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1
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Multidrug-resistant strains of coagulase-negative staphylococci isolated from patients with chronic sinusitis – MDR, XDR, PDR strains

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Michalik M., Podbielska-Kubera A., Samet A., Konopka W.
Otolaryngologia Polska
|
2020
|
vol. 74(2)
36-41
EN
Introduction: The development of resistance to multiple antimicrobial agents in pathogenic bacteria has become a threat to public health. Multidrug-resistant strains that are particularly dangerous include MDR, XDR and PDR strains. Material and methods: Aspirate material from paranasal sinuses, obtained from patients with chronic sinusitis undergoing functional endoscopic sinus surgery (FESS) in Medical Center MML in Warsaw, was subjected to bacteriologic analysis. The isolated strains were identified to the species level and tested for antibiotic resistance. Then, minimal inhibitory concentration (MIC) was determined. R esults: The isolated strains of coagulase-negative staphylococci were resistant mainly to macrolides, aminoglycosides and tetracycline. Nine of the isolated strains exhibited multidrug-resistance. Discussion: Bacteria causing chronic sinusitis are becoming increasingly resistant to antimicrobial agents. The diagnostic process for coagulase-negative staphylococci (CNS) is often limited to the identification of species, or even genus of the bacteria. The CNS strains are considered to be non-pathogenic and they are not subject to eradication. This may lead to erroneous therapeutic decisions and, consequently, to the development of antibiotic resistance. CNS infections are classified as nosocomial and therefore, appropriate epidemiological procedures have to be followed. The authors highlight the necessity to determine MIC values for antibiotics and to introduce personalized treatment.
2
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Leczenie głuchot z zastosowaniem implantów na przewodnictwo kostne

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Konopka W., Strużycka M., Śmiechura M.
Polski Przegląd Otorynolaryngologiczny
|
2016
|
vol. 5(1)
11-17
PL
Osoby z  niedosłuchem – lub głuchotą w  przebiegu przewlekłych chorób ucha środkowego, zewnętrznego czy wad wrodzonych – które nie mogą nosić klasycznych aparatów słuchowych, czy też nie poddają się leczeniu chirurgicznemu są kandydatami do wszczepienia implantu na przewodnictwo kostne. Druga kategoria kandydatów to chorzy z głuchotą „jednostronną”. Obecnie pacjenci i lekarze mają do dyspozycji wiele rozwiązań technicznych, które z powodzeniem mogą być zastosowane u  większości leczonych, dając im możliwość satysfakcjonującego słyszenia. Szczególną grupą chorych są dzieci, u których zastosowanie aparatów zakotwiczonych w kości możliwe jest już od 4–5 roku życia. Wprowadzenie implantów zakotwiczonych w kości z akcesoriami bezprzewodowymi pozwala pacjentom dodatkowo na bezprzewodowe korzystanie i łączenie się z innymi urządzeniami. Rozwiązania z magnetycznym wspornikiem umożliwiają schowanie implantu pod skórę, pozbawiają leczonych stygmatyzacji i są wygodne w codziennym użytkowaniu.
3
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Własne doświadczenia w rozpoznawaniu uszkodzeń słuchu za pomocą audiometrii impedancyjnej

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Kowalska S., Konopka W., Słomińska R., Olszewski J.
Otolaryngologia Polska
|
2008
|
vol. 62(6)
764-768
PL
Introduction. The aim of this work was to assess the value of impedance audiometry in the differential diagnostics of hearing disorders, especially in patients suffering from tinnitus. Material and methods. The analysis dealt with results of the audiological tests in 198 patients (116 female and 82 male), hospitalised in 2007 due to their hearing deterioration, tinnitus or sudden deafness. The conducted audiological tests covered threshold and suprathreshold pure tone audiometry, speech audiometry, BERA and impedance audiometry. Results of the studies. Women (58.5%) and people over 50 years old (58.6%) constituted the majority of the patients. In 166 (83.8%) patients the conducted tests via impedance audiometry did not prove any deviations from the normal condition, the lesions referred to both ears in 32 (16.9%) patients and one ear in 17 (8.5%) patients. An incorrect tympanogram was found in 23 people, including type As in 11, type Ad in 2, type B in 4 and type C in 6 subjects. Low values of acoustic receptivity of the middle ear were noted in 20 ears, whereas high values in 11 ears. In 3 ears we found low values of the gradient (below 0.3), high values – in 11 ears. The middle ear pressure between –170 and –350 daPa was noticed in 20 ears, and positive values, above +50 daPa up to +75 daPa, in 3 ears. Disorders in the stapedial refl ex registration were observed in 38 (19.1%) patients. The assessment of the conducted subjective and objective audiological examinations allowed to recognise bilateral perceptive hearing injuries in 139 patients, including 49(25,9%) of cochlear origin with OWG, in further 70 patients the hearing loss referred to higher frequencies and was rather slight. Conclusions. The own experiences indicated that the impedance audiometry constitutes the integral part of contemporary audiological diagnostics and still remains an objective method facilitating quick, non-invasive evaluation of the functions of particular elements in the middle ear.
4
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Early hearing evaluation in patients treated by surgery due to chronic otitis

