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Congenital spontaneous otogenic cerebrospinal fluid leak as a cause of recurrent meningitis in a 9-year-old child – case report and literature review

100%

Amernik K., Jaworowska E.

Polski Przegląd Otorynolaryngologiczny

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2022

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vol. 11

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issue 1

41-44

EN

Introduction: Congenital otogenic CSF leak is a rare cause of meningitis. The underlying reason may be a defect of the fundus of internal auditory meatus with pathological communication with the inner ear and CSF leak to middle ear space. This condition requires surgical closure. Case report: A 9-year-old boy with a history of recurrent meningitis – 3 episodes. During the last episode, β-2 transferrin test from ear fluid was positive. The patient complained of leakage of clear fluid through the nose on the right side. Otoscopy revealed a bulging tympanic membrane on the right side. The right ear was deaf with normal hearing on the left side. HRCT revealed congenital deformity of the right inner ear. Right side lateral petrosectomy with blind sac closure of the right external auditory canal was performed. During surgery there was an extensive CSF leak through the oval window niche due to a lack of the stapes footplate in the anterior part. Recovery was uneventful. After 24 months of follow up, no more leakage through the nose was observed. Control magnetic resonance performed one year after surgery showed no CSF in the mastoid cavity. Discussion: Inner ear malformations are a rare cause of meningitis, and the most common sites of congenital otogenic CSF leakage include the oval and round window. Surgical closure is the only solution in such cases. Several methods of sealing the inner ear space were described in the literature. Vestibular packing and stapedectomy were most frequently used. However, recurrences were stated in up to 1/2 of cases. Such a risk can be limited with lateral petrosectomy. For this reason, LP can be considered as the treatment of choice in congenital spontaneous otogenic cerebrospinal fluid leak. Conclusion: Every case of recurrent meningitis in children should be investigated with a suspicion of congenital ear malformation with spontaneous CSF leakage. Lateral petrosectomy is a safe and effective procedure for cases of otogenic CSF leak with a low risk of recurrence.

2

The use of petrosectomy in cochlear implant surgery

88%

Amernik K., Niemczyk K., Twardowska R., Jaworowska E.

Polski Przegląd Otorynolaryngologiczny

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2020

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vol. 9

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issue 2

1-6

EN

Introduction: The treatment and rehabilitation of hypoacusis with the use of cochlear implants is a safe and reliable method suitable for both children and adults. In people affected by chronic otitis media cholesteatomatosa or such who have previously undergone open repair of the ear, we use a special surgical technique known as lateral/subtotal petrosectomy. Material and methods: The study group consisted of patients with profound bilateral sensorineural hearing loss, in which otitis media with and without cholesteatoma has been diagnosed or after open repair of the middle ear. A retrospective analysis of patient data, as well as radiological and audiological results, was conducted. Results: In the Clinic of Otolaryngology and Laryngological Oncology of the Pomeranian Medical University in the years 2008–2018 we performed 90 cochlear implant surgeries, including a petrosectomy in 1 child with cholesteatoma (5 years) and in 2 adults after open repair (62 and 73 years). In all cases the procedure was done in a single stage. Healing proceeded correctly in all patients undergoing petrosectomy. The observation period ranges from 26 to 32 months, computed tomography examinations revealed no indirect characteristics of recurrent cholesteatoma. The patients remain under constant ENT supervision. The child has risk factors for autism and mental retardation, he displays good auditory responses and speech understanding; he has not developed active speech. As regarding free field pure tone audiometry, in adults hearing in the cochlear implant remains at 35 and 40 dB, and speech understanding at 80%. Discussion: Patients with chronic otitis media can be treated efficiently and safely with a cochlear implant using lateral petrosectomy. Lateral/subtotal petrosectomy is the access of choice when deep sensorimotor hearing loss coexists with chronic inflammation in the middle ear.

3

The use of petrosectomy in cochlear implant surgery

88%

Amernik K., Niemczyk K., Twardowska R., Jaworowska E.

