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1
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Przewlekłe zapalenie ucha środkowego maskujące rozwój nowotworu – opis przypadku

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Wierzbicka M., Gawęcki W., Leszczyńska M., Kopeć T.
Polish Journal of Otolaryngology
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2008
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vol. 62
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issue 6
797-799
EN
The authors would like to present a rare case of the middle ear cancer which has been developed in postoperative cave in 67 years old patient operated for cholesteatoma 50 years earlier. The patient was admitted to the ENT Department of Poznań University of Medical Sciences because of the ear suppuration and headache occurring for 3 months. CT and MR images suggested granulation tissue filling the postoperative spaces with bone destruction, infiltration of the dura and temporal lobe abscess formation. Intraoperative findings allowed excluding the preliminary diagnosis of intracranial complication in the course of chronic otitis media, revealing the tissue masses resembling neoplastic infiltration. The histopathology examination confirmed the final diagnosis of squamous cell cancer. The patient was directed to radiotherapy. The authors report a case of middle ear squamous cell carcinoma and discuss its diagnostic aspect.
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Efficacy of surgical treatment in patients with post-traumatic facial nerve palsy

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Marszał J., Bartochowska A., Gawęcki W., Wierzbicka M.
Polish Journal of Otolaryngology
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2021
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vol. 75
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issue 4
1-6
EN
Introduction: The most common mechanism of post-traumatic facial nerve palsy are road accidents and falls. Treatment schemes as well as proper timing of surgery are still controversial. Aim: The aim of the study was the evaluation of the effects of surgical treatment in patients with post-traumatic facial nerve palsy. Treatment results were correlated with epidemiological factors, mechanism of injury, level of nerve damage, time of surgery and its extent. Material and methods: 9 patients with facial nerve palsy after head trauma were analyzed. In all patients complete paresis of the VII nerve occurred immediately after the injury. In 5 patients the nerve was damaged in the course of the longitudinal fracture of the temporal bone, in 3 as a result of its transverse fracture while in one woman there was no evident fracture line. In all cases, surgical treatment was performed between 4 days and 13 weeks after the trauma. In all cases transmastoid approach was used. Edema lesions of the nerve dominated in 6 patients, in two cases a bone fragment was noted along its course, in one person nerve was disrupted but primary reconstruction was not possible – the man was excluded from further analysis. The results of treatment were assessed by House-Brackmann (HB) scale 12 months after the procedure. Results: Very good (HBI) or good (HBII) recovery of facial nerve function was achieved in 2 and 4 out of 8 patients respectively. Surgical timing, the extent of surgery, patient’s age, mechanism of injury and level of nerve damage had no effect on the final outcome. Conclusions: The management of post-traumatic facial nerve palsy should be individual. The commonly accepted recommendation on surgical treatment is to undertake it in patients with immediate-onset and complete paralysis. Patients who, due to their severe general condition, cannot undergo early facial nerve decompression may benefit from delayed treatment for up to 3 months after the injury.
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Analiza efektów leczenia chirurgicznego pourazowego porażenia nerwu twarzowego

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Marszał J., Bartochowska A., Gawęcki W., Wierzbicka M.
Polish Journal of Otolaryngology
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2021
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vol. 75
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issue 4
1-6
PL
Wstęp: Do pourazowych uszkodzeń nerwu VII najczęściej dochodzi podczas wypadków komunikacyjnych oraz upadków z wysokości. Wybór sposobu leczenia oraz czasu interwencji chirurgicznej wciąż budzi wśród klinicystów wiele kontrowersji. Cel: Celem pracy była analiza efektów leczenia chirurgicznego pacjentów z pourazowym uszkodzeniem nerwu twarzowego i ich zależności od: czynników epidemiologicznych, mechanizmu urazu, miejsca uszkodzenia nerwu, a także czasu podjęcia leczenia oraz rozległości zabiegu. Materiał i metody: Analizą objęto 9 pacjentów z porażeniem nerwu twarzowego po urazie czaszkowo-mózgowym. U wszystkich chorych pełne porażenie wystąpiło bezpośrednio po urazie. U 5 pacjentów do uszkodzenia nerwu doszło w przebiegu podłużnego złamania kości skroniowej, u 3 chorych na skutek jej złamania poprzecznego, u 1 chorej nie stwierdzono ewidentnej szczeliny złamania. We wszystkich przypadkach zastosowano leczenie operacyjne. Czas od urazu do podjęcia chirurgicznej interwencji wahał się od 4 dni do 13 tygodni. Wszystkich pacjentów operowano z dojścia przez wyrostek sutkowaty. U 6 chorych dominowały zmiany obrzękowe nerwu, w związku z czym wykonano jego dekompresję, u 2 pacjentów uwidoczniono częściowe zmiażdżenie nerwu przez odłam kostny, który usunięto, u jednej z osób stwierdzono przerwanie ciągłości nerwu; nie udało się go pierwotnie zrekonstruować, dlatego pacjenta wykluczono z dalszej analizy. Wyniki leczenia oceniano za pomocą skali House’a-Brackmanna (HB) po 12 miesiącach od zabiegu. Wyniki: Pełny powrót czynności nerwu twarzowego (HBI) uzyskano u dwóch pacjentów, satysfakcjonujący (HBII) u kolejnych czterech. Czas podjęcia leczenia oraz jego zakres, podobnie jak wiek chorego, mechanizm urazu oraz miejsce uszkodzenia nerwu pozostawały bez wpływu na ostateczny rezultat terapii. Wnioski: Postępowanie w przypadku pourazowego porażenia nerwu twarzowego powinno być ustalane w każdym przypadku indywidualnie. Powszechnie akceptowanym wskazaniem do leczenia zabiegowego jest uszkodzenie nerwu VII występujące bezpośrednio po urazie oraz jego całkowite porażenie. Pacjenci, u których ze względu na ciężki stan ogólny nie ma możliwości wczesnego przeprowadzenia zabiegu odbarczającego nerw twarzowy, mogą odnieść korzyść z odroczonego leczenia w okresie nawet do 3 miesięcy od urazu.
4
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Bliznowaty zanik odcinka szyjnego tchawicy w następstwie przedłużonej intubacji

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Gawęcki W., Kopeć T., Kruk-Zagajewska A., Jerzy W.
Polish Journal of Otolaryngology
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2007
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vol. 61
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issue 3
339-343
EN
Tracheal intubation is presently one of the basic medical procedures. It is connected with many different complications. One of them is tracheal stenosis, which occurs in 6–21 percent of patients after intubation of the trachea. In contrast to this high frequency of tracheal stenosis we didn’t find any publications about complete atrophy of a big part of trachea after prolongated intubation and we describe a first case of such complication. The reasons and the possibilities of treatment in such situation are discussed.
5
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Piezoelectric bone conduction hearing implant Osia® – audiological and quality of life benefits

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Marszał J., Gibasiewicz R., Błaszczyk M., Gawłowska M. B., Gawęcki W.
Polish Journal of Otolaryngology
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2021
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vol. 75
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issue 6
11-22
EN
Introduction: Nowadays, there are many options to treat hearing-impaired patients: tympanoplastic surgery, hearing aids and a wide range of implantable devices. Aim: The aim of this study is to present the mid-term audiological and quality of life benefits after the implantation of Osia®, an active piezoelectric bone conduction hearing implant. Material and methods: The state of the tissues in the implanted area, as well as audiological and quality of life results were analyzed at six, nine and twelve months after implantation in a group of four adult patients with bilateral mixed hearing loss (1 after bilateral canal-wall-down mastoidectomy, 2 with chronic simple otitis media and after myringoplasty in the opposite ear, 1 with bilateral otosclerosis and after stapedotomy in the opposite ear). Results: No postoperative complications were found in any of the cases. One year after surgery the mean audiological gain in FF PTA4 (pure tone average for 0.5, 1, 2, and 4 kHz) was 52.2 ± 3.5 dB in comparison to the unaided situation, the mean speech understanding with Osia® in quiet was 90 ± 8.2% for 50 dB SPL, 98.8 ± 2.5% for 65 dB SPL and 100 ± 0% for 80 dB SPL, and the mean speech understanding with Osia® in noise was 37.5% ± 23.6 for 50 dB SPL, 93.8 ± 4.8% for 65 dB SPL and 98.8 ± 2.5% for 80 dB SPL. There was also an evident improvement in the quality of hearing as well as in the quality of life, measured by APHAB (Abbreviated Profile of Hearing Aid Benefit) and SSQ (Speech, Spatial and Qualities of Hearing Scale). Conclusions: The Osia® is an effective treatment option for patients with bilateral mixed hearing loss. The mid-term audiological and quality of life results are excellent, but further observations including bigger groups of patients and a longer follow-up are required.
6
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Juvenile nasopharyngeal angiofibroma-20 years of experience in endoscopic treatment

