based on stridor, cough retractions, dyspnoea and cyanosis and the overall clinical assessment was scored on a visual scale. The results indicate that nebulised budesonide can be used as a safe and effective alternative treatment in children with moderate to severe subglottic laryngitis.

Pott's puffy tumor is an infrequent entity characterized by subperiosteal abscess associated with frontal bone osteomyelitis. It is usually seen as a complication of frontal sinusitis. Although cases, in patients of all ages have been reported, teenagers are the most frequently affected. Despite modern methods of diagnosis and treatment, 9 new cases in children, have been published in the last 7 years. This paper describes the case of 13-year-old boy with subperiosteal abscess resulting from exacerbation of chronic frontal sinusitis. Complete resolution occurred with an intensive antibiotic regime and drainage of frontal sinus and subperiosteal abscess.

Neck tumor is always an alarming symptom. Neck tumors are be divided into primary tumors and metastatic tumors. The latter may in turn be divided into tumors which come from a known primary focus and those coming from an unknown primary source. The most commonly found neck tumor takes the form of an enlarged lymph node which may be a primary or a secondary symptom of a disease developing in this area. The diagnostic methods consisted of a otolaryngological examination, laboratory examination, histopathological examination and image examination. In primary neck tumors the treatment proceedings depend on the kind of tumor. The most difficult case, however, is a neck metastasis from an unknown primary focus. In such cases, the most appropriate method of treatment appears to be a radical neck dissection. Combined radiation should be performed in those cases, in which sample tests show cancer infiltration of the node capsule or the presence of cancer plugs in the blood or lymph vessels.

The adenoids and tonsils are thought to be essential parts of the system protecting organism against pathogens invading the upper respiratory tracts. Human adenoids and tonsils are known to be immunologically reactive lymphoid organs, which manifest specific antibodies and B and T cells activity in response to variety of antigens carrying out the functions of humoral and cellular immunity. The purpose of the study was to observe the changes in systemic immunity in children with hypertrophy of adenoids and tonsils treated in Department of Laryngology, Children's Hospital in Warsaw in period 1994-1999. The study comprised 80 patients (33 girls and 47 boys, aged from 3 to 14 years, mean age 6.8 years) with diagnosed hypertrophy of adenoids and tonsils. The diagnosis of hypertrophy of adenoids and tonsils was based on characteristic history and laryngological examination. All patients were scheduled for adenotonsillotomy. The control group comprised 40 people (14 girls and 26 boys, aged from 3 to 15 years, mean age 7.6 years) without history of the recurrent upper tract infections. In all patients we carried out following examinations: serum levels of immunoglobulins A, G, M (humoral immunity); percentage of T lymphocytes (CD3); percentage of T helper (CD4) and T cytotoxic (CD8) lymphocytes (cellular immunity) and delayed cutaneous hypersensitivity-Multitest CMI (cell mediated immunity). Our study demonstrate that in children with hypertrophy of adenoids and tonsils exist changes in the immunological parameters. The observed changes appear not only locally but also generally. In the early period after adenotonsillotomy there was statistically significant decrease of the values of humoral and cellular immunity parameters. However, 6 months after operation we observed normalization of examined immunological parameters. We think that the examinations of parameters of immunological system (humoral and cellular) are necessary before planned adenotonsillotomy.