Acoustic outcomes and voice-related quality of life in male-to-female transsexuals undergoing Wendler glottoplasty: a single-centre experience

INTRODUCTION

Many transsexual women seek to feminise their voice through pitch elevation surgeries so that it becomes congruent with their gender identity. This study aims to determine the safety and effectiveness of Wendler glottoplasty (WG) in vocal feminisation through the assessment of acoustic and aerodynamic parameters of the voice, as well as voice-related quality of life (QoL) in male-to-female transsexuals.

MATERIAL AND METHODS

We retrospectively reviewed the medical records of transsexual women who underwent WG for voice feminisation at our institution between 2016 and 2023. All acoustic and aerodynamic analyses, a voice self-assessment, and a videolaryngostroboscopic evaluation were performed in the immediate preoperative period and at the follow-up visit 6 weeks after the procedure.

RESULTS

A total of 11 patients with a mean age of 32.73 years were included. After WG, there was a significant fundamental frequency and speaking fundamental frequency increase of 109.64 Hz and 83.48 Hz, respectively (p < 0.001), representing an average rise by 9.71 semitones and 8.36 semitones (STs), respectively. No significant differences were found between the mean pre- and postoperative values of fundamental frequencies, frequency range, upper limit of the frequency range of spoken voice, and maximum phonation time. Contrarily, the mean lower limit of frequency range rose by 75.56 Hz (p < 0.001), representing an average increase of 10.56 STs. None of the assessed spirometric parameters changed significantly after WG (p > 0.05). The mean overall Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) scores significantly improved after the surgery, decreasing by 24.54 points (p = 0.008) and 11.5 points (p = 0.001), respectively. A significant improvement was observed in the functional and emotional domains of VHI. Additionally, significantly fewer patients considered the overall quality of their voice to be "poor" after WG.

CONCLUSIONS

WG constitutes an effective method of surgical voice feminisation in male-to-female transsexuals with concurrent improvement in their voice-related QoL. Furthermore, it remains a safe procedure without persistent complications and negative influence on the acoustic-aerodynamic measures of the voice.

The Clinical Significance of Tonsillar Actinomyces in Histopathological Samples after Tonsillectomy

BACKGROUND

Actinomyces is a genus of Gram-positive anaerobic or microaerophilic bacteria with a branched filamentous shape. Their presence in tonsil tissue is usually determined by histopathological examination. In the crypts of removed tonsils, they have a prevalence ranging from 0.8% to 61.6%. The role of Actinomyces in diseases of the palatine tonsils is not clearly defined. The aim of the study was to determine the importance of Actinomyces in the pathology of palatine tonsils and to assess the impact of these bacteria on the clinical data.

METHODS

the retrospective analysis of the histopathological findings of patients undergoing tonsillectomy in our hospital from January 2017 to the end of December 2019 was performed in terms of the occurrence of Actinomyces. The data were collected based on the medical history. The study included 481 patients aged 3-82 years. From the study group, 100 adult patients were randomly selected, and a telephone survey was conducted. The questions included the co-occurrence of bronchial asthma, halitosis, tonsilloliths, and cigarette smoking. The questions were related to the complications following tonsillectomy and the severity of postoperative pain. