[An unusual parotid gland foreign body]

A foreign body in the parotid gland is extremely uncommon. It can penetrate to the parotid gland through the skin or from the oral cavity via the Stenonís duct. A case of 23-years-old man with the several pieces of glass within the superficial lobe of the right parotid gland was described. The surgical removal was performed and the diagnosis of the foreign body was quite easy.

[Perceptual method and videostroboscopy in patients with vocal fold hypertrophy underwent microsurgery]

INTRODUCTION

Chronic hypertrophic laryngitis concerns many people in our population. Their etiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. Organic voice disorders of the larynx, particularly concerning vocal folds are the cause of dysphonia. Both surgical and conservative methods in the treatment of patients with laryngeal hypertrophy are applied. Objective assessment of the voice improvement after microsurgery is the subject of discussion of many authors. The problem of voice improvement is rarely approached to in the comprehensive way, that is with reference to activity and anatomy of the larynx. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of subjective and videostroboscopic voice analysis. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness.

MATERIAL AND METHOD

The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Voice quality examinations were done just before microsurgery and 3 months after the operation. On the basis of histopathological results, following diagnosis were established: vocal fold polyps (oedematosus, teleangiectaticus and inflammatorius), oedema Reincke, laryngeal papilloma, laryngeal granuloma and cyst. The research methodology included: perceptual voice examination based on GRBAS scale (G--grade; R--roughness; B--breathiness; A--asthenicity; S--strain) and assessment of vibrations of vocal folds in videostroboscopy. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes.

RESULTS

In both groups (with minor and extensive vocal fold lesions) significant improvement in perceptual and videostroboscopic voice parameters was observed. The results in the group with minor vocal fold lesions were better after microsurgery.

CONCLUSIONS

The methodology based on the application of the two methods of voice examination could be an objective rate in the estimation of the treatment progress.

Sleep study in patients with overweight and obesity

Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by repetitive collapse of the pharyngeal airway during sleep, which leads to oxygen desaturation, sleep fragmentation and daytime somnolence. Obesity is one of the most important risk factor for the development of OSAS. The exact mechanisms responsible for the relationship between obesity and OSAS are still unclear. The fat deposits in the pharynx region as well as the reduction in the lung volume have been considered as factors that might be responsible for the increase of the upper airway collapsibility. The aim of our study was to evaluate the correlation between the Body Mass Index (BMI) and sleep study parameters in overweight and obese patients suffering from breathing disturbances during sleep. We studied a group of 106 consecutive obese or overweight patients with a primary complaint of snoring or other breathing disturbances during sleep. In all cases, BMI and sleep studies (PolyMESAM) were examined. We evaluated relationship between the BMI and sleep study parameters such as Respiratory Disturbance Index (RDI), Apnea Index (AI), Desaturation Index (DI) and Average of Lowest Saturation (LSAT). The results showed the lack of significant statistical correlations between BMI and all the sleep parameters studied in the overweight patients and the statistical positive correlation between the BMI and RDI in the obese cases. We conclude that BMI determination may be considered as a simple, yet important predictor, of the OSAS in the group of obese patients.

The nasal airway evaluation in morbid obesity

The aim of the present study was to evaluate objectively the nasal patency in the obese patients. A total of 18 morbidly obese patients were recruited for the study. All of them were surgically treated because of morbid obesity using Bilo-Pancreatic Diversion (BPD) or Laparoscopic Gastric Banding (LGB) methods. The patients were free of nasal abnormalities, such as septum deviation, polyps, nasal concha hypertrophy and paranasal sinus diseases. This group comprised 10 men and 8 women aged from 17 to 54. The mean Body Mass Index (BMI) was 51.6 kg/m(2), ranged from 34.7 to 61.8 kg/m(2). In all of the patients the nasal patency was examined by active anterior rhinomanometry according International Standardization Rhinomanometric Committee using air pressure 75, 100 and 150 dPa. The results were compared to the healthy control group. The correlation between BMI and nasal airflow pressure was also examined. We found that inspiration values for 75, 100 and 150 dPa as well as the expiration values for 100 and 150 dPa in standard method and expiration values for 100 and 150 dPa in Broms method using anterior rhinomanometry in morbidly obese patients were statistically significant higher in comparison with the healthy controls. No statistical significant correlation between BMI of obese patients and the airflow pressure values was found. We conclude that in the morbid obesity the nasal patency is reduced as compared to the healthy controls.

