Jedną z przyczyn konsultacji na ostrym dyżurze laryngologicznym są ciała obce o różnym umiejscowieniu. W gardle środkowym najczęściej znajdowanym ciałem obcym jest ość. W większości przypadków ciało obce, pomimo dolegliwości bólowych, pozostaje niewidoczne. Jego obecność wiąże się ze zranieniem błony śluzowej jamy ustnej i przesunięciem ciała obcego w kierunku dalszych odcinków drogi pokarmowej. Nietypowe umiejscowienie ciała obcego może to doprowadzić to do opóźnienia rozpoznania. W takich sytuacjach trzeba wdrożyć dokładniejszą diagnostykę, czasem nawet zabiegową.
Rhinolith is a mineralized deposit in nasal cavity. We present two cases of patients who have plastic surgery due to cleft palate in childhood, and who were diagnosed with rhino-lith in adulthood. Patients complained of nasal obstruction, lacrimation and recurrent inflammation of the nasolacrimal duct. On the basis of clinical and endoscopic examina-tion and after performing CT scan of the paranasal sinuses both patients were diagnosed with rhinolith of nasal cavity. Changes were removed under general anesthesia. In the follow-up after surgery, patients did not complain of nasal patency disorders and all symp-toms have subsided. It seems that the most likely mechanism of rhinolith formation in the first case was mineralization of retained secretions (rhinolith around the endogenous foreign body). However, in the second case, the mechanism was most likely based on a mineralization around exogenous foreign body (gauze left after previous surgery).
Test przedsionkowych miogennych potencjałów wywołanych z zastosowaniem bodźca akustycznego (AC-VEMP) jest jednym z oceniających funkcjonowanie równowagi. Oczne przedsionkowe miogenne potencjały wywołane (AC-oVEMP) są badaniem przedsionkowych potencjałów wywołanych z mięśni gałkoruchowych, głównie skośnych dolnych (położonych najbardziej powierzchownie), a impulsy są przewodzone przez górną gałąź nerwu przedsionkowego i pochodzą z plamki łagiewki. Mimo że test oVEMP jest dość nowy, stał się niezwykle powszechny i stanowi narzędzie wykorzystywane w diagnostyce otologicznej i neurotologicznej. Chociaż powstaje coraz więcej artykułów na jego temat, wciąż trwają dyskusje nad metodologią i interpretacją wyników. W niniejszej pracy przedstawione zostaną zagadnienia związane z badaniem AC-oVEMP, tj. metodologia wykonania i interpretacja wyników oraz możliwości zastosowania w diagnostyce zawrotów głowy.
Introduction: Certain problems in ear surgery are caused by temporal bone cholestetoma and chronic otitis media complicated by deafness, facial nerve dysfunction, vertigo or meningcephalocele. Lateral petrosectomy offers possibility of radical treatment and prevention of temporal bone destruction and following complications. Aim of study: It is an analysis of indications for lateral petrosectomy and it's results as a treatment of otitis media and temporal bone cholesteatoma. The possibility of synchronous cochlear implantation is noted. Material: Retrospective analysis of 62 patients after lateral petrosectomy, operated in the Department of Otolaryngology at the Medical University of Warsaw in 2001-2009. The group consisted of thirty one men and thirty one women. Results: Thirty two patients suffered from chronic granuloma or chronic choleateatoma otitis media or temporal bone cholesteatoma. Seventeen patients suffered from deafness prior surgery. Cochlear implantation was possible in fi ve patients: two of them after cranium fracture, two with deafness caused by chronic otitis media and one with deafness caused by osteoradionecrosis. Intraoperative CSF leak was observed of eight patients. In one case lateral perosectomy was used as a treatment of CSF leak after removal of cerebellopontine tumor. There was no evidence of CSF leak after surgery. Facial nerve dysfunction was observed in fi fteen cases. Conclusions: Lateral petrosectomy offers possibility of radical treatment in same patients with chronic otorrhea. The total removal of cholesteatoma prevents intracranial and intratemporal complications in case of chronic otitis media. Patients after lateral petrosectomy require systematic ENT and radiological (CT, NMR) examination.
Evaluation of acoustic vestibular evoked myogenic potentials (AC-VEMPs) is one of the tests performed to assess the function of the balance system. Evaluation of acoustic ocular vestibular evoked myogenic potentials (AC-oVEMPs) consists in the measurement of potentials evoked within oculomotor muscles, particularly the inferior oblique muscles (the most superficial muscles) with impulses being transmitted along the superior branch of the vestibular nerve from the utricular macula. Despite the fact that the measurement of oVEMPs was introduced relatively recently, it has found widespread use as a diagnostic tool in otology and neurotology. Despite the growing number of literature reports, the methodology of the test and the methods for the interpretation of its results are still subject to debate. This article is dedicated to various aspects of AC-oVEMP tests, including the methodology of the test, interpretation of its results and potential use in the diagnostics of vertigo.