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Wierzbicka M., Balcerowiak A., Gawęcki W., Juszkat R., Wierzbicka M.
Polish Journal of Otolaryngology
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2021
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vol. 75
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issue 2
9-14
EN
Introduction: Juvenile nasopharyngeal angiofibroma is a rare, benign tumor; however, it shows local aggression and leads to profuse nosebleeds. Aim: The aim of the study is to present 20 years of experience in endoscopic treatment of this tumor. Material and methods: The material covers 71 patients treated in the years 1985–2019 at the Department of Otolaryngology and Laryngological Oncology in Poznań. In these patients, either the classic external approach, or the double approach – external with the use of endoscopes, or only the endoscopic approach was used. In the entire population, external surgeries were performed in 37 patients, double access in 8 and endoscopic access in 26 patients. Results: Complete resection of the tumor was achieved in 51 patients (72%). The remaining 20 patients (28%) had a residual or recurrent tumor and all of these patients underwent reoperation. Conclusions: The endoscopic approach with the use of various optics and navigation allows for the removal of not only small tumors but also much more advanced ones. Pre-operative evaluation of imaging results is extremely important to avoid incomplete tumor removal. Individual development of an operating strategy, a wide range of optics and various surgical methods, and especially endoscopic ones, are the guarantee of therapeutic success.
7
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Current indications for cochlear implantation in adults and children

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Szyfter W., Karlik M., Sekula A., Harris S., Gawęcki W.
Polish Journal of Otolaryngology
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2019
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vol. 73
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issue 3
1-5
EN
Introduction: Surgical treatment of deafness by cochlear implants is used for more than 40 years, and during this period permanently, gradual and significant expansion of indications for this surgery has been observed. Material and methods: In our Department in the years 1994-2018 1480 cochlear implantations were performed, both in adults (647) and in children (883). In this study current indications and the rules for eligibility of patients based on 25 years of experience are presented. Results: Indications for cochlear implantation in adults are: 1) bilateral postlingual deafness, 2) bilateral sensorineural hearing loss - in pure tone audiometry > 70 dB HL (average 500-4000 Hz) and in speech audiometry in hearing aids understanding < 50% of words for the intensity of the stimulus 65 dB, in the absence of the benefits of hearing aids, 3) bilateral profound hearing loss for high frequency with good hearing for low frequency, in the absence of the benefits of hearing aids, 4) some cases of asymmetric hearing loss with intensive tinnitus in the deaf ear. An indication in children is bilateral sensorineural hearing loss > 80dB HL confirmed by hearing tests, after about 6 months of rehabilitation with the use of hearing aids. Discussion: Although cochlear implantation is used for more than 40 years, the indications for this treatment underlies constant modifications. They concern the age of eligible patients, implantation in patients with partially preserved hearing, as well as treatment for patients with difficult anatomical conditions. In many countries, bilateral implantations are commonly performed, and more and more centers recommend this treatment in the case of unilateral deafness or asymmetric hearing loss, especially with the accompanying tinnitus in the deaf ear.
8
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Niedosłuch przewodzeniowy po operacyjnym leczeniu otosklerozy – wieloletnie obserwacje