[Treatment of otosclerosis in children]

Between 1994 and 2004 in the ENT Department Silesian Medical University Zabrze 330 stapedotomy were performed in patients suffered from otosclerosis. In this group of patient's 16 stapedotomies in 13 children aged from 9 to 17 years were performed. 4.85% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedotomies in children. The postoperative evaluations were performed in the period from 6 months to 8 years after the surgical treatment. In the hearing state evaluation we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedotomy was successful (postoperative air bone gap within 10 dB) in 62.5% of the cases. In 5 cases the air bone gap was lower than 20 dB (31.25%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 4.39 dB level. The results were comparable with the other authors. Stapedotomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

[The rare case of sinonasal osteosarcoma in a 22-year-old patient (case report)]

Sarcomas of head and neck are very rare and comprise about 10 to 15% of all malignant nonepithelial neoplasms. A case of 22-year old patient with sinonasal osteosarcoma was presented. The authors stressed the significance of CT in the diagnostic procedures. The preoperative symptoms, histological character of the tumor and postoperative status were shown and discussed. Patient was treated by combined method: the surgical excision and radio-chemotherapy. The 24 months follow-up period was free of symptoms.

[Videostroboscopy assessment in patients with vocal fold hypertrophy underwent microsurgery]

Chronic hypertrophic laryngitis concerns many people in our population. Their aetiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of videostroboscopy examination. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Videostroboscopy examination was done just before microsurgery and 3 months after operation. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The first group consist of patients with minor vocal fold lesions (limited to I of vocal fold length), the second group consist of patients with extensive vocal fold lesions (above I of vocal fold length). The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. In both groups (with minor and extensive vocal fold lesions) significant improvement in videostroboscopy parameters was observed. The functional results in the group with minor vocal fold lesions were better after microsurgery, but it turned out that results were not statistically significant.

[Sialolithiasis of the parotid gland--case report]

In this study the very rare case of a parotid gland sialolithiasis was presented. The authors described opinions concerned with symptomatology, localization, diagnostics and methods of treatment in parotid sialolithiasis. The 12 months follow-up period was free of symptoms.

[Tuberculosis within the laryngologic organs]

Tuberculosis, considering entry of infection, most frequent concerns the lungs. Rarely we observed extrapulmonary cases of tuberculosis within the bones, joints, urogenital organs and lymph nodes as well as within the head and neck region--larynx, nose and paranasal sinuses, middle ear, pharynx, tonsils, tongue, parotid glands and central nervous system. The diagnosis of head and neck tuberculosis is based on patient's examination as well as on the bacteriologic and histologic study of the biopsy specimen.

AIM

The aim of the study was to show our own, very rare cases of head and neck tuberculosis.

MATERIAL AND METHODS

We showed our own experience in the diagnosis and treatment of patients suffer from head and neck tuberculosis. 7 cases of head and neck tuberculosis (4 laryngeal, 2 sinonasal and 1 middle ear) were treated from 1986 to 2004 in the II ENT Department Silesian Medical University in Zabrze. In all the cases the diagnosis was based on the histological examination of the tissue specimen. All of the patients were suspected of the neoplastic disease. We assessed good long-term results after the conservative treatment (sometimes completed by surgery).

CONCLUSIONS

Tuberculosis of the head and neck region should be taken into consideration during the differential diagnosis of neoplastic diseases.

[Histopathologic changes of the soft palate in snoring and obstructive sleep apnea syndrome patients]

Histology of the soft palate and uvula in snorers and patients with OSA syndrome has been a subject of investigation of many authors. In majority of specimens the hypertrophy of the salivary glands as well as congestion and dilation of the thin-walled vessels were observed. Some of the samples presented atrophy of the muscle bundles. Also, the inflammatory changes as lymphocytic infiltrations were proven. In each case adults served as a control group. In this study the histologic analysis of the soft palate and uvula samples from patients suffering from snoring and OSA syndrome was performed. The uvula samples from the newborn who died on the first day of their lives were chosen as a control group. The choice of such a group excluded the influence of vibration force on the soft palate structure. Comparisons among the groups were made by Fisher exact two-tailed test. The muscular atrophy was observed only in patients with airway disturbances. No case of neonatal tissue sample with this pathology was found. Less dilation and congestion of the blood vessels were observed in the newborn group. Significantly more frequent superficial salivary glands localized between the muscle bundles and epithelium were found in the OSA and snoring patients. Our results showed distinct differences between the tissues of the patients with airway disturbances and the control group. These differences may be caused by the influence of the vibration on the soft palate and uvula, but on the other hand they may be the reason for excessive flaccidity of these structures and disturbances occurring during sleep.