Autorzy przedstawili przypadek 15-letniej pacjentki z zapaleniem kości skroniowej w przebiegu wysiękowego zapalenia ucha środkowego. Wysiękowe zapalenie ucha środkowego jest rzadką przyczyną rozwoju zapalenia piramidy kości skroniowej. Zapalenie piramidy kości skroniowej sporadycznie występuje u dzieci, w większości w starszej grupie wiekowej. Podejrzenie zapalenia kości skroniowej wymaga wykonania badań radiologicznych: RM, TK. W przypadku rozwiniętych objawów zapalenia kości wyłącznie leczenie farmakologiczne nie jest skuteczne. Niezbędne jest leczenie operacyjne z zastosowaniem różnych dostępów chirurgicznych, zapewniających radykalne usunięcie zmian zapalnych, w tym dojścia przez środkowy dół czaszki.
Patients with foreign bodies in various locations often present to ENT emergency units. In the oropharynx, fishbone is the most common foreign body. In most cases, the foreign body cannot be found despite pain reported by the patient. The pain is due to injury to the oral mucosa and foreign body transition towards the gastrointestinal tract. If the foreign body is localized in an unusual location, diagnosis can be delayed. In such situations, diagnostic workup should be extended, which may include surgery.
Introduction: Certain problems in ear surgery are caused by temporal bone cholestetoma and chronic otitis media complicated by deafness, facial nerve dysfunction, vertigo or meningcephalocele. Lateral petrosectomy offers possibility of radical treatment and prevention of temporal bone destruction and following complications. Aim of study: It is an analysis of indications for lateral petrosectomy and it's results as a treatment of otitis media and temporal bone cholesteatoma. The possibility of synchronous cochlear implantation is noted. Material: Retrospective analysis of 62 patients after lateral petrosectomy, operated in the Department of Otolaryngology at the Medical University of Warsaw in 2001-2009. The group consisted of thirty one men and thirty one women. Results: Thirty two patients suffered from chronic granuloma or chronic choleateatoma otitis media or temporal bone cholesteatoma. Seventeen patients suffered from deafness prior surgery. Cochlear implantation was possible in fi ve patients: two of them after cranium fracture, two with deafness caused by chronic otitis media and one with deafness caused by osteoradionecrosis. Intraoperative CSF leak was observed of eight patients. In one case lateral perosectomy was used as a treatment of CSF leak after removal of cerebellopontine tumor. There was no evidence of CSF leak after surgery. Facial nerve dysfunction was observed in fi fteen cases. Conclusions: Lateral petrosectomy offers possibility of radical treatment in same patients with chronic otorrhea. The total removal of cholesteatoma prevents intracranial and intratemporal complications in case of chronic otitis media. Patients after lateral petrosectomy require systematic ENT and radiological (CT, NMR) examination.
Authors presented a case of a 15-year-old girl diagnosed with otitis media with effusion complicated by petrositis. Otitis media with effusion is not a common cause of petrositis. The condition occurs mostly in adults, rarely in the pediatric population. Patients with suspected petrositis require magnetic resonance and computed tomography imaging. Conservative treatment is not sufficient when symptoms appear. Surgical treatment is essential to complete removal of inflamed tissues. A few surgical approaches are recommended (e.g., middle fossa approach).
Basal cell carcinoma (BCC) is the most frequent malignant neoplasm of the skin. In this report we present a case of a 59-year-old patient, who had noticed for five years gradually growing tumor of the facial skin. MR scans revealed pathological lesion in the left orbit. The patient required partial resection of the nose, orbital exenteration with anterolateral thigh free flap reconstruction. The authors present diagnostic problems and methods of treatment BCC.
