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Straburzyński M, M Agius A, Boczarska-Jedynak M, Brożek-Mądry E, Dżaman K, Gradek-Kwinta E, Gryglas-Dworak A, Nowaczewska M, Sama A, Smardz J, Tsang HK, Więckiewicz M, Waliszewska-Prosół M. The midfacial segment pain: little known disorder in need of scientific evaluation. Cephalalgia 2024; 44:3331024231226176. [PMID: 38215229 DOI: 10.1177/03331024231226176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Despite its inclusion in the International Classification of Orofacial Pain, tension-type orofacial pain has little support in the scientific literature. However, a similar-in-phenotype orofacial pain perceived in the middle segment of the face has been described by few case series from mostly ear, nose and throat clinics. The authors of these descriptions used the term 'midfacial segment pain'. Patients had no significant sinonasal disorder in these studies, but experienced symmetrical pain perceived mostly over the maxillary and ethmoid sinuses. No aura or autonomic symptoms were present apart from mild nasal congestion or rhinorrhoea in some individuals. This description appears similar to tension-type headache, but with midfacial location. In this viewpoint, we indicate a need to fill this gap in scientific knowledge and propose a multicentre interdisciplinary study that would give a detailed description of this type of orofacial pain.
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Affiliation(s)
- Marcin Straburzyński
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | - Adrian M Agius
- Department of Otolaryngology, University of Malta, Msida, Malta
| | | | - Eliza Brożek-Mądry
- Department of Otorhinolaryngology, National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Karolina Dżaman
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | | | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery and Laryngological Oncology, Bydgoszcz, Poland
| | - Anshul Sama
- Department of Otorhinolaryngology, Nottingham University Hospital, Nottingham, UK
| | - Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Hoo Kee Tsang
- Pain Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mieszko Więckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
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Bonek K, Brożek-Mądry E, Wroński J, Płaza M, Zielińska A, Helon K, Wójcik K, Wisłowska M. Combination Treatment of Locoregionally Aggressive Granulomatosis with Polyangiitis and Cranial Base Infiltration. Brain Sci 2023; 13:1140. [PMID: 37626497 PMCID: PMC10452321 DOI: 10.3390/brainsci13081140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/16/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES To present a personalized approach in three cases of treatment-resistant, locoregionally aggressive forms of cANCA-positive granulomatosis with polyangiitis (GPA) and skull base involvement. METHODS Three patients with GPA and skull base involvement were described alongside a critical review of the current literature. RESULTS All presented patients suffered from GPA with an inflammatory tumor at the skull base, alongside cerebellopontine angle involvement, cranial nerve palsies, cerebellar disorders, concomitant hearing loss, and severe otalgia. Symptoms were associated with progressive granulomatous destruction of the temporal bone, laryngopharynx, and central nervous system infiltration. Treatment with cyclophosphamide and high doses of glucocorticoid steroids were ineffective but subsequent therapy with rituximab was successful in the presented cases. The literature review showed that the course of the disease with skull base involvement is associated with poorer clinical and radiological responses to standard pharmacotherapies. CONCLUSION Granulomatous inflammation localized in the skull base is associated with a more aggressive disease progression and is less likely to respond to pharmacotherapy. Standard induction therapy with cyclophosphamide and glucocorticoid steroids may be ineffective. A better response may be achieved by using rituximab and concomitant local treatment with glucocorticoid steroid injections.
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Affiliation(s)
- Krzysztof Bonek
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Eliza Brożek-Mądry
- Department of Otorhinolaryngology, National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Jakub Wroński
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Mateusz Płaza
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Agnieszka Zielińska
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Katarzyna Helon
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Krzysztof Wójcik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, 31-007 Krakow, Poland
- POLVAS Consortium, Jagiellonian University Medical College, 31-007 Krakow, Poland
| | - Małgorzata Wisłowska
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
- POLVAS Consortium, Jagiellonian University Medical College, 31-007 Krakow, Poland
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Szot P, Płachta I, Nagórska E, Brożek-Mądry E. Analysis of mastoid portion of facial nerve course in temporal bone using computed tomography. Otolaryngol Pol 2023; 77:39-47. [PMID: 37772376 DOI: 10.5604/01.3001.0016.3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<b>Introduction:</b> The facial nerve (FN) follows a complex route in the temporal bone. Successful temporal bone surgery requires knowledge of its course which can be achieved using imaging methods such as computed tomography. This investigation aims to analyze the FN course in its mastoid portion and second genu and the frequency of its atypical course.</br></br> <b>Material and methods:</b> This is a retrospective study that enrolled 104 CT scans of temporal bones of patients followed up in the outpatient clinic of the Otorhinolaryngology Department of Dentistry Faculty of the Medical University of Warsaw between 2020 and 2022. FN courses were classified as straight, bulging, or letter "S"-like. Other parameters estimated: </br> • position of the second genu according to the prominence of the lateral semicircular canal (classified as lateral, medial, or middle) and its distance from a line adjacent to the lateral semicircular canal was measured;</br> • the distance between the short process of the incus and the outermost point of the second genu;</br> • the course of the mastoid portion of FN and the location of SG in comparison to the tympanic portion of n. VII. The course was later classified as lateral, medial, or middle.</br></br> <b>Results:</b> Among the 104 assessed temporal bones, the course of the mastoid portion of FN was classified as bulging in 47 cases (45.2%). Straight and letter "S"-like courses were present in 41 (39.4%) and 16 (15.4%) cases, respectively. Deviation of the second genu according to the prominence of the lateral semicircular canal was medial in 86 cases (82.7%), and middle in 4 cases (3.8%). In the rest, second genu was paramedian to the prominence of the later circular canal. The mean distance between the short process of the incus and the outermost point of SG was 4.9 mm (0.73 mm). The mastoid portion was located laterally, medially, and in the middle of the tympanic portion plane in, respectively, 4.8%, 83.7%, and 11.5%. The second genu was located laterally, medially, and in the middle of the tympanic portion plane in 1.9%, 73.1%, and 25%, respectively. In conclusion, seven temporal bones (6.7%) of five patients presented with a lateral displacement of FN in relation to the established anatomical landmarks.</br></br> <b>Conclusions:</b> Although the atypical course of FN, including the lateral displacement of the mastoid portion, is rare, screening for it is crucial before surgical exploration.
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Affiliation(s)
- Paulina Szot
- Department of Otorhinolaryngology, Faculty of Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Iga Płachta
- Department of Otorhinolaryngology, Faculty of Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Emilia Nagórska
- Department of Otorhinolaryngology, Faculty of Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Eliza Brożek-Mądry
- Department of Otolaryngology, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Warsaw, Poland
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Jurkiewicz D, Kupczyk M, Brożek-Mądry E, Rapiejko P. Biologicals in the treatment of chronic rhinosinusitis with nasal polyps – position of the Polish Society of Otorhinolaryngologists –Head and Neck Surgeons and the Polish Society of Allergology experts. Otolaryngol Pol 2023; 77:1-11. [PMID: 37347975 DOI: 10.5604/01.3001.0053.5965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) has a significant impact on the well-being and social functions of the patient. The generalized inflammatory process with the formation of nasal polyps and excess eosinophils in the mucosa of the paranasal sinuses is called type 2 inflammation, which is mediated by Th2 lymphocytes – cells of the immune system responsible for chronic inflammatory processes. Today, we also know the key pro-inflammatory mediators against which new drugs have been developed, the so-called biological drugs, are produced in cell lines. In this document, we present currently available biologicals approved for the treatment of patients with T2-related chronic rhinosinusitis.
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Affiliation(s)
- Dariusz Jurkiewicz
- Klinika Otolaryngologii i Onkologii Laryngologicznej z Klinicznym Oddziałem Chirurgii Czaszkowo-Szczękowo-Twarzowej, Wojskowy Instytut Medyczny - Państwowy Instytut Badawczy w Warszawie, Polska
| | - Maciej Kupczyk
- Klinika Chorób Wewnętrznych, Astmy i Alergii, Uniwersytet Medyczny w Łodzi, Polska
| | - Eliza Brożek-Mądry
- Klinika Otolaryngologii, Państwowy Instytut Medyczny MSWiA w Warszawie, Polska
| | - Piotr Rapiejko
- Klinika Otolaryngologii i Onkologii Laryngologicznej z Klinicznym Oddziałem Chirurgii Czaszkowo-Szczękowo-Twarzowej, Wojskowy Instytut Medyczny - Państwowy Instytut Badawczy w Warszawie, Polska
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Szot P, Burghard M, Brożek-Mądry E, Krzeski A. Adenoid facies as a risk factor in pediatric obstructive sleep apnea syndrome (OSAS). Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Burska Z, Burghard M, Brożek-Mądry E, Steć Z, Sierdziński J, Krzeski A. Oral cavity, lingual frenulum and head forward posture in children at risk of OSAS. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Steć Z, Burska Z, Brożek-Mądry E, Straburzyński M, Waliszewska-Prosół M, Krzeski A. Clinical characteristics of acute rhinosinusitis in COVID-19 a post hoc analysis of a longitudinal study. Otolaryngol Pol 2022; 77:1-5. [PMID: 36805512 DOI: 10.5604/01.3001.0016.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acute rhinosinusitis (ARS) is a common and well-defined disorder, primarily of viral aetiology, with rhinovirus and coronavirus accounting for more than 50% of viral ARS. The fight with COVID-19 pandemic resulted in an increased availability viral testing, which in turn allowed testing for presence of SARS-Cov-2 in all patients presenting common cold (or ARS) symptoms. The aim of this study was to assess the clinical characteristics of acute rhinosinusitis in patients diagnosed with COVID-19. METHODOLOGY/PRINCIPAL This study is a post-hoc analysis. Patients symptoms were evaluated using a structured questionnaire twice: directly after a positive SARS-Cov-2 result and 7-12 days following the first evaluation. Subjects were asked about presence of nasal and systemic symptoms as well as headache. RESULTS A total of 130 COVID-19 symptomatic patients were recruited into the study, 58 (45%) patients met EPOS2020 diagnostic criteria for ARS. Of all ARS patients, 72% presented with rhinorrhoea, 69% with pain perceived over paranasal sinuses, 62% with nasal congestion, 52% with cough, 45% with olfactory dysfunction, 38% with fever, 33% with facial pressure and in 22% pain was exacerbated by sinus palpation. CONCLUSIONS Half of COVID-19 subjects has ARS. The course of SARS-Cov-2 ARS does not seem to differ significantly from ARS of other aetiologies. Since ARS in the course of COVID-19 seems to meet the definition of ARS proposed by EPOS 2020, we hypothesize that substances validated for ARS treatment, such as intranasal corticosteroids could be effective in SARS-Cov-2 ARS.
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Affiliation(s)
- Zuzanna Steć
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Poland
| | - Zofia Burska
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Poland
| | - Eliza Brożek-Mądry
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Poland
| | - Marcin Straburzyński
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Antoni Krzeski
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Poland
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Brożek-Mądry E, Jurek-Matusiak O, Krzeski A. Postsurgical Complications in Orbital Decompression for Thyroid Eye Disease. B-ENT 2022. [DOI: 10.5152/b-ent.2022.21708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Burska Z, Burghard M, Brożek-Mądry E, Sierdziński J, Krzeski A. Oral cavity morphology among children at risk of sleep disordered breathing. Eur Arch Paediatr Dent 2022; 23:429-435. [PMID: 35366217 DOI: 10.1007/s40368-022-00701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate oral cavity morphology in children at risk of sleep disordered breathing (SDB). METHODS The study included children 3-17 years of age. The risk of SDB was evaluated using the paediatric sleep questionnaire (PSQ); afterwards, children at risk of SDB were enrolled in the study group. A control group was randomly established from patients with negative PSQ results. The oral cavity morphology evaluation included assessment of the oropharynx using Mallampati classification (MC), palatine tonsil size using the Pirquet scale, occlusion and the presence of a high-arched palate and lingual frenulum. RESULTS A total of 131 children were evaluated, 65 in the study and 66 in the control group. The mean ages were 9.5 ± 3.0 and 9.4 ± 3.1 years, respectively. The presence of higher scores on the MC, higher scores in the Pirquet scale, a crossbite, a high-arched palate and a short frenulum were significantly more frequent in the study group than the control group. CONCLUSION The evaluation of oral morphology is an important part of paediatric examination. Enlarged palatine tonsils; higher scores on the MC; and the presence of a crossbite, short lingual frenulum and high-arched palate may suggest abnormal breathing during sleep in children.
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Affiliation(s)
- Z Burska
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland
| | - M Burghard
- Medical Center in Ostrołęka, Ostroleka, Poland
| | - E Brożek-Mądry
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland.
| | - J Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - A Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Stępińska 19/25, 00-739, Warsaw, Poland
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Jurek-Matusiak O, Brożek-Mądry E, Jastrzębska H, Krzeski A. Orbital decompression for thyroid eye disease: surgical treatment outcomes in endocrinological assessment. Endokrynol Pol 2021; 72:609-617. [PMID: 34647604 DOI: 10.5603/ep.a2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgical orbital decompression involves removal of one or more orbital bony walls in order to gain space for overgrown muscles and adipose tissue, which results in a reduction in pressure on the eye. This observational study aims to perform an endocrinological assessment of the surgical treatment outcomes of thyroid eye disease (TED) patients before and after orbital decompression. Material &Methods: This retrospective study included 51 TED patients (84 orbits) who underwent endoscopic orbital decompression (EOD) or balanced orbital decompression.The effect of surgical treatment was evaluated via the clinical activity score (CAS), modified NOSPECS and EUGOGO classification. RESULTS Before orbital decompression, the average CAS index was 3.83+/-1.86 points, whereas the modified NOSPECS score was 3.31+/-0.97 points. After surgical intervention, the values were as follows: 2.07+/-1.84 points for CAS and 2.5+/-0.97 points for modified NOSPECS. The EUGOGO classification before surgery showed that Graves' orbitopathy (GO) was mild, moderate to severe and sight-threatening in 1%, 25% and 74% of the orbits, respectively. After surgery, GO was determined to be mild, moderate to severe and sight-threatening in 24%, 57% and 19% of the orbits. Statistical analysis was performed using the R 3.6.2 statistical environment. Inference about the statistical reliability of the parameter was made by calculating the mean and the 95% credibility interval (CI). CONCLUSIONS The severity of TED decreased after orbital decompression. The CAS, modified NOSPECS and EUGOGO classification showed a statistically reliable postoperative reduction. The drop in activity of the disease after orbital surgery requires careful follow-up.
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Affiliation(s)
- Olga Jurek-Matusiak
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Stepinska 19/25, 00-739 Warsaw, Poland.
| | - Eliza Brożek-Mądry
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Stepinska 19/25, 00-739 Warsaw, Poland
| | - Helena Jastrzębska
- Department of Endocrinology, Medical Center of Postgraduate Education in Warsaw, Cegłowska 80,, 01-809 Warsaw,, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Stepinska 19/25, 00-739 Warsaw, Poland
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Brożek-Mądry E, Szopiński K, Życińska K, Krzeski A. Radiological markers of granulomatosis with polyangiitis with nasal involvement. Pol Arch Intern Med 2021; 131:649-657. [PMID: 34002970 DOI: 10.20452/pamw.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Granulomatosis with polyangiitis (GPA) is an autoimmune disease leading to necrotizing lesions in the affected tissues. Computed tomography (CT) of paranasal sinuses reveals multiple lesions in patients with GPA, for example, sinus opacification, bone / cartilage destruction, and neoosteogenesis. OBJECTIVES We aimed to describe and compare CT lesions found in patients with GPA and those with chronic rhinosinusitis (CRS) and to propose a new radiological marker of GPA-nasal strands. PATIENTS AND METHODS This retrospective study (2014-2019) included 53 patients with GPA (22 men, 31 women) at a median (interquartile range) age of 45 (34-60) years. Computed tomography findings of mucosal lesions in paranasal sinuses, neoosteogenesis, bony and cartilaginous lesions, and nasal strands were analyzed. Nasal strands were described as intermucosal adhesions resembling bands. A total of 71 patients with CRS (reference group) were assessed for the presence of the same parameters. RESULTS Computed tomography scans showed mucosal lesions in the sinuses of 35 patients (66%) with GPA. Nasal septum perforation was observed in 19 patients (35.8%), neoosteogenesis in 17 (32.1%), and bone damage in 14 (26.4%). External nose deformity was present in 16 patients (30.2%). Nasal strands on CT were found in 36 patients with GPA (68%) and 32 patients with CRS (45%). The presence of 5 or more strands was more characteristic of GPA than CRS (P <0.001). A positive correlation was found between the number of strands greater than or equal to 5 and the presence of proteinase 3 antineutrophil cytoplasmic antibodies (P = 0.046). CONCLUSIONS Nasal strands, a parameter reflecting pathologic mucus and atrophic lesions (tissue loss), should have a place in CT evaluation of the nasal cavities in patients suspected of or diagnosed with GPA.
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Affiliation(s)
- Eliza Brożek-Mądry
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw, Poland.
| | - Kazimierz Szopiński
- Department of Dental and Maxillofacial Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Życińska
- Department of Family Medicine, Medical University of Warsaw, Warsaw, Poland
- Department of Rheumatology, Connective Tissue and Rare Diseases, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Warsaw, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw, Poland
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Brożek-Mądry E, Burska Z, Steć Z, Burghard M, Krzeski A. Short lingual frenulum and head-forward posture in children with the risk of obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2021; 144:110699. [PMID: 33823467 DOI: 10.1016/j.ijporl.2021.110699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have shown that a short lingual frenulum is a potential risk factor for obstructive sleep apnea syndrome (OSAS) in children. A short frenulum leads to abnormal orofacial development and may consequently contribute to sleep-disordered breathing by narrowing the upper airways and increasing the risk of upper-airway collapsibility. The aim of this study was to assess the impact of a short lingual frenulum on the risk of OSAS in children. METHODS Children from pre-, primary, secondary, and high school, aged 3-17 years, were included in the study. Parents/guardians were asked to fill in the Pediatric Sleep Questionnaire (PSQ), and then, children at risk of OSAS were enrolled in the study group. A control group was established randomly from patients with negative PSQ results. A physical examination, including measurements of head-forward posture (HFP) and length of the free tongue, inter-incisor distance and subjective high-arched palate evaluation was performed in children from both groups. RESULTS A total of 1,500 PSQ questionnaires were distributed, and less than half (713) were returned correctly filled in. In the second part of the study, 135 children were evaluated: 67 in the study group and 68 in the control group. The mean ages were 9.4 ± 3.0 and 9.5 ± 3.1 years, respectively. Children in the study group had significantly shorter lingual frenula, higher HFP measures, and had a higher prevalence of a high-arched palate. Based on statistical analysis, a short lingual frenulum (OR 5.02 [1.58-15.94]). CONCLUSIONS The study identified a relationship between a short lingual frenulum and the risk of OSAS in children. Detecting and addressing ankyloglossia in children is necessary before it leads to orofacial changes, malocclusion, and consequently, sleep apnea. Furthermore, OSAS was associated with higher HFP, but no relationship was found between the two parameters.
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Affiliation(s)
- Eliza Brożek-Mądry
- Department of Otorhinolaryngology, Medical University of Warsaw, Poland.
| | | | - Zuzanna Steć
- Department of Otorhinolaryngology, Medical University of Warsaw, Poland
| | | | - Antoni Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Poland
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Burghard M, Brożek-Mądry E, Krzeski A. Sleep disordered breathing in children - Diagnostic questionnaires, comparative analysis. Int J Pediatr Otorhinolaryngol 2019; 120:108-111. [PMID: 30772613 DOI: 10.1016/j.ijporl.2019.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/16/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVES The purpose of this work is to present available questionnaires enabling diagnostic screening when obstructive sleep disordered breathing (SDB) in a child is suspected or its effects are observed and polysomnography is unavailable. These questionnaires are designed to facilitate further diagnostic process or even therapeutic decisions, aid in selecting the optimal one for the specified conditions of clinical practice, with the caveat that none of these represents a diagnostic equivalent to PSG. METHODS The questionnaires subjected to analysis: Pediatric Sleep Questionnaire (PSQ), Sleep Clinical Record (SCR), OSA-18 score (OSA-18), Brouilette score (BS), "I'm Sleepy" questionnaire (I'M SLEEPY), and "Sleeping Sleepless Sleepy Disturbed Rest" questionnaire (SSSDR). The comparative analysis of questionnaires included the following parameters: simplicity and time of administer; necessity to engage a physician or other trained individual; taking into account examination of the patient; type and scope of considered symptoms and consequences of obstructive SDB, sensitivity, specificity, recommendations of the guidelines. RESULTS Seven questionnaires were subjected to analysis with presentation of their similarities and differences. Six out of seven were evaluated as simple in administration. Time required to fulfill the questionnaires ranged between 1 and 60 min. Three of them involved a physician or a trained personnel. Physical examination was necessary in two out of seven questionnaires. Sensitivity was estimated in 5 of them and ranged between 59 and 96%. Specificity ranged between 46 and 72%. CONCLUSIONS Several questionnaires enabling quick, simple, and inexpensive screening for OSAS have been created. Four (of the seven analyzed) questionnaires may be useful in diagnosis of obstructive SDB in children - two follow current (2015) recommendations. However, there is a need for further work on optimizing such tools, particularly on improving their specificity.
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Affiliation(s)
| | - Eliza Brożek-Mądry
- Medical University of Warsaw, Faculty of Medicine and Dentistry, Department of Otorhinolaryngology, Poland.
| | - Antoni Krzeski
- Medical University of Warsaw, Faculty of Medicine and Dentistry, Department of Otorhinolaryngology, Poland
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Brożek-Mądry E, Chmielik LP, Gałązka A, Rogulska J, Frąckiewicz M, Biejat A. Chronic rhinosinusitis in children--bacteriological analysis in terms of cytological examination. Int J Pediatr Otorhinolaryngol 2012; 76:512-22. [PMID: 22305689 DOI: 10.1016/j.ijporl.2012.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/05/2012] [Accepted: 01/08/2012] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The mechanisms of inflammatory response occurring in chronic rhinosinusitis in children are multifactorial. Besides the history and a physical examination, amongst diagnostic tools there are cytological and bacteriological examinations. OBJECTIVES 1 Determining the nature of the bacterial flora present in the nasal cavities and paranasal sinuses in children with chronic rhinosinusitis amongst patients of The Department of Paediatric Otolaryngology,Warsaw Medical University. 2 Determining the relation between bacterial strains and cytological examination of nasal mucosa in children with chronic rhinosinusitis. MATERIALS AND METHODS The study group included 64 patients with chronic rhinosinusitis without polyps. The control group included 30 randomly chosen children. Diagnostic tests performed in both groups were: middle meatal culture and cytological examination from the inferior nasal concha and middle meatus. Statistical analysis was accomplished with Statistica 8.0. CONCLUSIONS Damage to the respiratory epithelial surface is understood as damage to the innate immune barrier, and repeated antibiotic therapy with the subsequent repopulation of the epithelium accidentally by various bacteria can become responsible for the pathogenic effect of bacteria in chronic rhinosinusitis.
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Affiliation(s)
- Eliza Brożek-Mądry
- Department of Paediatric Otolaryngology, Medical University of Warsaw, Poland
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