[Treatment of patients with breathing disturbances during sleep in the II ENT Department Silesian Medical University Zabrze]

INTRODUCTION

The treatment of snoring and obstructive sleep apnea syndrome comprises preventive behavior, conservative methods (CPAP) and surgical treatment. In the diagnostics procedures the most important aim is to determinate whether the patient is an habitual snorer or OSA patient. Very important thing is also patient's qualification for proper mode of treatment. The aim of the surgical treatment is to remove all the reasons that obturate the upper airways and cause the increasing of respiratory air stream resistance. The most collapsible airway region during sleep is oropharynx involves the soft palate, uvula, tonsils, tonsillar pillars, base of the tongue and pharyngeal muscles.

MATERIAL AND METHODS

In the study the results of surgical treatment of 138 patients suffer from breathing disturbances during sleep treated at the ENT Department Silesian Medical University in Zabrze in the years 1997 to 2002 were presented. In the evaluated group were 51 habitual snorer and 87 OSA patients. Various type of surgical procedures were performed depend on the airway obturation level (septoplasty, tonsillectomy, LAUP, arytenoidectomy). The postoperative control sleep studies were performed in 68 patients (49.3%) 6 to 12 weeks after the end of the surgical treatment. In all the patients the subjective improvement were evaluated.

RESULTS

In 35 from 45 OSA patients (77.8%) RDI decreased after the surgical treatment more then 50% of the preoperative value or was lower then 10 (RDI lower then 10 was in 16 patients, in 19 patients decreased more than 50%). The subjective radical improvement was obtained in 107 patients (77.5%), moderate improvement in 19 cases (13.8%) and no improvement in 12 patients (8.7%).

CONCLUSIONS

On the base of our results we concluded that surgery is successful method for treatment of selected patients with breathing disturbances during sleep.

[A very rare case of low-grade angiosarcoma of the nose and paranasal sinuses]

Angiosarcomas of the nose and paranasal sinuses are extremely rare. Histologically angiosarcomas are divided into two groups: low and high-grade. We present a case of angiosarcoma of apparent low-grade malignancy localized within the nasal cavity and paranasal sinuses in a 74-year old woman treated by radiotherapy due to middle ear chemodectoma 21 years ago. She was surgically treated via the lateral rhinotomy. During the 23 months follow-up no recurrence or epistaxis have been observed.

Morphometric characteristics of cell nuclei of the precancerous lesions and laryngeal cancer

BACKGROUND

The purpose of this study was to characterize normal epithelium, precancerous lesions and laryngeal squamous cell carcinoma (SCC) with the use of nuclear morphometry. The relationship between the morphometric parameters of the cell nuclei and the pathological lesions was analyzed. In addition, a morphometric comparison was performed among normal epithelium, precancerous lesions, and cancer of the larynx.

MATERIAL/METHODS

Our research involved 12 patients after total laryngectomy. All the postoperative histological specimens consisted of laryngeal SCC, precancerous lesions (dysplasia), keratosis with mild dysplasia, and normal epithelium. The cell nuclei of the SCC, dysplasia, keratosis, and the basal and superficial layers of the normal epithelium were measured. The nuclear parameters included area, equivalent diameter, length, breadth, perimeter, mean and integrated grey levels, convex area and convex perimeter, roundness, aspect ratio and fullness ratio. For each case, 500 nuclei were studied using a Polyvar Reicher microscope connected to a Quantimet 500 computer system.

RESULTS

The relationship between karyometrical parameters and pathological lesions was found to be statistically significant. We observed the largest nuclei in keratosis lesions and the smallest in basal layers of normal epithelium. In some cases there were no significant differences between dysplasia nuclei and the superficial layers of normal epithelium.

CONCLUSIONS

Karyometrical parameters correlate with morphometrical lesions in the larynx and may be useful in the prediction of laryngeal neoplasm.

[Rare case of primary isolated orbital sarcoidosis in 53 year old woman]

Isolated to one organ cases of sarcoidosis are observed extremely rare. We described a case of 53 year old woman suffer from isolated to orbit form of sarcoidosis. Systemic sarcoidosis (lymphadenopathy, pulmonary infiltrates, skin lesions) are excluded. The patient was treated by surgery (excision of orbital tumor) with following prolonged steroidotherapy. Total retirement of symptoms was obtained. During the 19 months follow-up no recurrence have been observed.

[New composite implant for tracheal reconstruction--preliminary study]

Stenosis of trachea's diameter occurs the most often as complications after intubation and tracheotomy. Among the other reasons of narrowing of this organ the following are being named: mechanical injuries, chemical damages, primary and metastasis tumors. The therapy of trachea's stenosis includes both alternative and radical treatments. The radical treatment consists of surgical excision of the narrowed segment followed by reconstruction of trachea (anastomosing of free ends or filling of lost segment with use of auto- or allogenic material). There is no appropriate alloplastic material developed to date, the use of which in reconstructive surgery of large segment trachea defects would bring about positive long-term experimental results. The success of alloplastic material implantation in the reconstruction of large tracheal defects is limited by the fact that the biomechanical characteristics of replaced tissue are distinctly different from synthetic material. The work is devoted to evaluation of complex mechanical characteristic of natural sheep trachea before designing the proper synthetic material for large tracheal defects reconstruction. Various mechanical tests were conducted to study the mechanical behavior of total trachea. Samples of tissue cut out from trachea were also examined. The results revealed strong directional--dependent mechanical properties of trachea. Composite constituents, namely carbon fibers and biocompatible and biostable polysulfone were used to manufacture the implant.

Obstructive sleep apnea syndrome and snoring in patients with bilateral vocal cord paralysis

The analysis of the correlation between bilateral vocal cord paralysis and the occurrence of obstructive sleep apnea syndrome and snoring is presented. The aim of the study was to establish whether the decrease of the air flow in the upper airway in patients with bilateral vocal cord paralysis involves OSAS and/or snoring occurrence and whether arytenoidectomy affects an improvement of breathing parameters measured during sleep. Fourteen patients with bilateral vocal cord paralysis underwent Poly-MESAM examination before and 3 months after arytenoidectomy. They had never complained of snoring before. The Epworth sleepiness scale was used to quantify excessive daytime somnolence. The RDI, DI, mean saturation and percentage of snoring, loud snoring and sleep without snoring were estimated and compared pre- and postoperatively. The results were compared by the Student's t-test for dependent values. No significant differences were shown between the Epworth scores before and after the treatment. The RDI, DI and mean saturation were normal before and after the operation. The percentage of loud snoring decreased and the percentage of sleep without snoring increased significantly after arytenoidectomy in both cases. The mechanism of snoring in patients with vocal cord paralysis seems to be similar to OSAS. The difference consists in the level of flow limitation. On the basis of the results there is no reason to diagnose OSAS and UARS in patients with bilateral vocal cord paralysis. On the other hand, the intensive snoring that occurs after paralysis was significantly reduced as a result of arytenoidectomy.

[Ceruminous gland adenoma of the external auditory canal: a case report]

Ceruminous adenoma (ceruminoma) of the external auditory meatus is a rare neoplasm with benign clinical behavior. This tumor is mainly composed of the ceruminous gland cells (modified apocrine sweat glands). These glands are localized deep in the skin mostly in the cartilaginous part of the external auditory meatus. The most often symptom of the ceruminous adenoma of external auditory meatus is the unilateral conductive hearing loss. Occasionally symptoms of this tumor (pain, otorrhoea) can result from an otitis externa secondary to meatus obstruction. Ceruminous adenoma should be radical excised with adequate margins of the normal tissues. The prognosis of these tumors is good. The difficulties of nomenclature, histological structure of the auditory external meatus ceruminoma, as well as symptomatology, treatment and clinical behavior are discussed on the basis of the literature. A case of histologically confirmed ceruminoma (ceruminous adenoma) of the external auditory meatus in a surgically treated 53 years old men is presented.

[Nuclear shape assessment of the cells in precancerous lesions and laryngeal cancer]

The authors assessed morphometrically the nuclei shape of the normal mucosa, precancerous lesions (dysplasia, keratosis) and laryngeal cancer in the postoperative samples of 12 patients treated in the Laryngology Department Silesian Medical Academy in Zabrze. Five slides from the same patient, each 4 um thick were assessed. The histologic samples were measured by system Quantimet 500 + Color Option with magnification 2100x. Roundness, aspect ratio and fullness ratio were evaluated. The relationship among the morphologic lesions using shape descriptors was assessed. In some cases there were no significant differences between the nuclei of mild dysplasia cells and the cells of the normal epithelium. The results indicate significant karyometric shape differences of the normal mucosa, precancerous lesions and cancer of the larynx.