Round window’s movability measurements with helping of LDV in evaluation of ossicular chain functioning. Aim of study: Quantitive evaluation of round window movability in normal conditions and after malleus stapes assembly reconstruction were aims of the study. Methods and materials: In the experiment there were taken 10 non-frozen temporal bones harvested within 48 hours.Temporal bones specimens were prepared like in closed technique with antromastoidectomy and large posterior tympanotomy. Hearing system before and after MSA reconstruction were evaluated by measurement of round window movement. Measurements were performed at four frequencies: 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. Results: In the normal ossicular chain the biggest movability were stated at frequency of 1 kHz. After reconstruction at all frequencies measurements were signifi cantly worse. In reconstructed ears the highest movabilities were stated at frequencies 2000 Hz and 4000 Hz. Conclusions: Round window movability could be measured by Laser Doppler Vibrometry in posterior tympanotomy approach. Before reconstruction the biggest movability were evaluated at 1000 Hz and after MSA at 2000 Hz
Autorzy przedstawiają technikę operacji tympanoplastycznych typu zamkniętego stosowaną w leczeniu przewlekłych zapaleń uszu oraz system śródoperacyjnej oceny wyniku czynnościowego z aplikacją OssiMon LAIOM. Opracowana technika operacyjna może być stosowana jednoetapowo lub dwuetapowo umożliwiając wykonywanie śródoperacyjnych pomiarów efektu czynnościowego operacji ucha. Za pomocą aplikacji OssiMon LAIOM mogą być zastosowane jednocześnie pomiary elektrofizjologiczne potencjałów stanu ustalonego (ASSR ‒ auditory steady state response) oraz pomiary drgań kosteczek słuchowych (LDV – laser dopler vibrometry). OssiMon LAIOM wykorzystuje do pomiarów elektrofizjologicznych ASSR platformę Intelligent Hearing System, a do oceny ruchomości kosteczek słuchowych jednopunktowy laser Polytec. Pomiary można wykonywać jednocześnie obiema metodami lub pojedynczo każdą z nich niezależnie od siebie. Aplikacja OssiMon LAIOM pozwala na uzyskanie podczas operacji zapisu odpowiedzi ASSR w formie automatycznie zaznaczonej odpowiedzi na siatce audiogramu z zapisanym poziomem słuchu przed operacją. Próg drgań kosteczek słuchowych jest ustalany na podstawie rejestracji odpowiedzi LDV. OssiMon LAIOM wg wiedzy autorów jest pierwszym rozwiązaniem umożliwiającym obiektywne pomiary efektywności tympanoplastyk za pomocą jednocześnie stosowanych 2 metod ASSR i LDV. System ten może mieć bardzo duże zastosowanie w badaniach funkcji ucha środkowego oraz w praktyce klinicznej.
We present a surgical technique of closed tympanoplasty for chronic otitis, together with an intraoperative functional evaluation system with the OssiMon LAIOM software. The technique can be used in one or two steps for an intraoperative evaluation of the functional effect during ear operation. Using OssiMon LAIOM, we were able to simultaneously measure the auditory steady-state response (ASSR), as well as to perform laser dopler vibrometry (LDV). For electrophysiologic measurements, OssiMon LAIOM uses the Intelligent Hearing System platform, and the Polytec single-point laser to evaluate the ossicular mobility. The measurements can be conducted using both methods at the same time or separately, applying each method independently. The OssiMon LAIOM software records the ASSR response intraoperatively and marks it automatically on the audiogram with the preoperative hearing level. The ossicular vibration level is determined based on the measured LDV response. To the best of our knowledge, OssiMon LAIOM is the first solution allowing to objectively measure the effectiveness of tympanoplasty using two methods simultaneously, i.e. ASSR and LDV. The system could be widely applied in the functional evaluation of the middle ear and in clinical practice.
Rak podstawnokomórkowy (BCC) jest najczęstszym nowotworem złośliwym skóry. W niniejszej pracy przedstawiamy przypadek 59-letniej kobiety z guzem skóry twarzy stopniowo powiększającym się od 5 lat. Badanie MR ujawniło nieprawidłowy naciek w lewym oczodole. Pacjentka została zakwalifikowana do częściowej resekcji nosa zewnętrznego, enukleacji oczodołu, maksylektomii przyśrodkowej wraz z rekonstrukcją ubytku tkanek płatem przedniobocznym uda. Autorzy przedstawiają problemy diagnostyczne oraz metody leczenia BCC.
Round window’s movability measurements with helping of LDV in evaluation of ossicular chain functioning. Aim of study: Quantitive evaluation of round window movability in normal conditions and after malleus stapes assembly reconstruction were aims of the study. Methods and materials: In the experiment there were taken 10 non-frozen temporal bones harvested within 48 hours.Temporal bones specimens were prepared like in closed technique with antromastoidectomy and large posterior tympanotomy. Hearing system before and after MSA reconstruction were evaluated by measurement of round window movement. Measurements were performed at four frequencies: 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. Results: In the normal ossicular chain the biggest movability were stated at frequency of 1 kHz. After reconstruction at all frequencies measurements were signifi cantly worse. In reconstructed ears the highest movabilities were stated at frequencies 2000 Hz and 4000 Hz. Conclusions: Round window movability could be measured by Laser Doppler Vibrometry in posterior tympanotomy approach. Before reconstruction the biggest movability were evaluated at 1000 Hz and after MSA at 2000 Hz