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Wierzbicka M., Gawęcki W., Bartochowska A., Balcerowiak A., Pietraszek M., Wierzbicka M.
Polish Journal of Otolaryngology
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2021
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vol. 75
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issue 1
1-6
PL
Wstęp: Leczenie chirurgiczne otosklerozy od wielu lat stanowi powszechnie przyjęty sposób postępowania. Poprawa słuchu po operacji jest czasami wręcz spektakularna, a dobre wyniki uzyskuje się w wielu ośrodkach w ponad 90% całej operowanej populacji chorych. Jednakże w kolejnych latach po zabiegu u części pacjentów obserwowany jest stały lub postępujący niedosłuch przewodzeniowy. Cel: Celem pracy jest przedstawienie grupy chorych z niedosłuchem przewodzeniowym, który pojawił się po pierwszej operacji otosklerozy, oraz analiza przyczyn jego wystąpienia. Materiał i Metody: Analizie retrospektywnej poddano pacjentów operowanych pierwszorazowo w latach 2000–2009. Przeanalizowano ich dokumentację medyczną do końca 2019 roku, co umożliwiło uzyskanie wyników co najmniej 10-letnich obserwacji pooperacyjnych. Była to grupa 1118 chorych w wieku 14–82 lat, w tym 802 kobiet i 316 mężczyzn. Wyniki: Reoperacje z powodu niedosłuchu przewodzeniowego wykonano u 93 chorych, co stanowiło 8,3% pierwotnie operowanych. Zdecydowanie częściej wykonywano je u pacjentów po stapedektomiach (19,7%) niż po stapedotomii (5,5%). Śródoperacyjnie najczęściej stwierdzano przemieszczenie się protezki (44,1%), często związane z erozją lub nekrozą odnogi długiej kowadełka (28%). Rzadziej występowały: zrosty wokół protezki (10,8%), za mały otwór w płytce strzemiączka (8,6%), za krótka protezka (8,6%), progresja otosklerozy (7,5%), za długa protezka (6,4%), obecność ziarniniaka wokół protezki (5,4%) oraz przemieszczone kowadełko (4,3%). Wnioski: W przypadku otosklerozy leczenie operacyjne stanowi uznaną i dobrą metodę. Pozwala ono na uzyskanie poprawy słuchu u zdecydowanej większości leczonych w ten sposób chorych. Niestety na przestrzeni lat u części pacjentów ponownie rozwija się niedosłuch przewodzeniowy. Reoperacja daje szansę na ustalenie przyczyny i poprawę słuchu w większości takich przypadków.
9
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Conductive hearing loss after surgical treatment of otosclerosis – long-term observations

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Wierzbicka M., Gawęcki W., Bartochowska A., Balcerowiak A., Pietraszek M., Wierzbicka M.
Polish Journal of Otolaryngology
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2021
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vol. 75
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issue 1
1-6
EN
Introduction: For many years, surgical treatment of otosclerosis has been a widely accepted approach. Hearing improvement following stapes surgery is sometimes spectacular, and good treatment results are obtained in many centers in over 90% of patients. However, in the subsequent years after the treatment, some patients develop permanent or progressive conductive hearing loss. Aim: The aim of the study is to present a group of patients with conductive hearing loss after the first otosclerosis surgery and to analyze the causes of its occurrence. Materials and Methods: The retrospective review covered patients who underwent the initial surgery in the years 2000–2009. We analyzed the patients’ medical records from before the end of 2019, which provided results of at least 10 years of postoperative follow-up. The group consisted of 1118 patients aged 14–82, including 802 women and 316 men. Results: Reoperations due to conductive hearing loss were performed on 93 patients, who accounted for 8.3% of the originally operated patients. They were much more common in patients after stapedectomies (19.7%) than in patients after stapedotomy (5.5%). Prosthesis dislocation was found to be the most frequent intraoperative observation (44.1%) and was often associated with erosion or necrosis of the long process of incus (28%). Less frequent reasons for hearing loss were: adhesions around the prosthesis (10.8%), too small hole in the stapes footplate (8.6%), too short prosthesis (8.6%), progression of otosclerosis (7.5%), too long prosthesis (6.4%), presence of a granuloma around the prosthesis (5.4 %), and displacement of incus (4.3%). Conclusions: Surgical treatment of otosclerosis is a widely accepted and good method. It allows to achieve an improvement in hearing in the vast majority of patients treated in this way. Unfortunately, over the years some patients develop recurrent conductive hearing loss. Reoperation creates an opportunity for finding the cause and improving hearing in the majority of cases.
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