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Olszewski J., Konopka W., Repetowski M.
Otolaryngologia Polska
|
2008
|
vol. 62(6)
731-734
EN
Intoduction. The aim of the study was the comparison of hearing before and after ear surgery in patients with chronic otitis media according to Fowler and Sabine criteria. Material. The study comprised 42 patients (42 ears), aged 19–72 (26 females and 16 males). The patients were divided into three groups, considering the type of surgery; Group I – 20 ears after myringoplasty, group II – 14 ears after mastoidectomy with canal up and myringoplasty and group III – 8 ears after the mastoidectomy with canal down. Methods. Audiologic examination was performed together with the evaluation of hearing loss according to the criteria of Fowler and Sabine (CPT), before and 3 months after the ear surgery. The difference of 20% (CPT) was considered improvement or deterioration of the hearing. Results. On the basis of the intraoperative examination, chronic otitis media with perforation was found in 18 patients, granulating otitis media in 16 patients and the chronic otitis with cholesteatoma in 8 patients. The myringoplasty was performed in 20 patients, the mastoidectomy with canal up and myringoplasty in 14 patients and the mastoidectomy with canal down in 8 patients. In 14 ears of group I (70%) hearing improvement was noticed, and in 6 (30%) remained unchanged. The mean hearing loss according to CPT in this group was 40,39% before ear surgery and 24,26% after. In group II in 6 ears (43%) hearing improvement was observed, whereas in 8 (57%) remained unchanged. The mean hearing loss according to CPT in this group was 71,40% before and 61,85% after surgical treatment. In group III, hearing improvement was noticed in 37% of ears and in 5 (63%)did not change after the ear operation. The mean hearing loss (CPT) in this group was 81,57% before treatment and 71,37% after. Conclusions. Considering early evaluation of hearing the best results were obtained in patients subjected to myringoplasty and conservative operations of the middle ear with canal up procedure.
5
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Wczesna ocena słuchu u chorych leczonych operacyjnie z powodu przewlekłego zapalenia ucha środkowego

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Olszewski J., Konopka W., Repetowski M.
Otolaryngologia Polska
|
2008
|
vol. 62(6)
731-734
PL
Intoduction. The aim of the study was the comparison of hearing before and after ear surgery in patients with chronic otitis media according to Fowler and Sabine criteria. Material. The study comprised 42 patients (42 ears), aged 19–72 (26 females and 16 males). The patients were divided into three groups, considering the type of surgery; Group I – 20 ears after myringoplasty, group II – 14 ears after mastoidectomy with canal up and myringoplasty and group III – 8 ears after the mastoidectomy with canal down. Methods. Audiologic examination was performed together with the evaluation of hearing loss according to the criteria of Fowler and Sabine (CPT), before and 3 months after the ear surgery. The difference of 20% (CPT) was considered improvement or deterioration of the hearing. Results. On the basis of the intraoperative examination, chronic otitis media with perforation was found in 18 patients, granulating otitis media in 16 patients and the chronic otitis with cholesteatoma in 8 patients. The myringoplasty was performed in 20 patients, the mastoidectomy with canal up and myringoplasty in 14 patients and the mastoidectomy with canal down in 8 patients. In 14 ears of group I (70%) hearing improvement was noticed, and in 6 (30%) remained unchanged. The mean hearing loss according to CPT in this group was 40,39% before ear surgery and 24,26% after. In group II in 6 ears (43%) hearing improvement was observed, whereas in 8 (57%) remained unchanged. The mean hearing loss according to CPT in this group was 71,40% before and 61,85% after surgical treatment. In group III, hearing improvement was noticed in 37% of ears and in 5 (63%)did not change after the ear operation. The mean hearing loss (CPT) in this group was 81,57% before treatment and 71,37% after. Conclusions. Considering early evaluation of hearing the best results were obtained in patients subjected to myringoplasty and conservative operations of the middle ear with canal up procedure.
6
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Wielolekooporne szczepy gronkowców koagulazo-ujemnych wyizolowane od chorych z przewlekłym zapaleniem zatok przynosowych – oporność typu MDR, XDR, PDR