[Complication after laser assisted uvulopalatoplasty in the treatment of snoring and obstructive sleep apnea syndrome]

Laser Assisted Uvulopalatoplasty (LAUP) is the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome. LAUP was first time performed by Kamami in 1986. LAUP can reduce the airway obstruction on the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. Between 1997 and 2001 the authors of the study prospectively evaluated 400 patients referred to ENT Clinic in Zabrze to treat the breathing disturbances during sleep. In this group of patients LAUP procedure was performed in 68 cases. There were 4 cases of complications (4.4%). These complications included: postoperative hemorrhage in one patient, 2 cases mycotic infections and in one patient, 2 cases mycotic infections and in one patient temporary loss of taste. In this group of patients there were no cases of bleedings needed hospitalization, nasal speech, nasopharyngeal stenosis, palatal incompetence, airway compromise or death.

[Hearing evaluation in patients suffering from hypercholesterolemia]

The negative influence of hypercholesterolemia on the blood vessels condition and following degeneration lesions of the organs is well known. The aim of our study was to estimate the lipid balance disorders influence on the small blood vessels of the brain and inner ear in the patients with hypercholesterolemia and hypertriglyceridemia on the base of the audiometric, ABR and TEOAE evaluations. In our study we observed no statistical significant differences between the mean auditory thresholds in the study and control groups as well as statistical negative correlation between cholesterol serum level and amplitudes of TEOAE. In the ABR evaluation we stated the prolonged latency of the wave III and V as well as I-III and III-V interpeaklatencies in the patients with hyperlipidemia in comparison with the control group.

[Surgical treatment of acquired external auditory canal atresia]

Acquired atresia of the external auditory canal is a relatively rare disease, that can be the result of the recurrent external otitis, chronic media otitis, ear trauma, neoplasms or iatrogenic complications. The surgical treatment results after operation in the 7 patients with acquired external auditory canal atresia were presented. The mean age of the patients was 34.1 and the female to male ratio was 2:5. In 6 cases we performed transcanal operation. The meatus atresia was removed and then the stenotic canal was widened by removing the skin and fibrous tissue. We especially focused our attention on the state of the anterior angle of the tympanic membrane. The bony canal was widened by burr in cases with bony overhangs. The bony canal walls were lined with pediculate or free skin grafts. In cases of tympanic membrane perforation we performed myringoplasty with temporal muscle fascia or tragus perichondrium. The follow-up period was from 8 to 39 months. The hearing improvement with primary closure of air bone gap within 20 dB was achieved in 43% of cases. In 28% of the patients recurrent atresia developed. The early surgical treatment is recommended in all the cases because cholesteatoma behind the atresia was found in 28% of patients.

[Stapedectomy in the treatment of otosclerosis in children]

In the years 1994-2000 in the Laryngology Department Silesian Medical Academy in Zabrze 167 stapedectomy were performed in 143 patients with otosclerosis. In this group of patients 11 stapedectomies in 8 children aged from 9 to 17 years were performed. 5.6% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedectomies in children. The postoperative evaluations were performed in the period from 6 months to 6 years after the surgical treatment. In the estimation of the hearing state we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedectomy was successful (postoperative air bone gap within 10 dB of the preoperative bone conduction) in 63.6% of the patients. In 3 cases the air bone gap was lower than 20 dB (27.3%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 5.75 dB level. The results were comparable with the other authors. Stapedectomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

[Laser assisted uvulopalatoplasty (LAUP) in the treatment of snoring and obstructive sleep apnea syndrome]

Laser Assisted Uvulopalatoplasty (LAUP) the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome was first performed by Kamami in 1988. LAUP can reduce the airway obstruction in the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. From 1998 to 2000 37 patients underwent LAUP in our ENT Department in Zabrze. This group comprised of 19 OSA patients and 18 habitual snorers. In cases of nasal obstruction by turbinate hypertrophy or septal deviation we performed septoplasty or partial inferior turbinectomy by laser CO2. In some cases with palatin or lingual tonsils hypertrophy we also performed tonsillectomy or lingual tonsil laser ablation. In 5 patients LAUP was performed in several stages. Before and after the surgical treatment each patient were evaluated by PolyMESAM--the device belongs to the third diagnostic level. In all postoperative evaluated OSA patients the RDI decreased significantly. In 4 patients (50% of evaluated after LAUP patients) the RDI dropped to 10 or lower. Snoring was eliminated or significantly reduced in 83% of patients classified as the habitual snorers. No serious complications were observed. LAUP is a good alternative to UPPP in the surgical treatment of habitual snorers and some of the patients with OSA syndrome.