Polski Przegląd Otorynolaryngologiczny

|

2020

|

vol. 9(2)

1-6

EN

Introduction: The treatment and rehabilitation of hypoacusis with the use of cochlear implants is a safe and reliable method suitable for both children and adults. In people affected by chronic otitis media cholesteatomatosa or such who have previously undergone open repair of the ear, we use a special surgical technique known as lateral/subtotal petrosectomy. Material and methods: The study group consisted of patients with profound bilateral sensorineural hearing loss, in which otitis media with and without cholesteatoma has been diagnosed or after open repair of the middle ear. A retrospective analysis of patient data, as well as radiological and audiological results, was conducted. Results: In the Clinic of Otolaryngology and Laryngological Oncology of the Pomeranian Medical University in the years 2008–2018 we performed 90 cochlear implant surgeries, including a petrosectomy in 1 child with cholesteatoma (5 years) and in 2 adults after open repair (62 and 73 years). In all cases the procedure was done in a single stage. Healing proceeded correctly in all patients undergoing petrosectomy. The observation period ranges from 26 to 32 months, computed tomography examinations revealed no indirect characteristics of recurrent cholesteatoma. The patients remain under constant ENT supervision. The child has risk factors for autism and mental retardation, he displays good auditory responses and speech understanding; he has not developed active speech. As regarding free field pure tone audiometry, in adults hearing in the cochlear implant remains at 35 and 40 dB, and speech understanding at 80%. Discussion: Patients with chronic otitis media can be treated efficiently and safely with a cochlear implant using lateral petrosectomy. Lateral/subtotal petrosectomy is the access of choice when deep sensorimotor hearing loss coexists with chronic inflammation in the middle ear.

4

Usznopochodny ropień mózgu – opis przypadku

63%

Szleper A., Brożek-Mądry E., Bartoszewicz R., Niemczyk K.

Polski Przegląd Otorynolaryngologiczny

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2021

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vol. 10(3)

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issue 3

1-5

EN

Otogenic intracranial complications - although less common than before - should always alert otolaryngologists and other specialists, including those in the field of outpatient healthcare. Due to their life-threatening consequences, early detection and appropriate management, including surgical treatment, is crucial for a prompt recovery. Below we present a case of a patient in whom the brain abscess has progressed despite the surgical treatment, and describe what strategy was adopted and what followed its choice.

PL

Usznopochodne powikłania wewnątrzczaszkowe, występujące obecnie rzadziej niż niegdyś, zawsze powinny budzić czujność otolaryngologów, lekarzy innych specjalności, w tym lekarzy poruszających się w zakresie ambulatoryjnej opieki zdrowotnej. Z uwagi na zagrożenia dla zdrowia i życia, wynikające z istoty choroby oraz powikłań, wczesne wykrywanie i odpowiednie postępowanie, w tym operacyjne, jest kluczowe dla szybkiego powrotu pacjenta do zdrowia. Poniżej został przedstawiony przypadek pacjentki, u której pomimo zastosowanego leczenia operacyjnego w przebiegu perlakowego zapalenia ucha środkowego doszło do progresji wewnątrzczaszkowych zmian zapalnych. Została opisana strategia dalszego postępowania, czym kierowano się przy jej wyborze. W leczeniu usznopochodnego powikłania wewnątrzczaszkowego została zastosowana petrosektomia boczna.

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4 Polski Przegląd Otorynolaryngologiczny

1 2022

1 2021

2 2020

3 Amernik K.

3 Jaworowska E.

3 Niemczyk K.

2 Twardowska R.

1 Bartoszewicz R.

1 Brożek-Mądry E.

1 Szleper A.

Congenital spontaneous otogenic cerebrospinal fluid leak as a cause of recurrent meningitis in a 9-year-old child – case report and literature review

The use of petrosectomy in cochlear implant surgery

The use of petrosectomy in cochlear implant surgery

Usznopochodny ropień mózgu – opis przypadku