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Michalik M., Podbielska-Kubera A., Samet A., Konopka W.
Otolaryngologia Polska
|
2020
|
vol. 74(2)
36-41
PL
Wstęp: Pojawienie się oporności na wiele środków przeciwdrobnoustrojowych u bakterii chorobotwórczych stało się znaczącym zagrożeniem dla zdrowia publicznego. Szczególnie niebezpieczne są wielooporne szczepy: MDR, XDR, PDR. Materiały i metody: Analizie bakteriologicznej poddano materiał w postaci aspiratów z zatok przynosowych, pobranych w czasie zabiegu operacyjnego FESS od pacjentów Centrum Medycznego MML w Warszawie, leczonych z powodu przewlekłego zapalenia zatok. Przeprowadzono izolację i identyfikację szczepów do gatunku oraz określono ich lekooporność wraz z wartościami minimalnego stężenia hamującego (MIC). Wyniki: Wśród wyizolowanych szczepów gronkowców koagulazo-ujemnych przeważała oporność na makrolidy, aminoglikozydy i tetracyklinę. Dziewięć spośród wyizolowanych szczepów wykazywało oporność wielolekową. Dyskusja: Oporność na środki przeciwdrobnoustrojowe wzrasta w przypadku bakterii powodujących przewlekłe zapalenie zatok. Jeśli chodzi o CNS, zbyt często proces diagnostyczny zamyka się na etapie identyfikacji gatunku, a nawet rodzaju bakterii. Szczepy te są traktowane jako bakterie niechorobotwórcze i nie podlegają eradykacji. Może to prowadzić do błędnych decyzji terapeutycznych, a tym samym do generowania oporności na antybiotyki. Szczepy CNS są zaliczane do zakażeń szpitalnych, dlatego niezbędne jest podjęcie właściwych procedur epidemiologicznych. Autorzy zwracają uwagę na konieczność oznaczania wartości MIC dla antybiotyków oraz wprowadzenia leczenia spersonalizowanego dla pacjentów.
7
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The value of impedance audiometry in the hearing loss diagnosis

100%
Kowalska S., Konopka W., Słomińska R., Olszewski J.
Otolaryngologia Polska
|
2008
|
vol. 62(6)
764-768
EN
Introduction. The aim of this work was to assess the value of impedance audiometry in the differential diagnostics of hearing disorders, especially in patients suffering from tinnitus. Material and methods. The analysis dealt with results of the audiological tests in 198 patients (116 female and 82 male), hospitalised in 2007 due to their hearing deterioration, tinnitus or sudden deafness. The conducted audiological tests covered threshold and suprathreshold pure tone audiometry, speech audiometry, BERA and impedance audiometry. Results of the studies. Women (58.5%) and people over 50 years old (58.6%) constituted the majority of the patients. In 166 (83.8%) patients the conducted tests via impedance audiometry did not prove any deviations from the normal condition, the lesions referred to both ears in 32 (16.9%) patients and one ear in 17 (8.5%) patients. An incorrect tympanogram was found in 23 people, including type As in 11, type Ad in 2, type B in 4 and type C in 6 subjects. Low values of acoustic receptivity of the middle ear were noted in 20 ears, whereas high values in 11 ears. In 3 ears we found low values of the gradient (below 0.3), high values – in 11 ears. The middle ear pressure between –170 and –350 daPa was noticed in 20 ears, and positive values, above +50 daPa up to +75 daPa, in 3 ears. Disorders in the stapedial refl ex registration were observed in 38 (19.1%) patients. The assessment of the conducted subjective and objective audiological examinations allowed to recognise bilateral perceptive hearing injuries in 139 patients, including 49(25,9%) of cochlear origin with OWG, in further 70 patients the hearing loss referred to higher frequencies and was rather slight. Conclusions. The own experiences indicated that the impedance audiometry constitutes the integral part of contemporary audiological diagnostics and still remains an objective method facilitating quick, non-invasive evaluation of the functions of particular elements in the middle ear.
8
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Wady wrodzone ucha wewnętrznego – klasyfikacja, przegląd, problemy kliniczne

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Haber K., Konopka W., Amernik K., Mierzwiński J.
Polski Przegląd Otorynolaryngologiczny
|
2020
|
vol. 9(3)
1-11
PL
Wprowadzenie: U części pacjentów z głębokim niedosłuchem odbiorczym stwierdzane są wady ucha wewnętrznego. Początkowo uważano je za przeciwskazanie do wszczepienia implantu ślimakowego. Jednakże wraz z rozwojem chirurgii i technologii implantów ślimakowych możliwe stało się leczenie również tej grupy pacjentów. Wszczepienie implantu w przypadku wad ucha wewnętrznego może jednak wiązać się z wieloma trudnościami chirurgicznymi i możliwymi komplikacjami. Cel: Celem pracy jest przedstawienie: (1) współczesnej klasyfikacji wad ucha wewnętrznego, (2) problemów chirurgicznych i klinicznych związanych z poszczególnymi wadami, a także (3) przypadków wad ucha wewnętrznego stwierdzonych w ośrodkach autorów. Materiał i metody: Ze 111 dzieci kwalifikowanych do wszczepienia implantu ślimakowego w trzech ośrodkach klinicznych wyłoniono grupę pacjentów, u których stwierdzono wady ucha wewnętrznego. Przeanalizowano: badania obrazowe pacjentów wykonane przed założeniem implantu, badania słuchu, protokoły operacyjne ze wszczepienia implantu ślimakowego, wyniki pomiarów śródoperacyjnych oraz śródoperacyjne badania obrazowe. Omówiono klasyfikację wad ucha wewnętrznego uznawaną obecnie za wiodącą. Wyniki: U 19/111 (17%) dzieci stwierdzono duże wady ucha wewnętrznego w 35 uszach. U 13/19 (68%) pacjentów wada była obustronna i symetryczna, u 6/19 (32%) pacjentów zaobserwowano inne wady w uchu prawym i lewym lub wadę jednostronną. Stwierdzono wszystkie z głównych wad wyróżnionych w klasyfikacji, poza resztkową otocystą. Najczęstsze z nich to: hipoplazja ślimaka, niepełny podział ślimaka i poszerzony wodociąg przedsionka. Dyskusja: Duże wady wrodzone ucha wewnętrznego są istotnym problemem diagnostycznym i klinicznym u dzieci kwalifikowanych do wszczepienia implantu ślimakowego. Mogą one uniemożliwiać bądź znacząco utrudniać wszczepienie implantu ślimakowego i opiekę pooperacyjną. Duże wady stwierdzane są w badaniach obrazowych nawet u od 20 do 30% pacjentów z głębokim niedosłuchem.
9
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Inner ear malformations – overview, current classifications, challenges in management

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Haber K., Konopka W., Amernik K., Mierzwiński J.
Polski Przegląd Otorynolaryngologiczny
|
2020
|
vol. 9(3)
1-11
EN
Introduction: Some patients with profound sensorineural hearing loss have inner ear malformations. Initially, those were believed to be a contradiction to cochlear implantation. However, with the advance of cochlear implant surgery and technology, it has become possible to treat this group of patients. However, cochlear implantation in the case of inner ear malformations can be associated with numerous surgical difficulties and possible complications. Purpose: The paper aims to present: (1) modern classification of inner ear malformations, (2) surgical and clinical challenges related to all types of malformations, and (3) cases of inner ear malformations identified in the authors’ centers. Material and methods: Of 111 children enrolled for cochlear implantation in three clinical centers, a group of patients with malformations of the inner ear was selected. We analyzed: preoperative imaging studies of patients performed prior to cochlear implantation, hearing tests, surgical protocols of cochlear implantation, results of intraoperative measurements and intraoperative imaging studies. We discuss what is currently believed to be the leading classification of inner ear malformations. Results: In 19/111 (17%) children, we diagnosed severe inner ear malformations in 35 ears. In 13/19 (68%) patients the malfor mations were bilateral and symmetrical, while 6/19 (32%) patients had different malformations in the right and left ear or one-sided malformation. All inner ear malformations described in the classification were found, except for rudimentary oto cyst. The most common are: cochlear hypoplasia, incomplete partition, and enlarged vestibular aqueduct. Discussion: Severe inner ear malformations are a major diagnostic and clinical challenge in children qualified for cochlear implantation. They can preclude or considerably complicate cochlear implantation and postoperative care. Inner ear malformations are found in imaging studies even in 20 to 30% of patients with profound hearing loss.
10
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Treatment of deafness using bone anchored hearing device (BAHD)

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Konopka W., Strużycka M., Śmiechura M.
Polski Przegląd Otorynolaryngologiczny
|
2016
|
vol. 5(1)
11-17
EN
People with hearing loss or deafness in the course of chronic middle ear, external or birth defects, which cannot wear conventional hearing aids or not treatable surgery are candidates for the implant to the bone conduction. The second category candidates are patients with „one-sided” deafness. Currently available to patients and physicians are many technical solutions that can be successfully used in the majority of treated giving them the opportunity satisfactory hearing. A special group of patients are children who can be the use of BAHD (Bone Anchored Hearing Device) from 4–5 years of age. The introduction of recently BAHD of wireless accessories also allows patients to wirelessly and connect to other devices. In contrast, solutions to hide the implant under the skin deprives treated stigma and is comfortable in everyday use. The aim of the study is to present the most widely used solutions using Bone Anchored Hearing Device in the rehabilitation of hearing and present their own experiences.
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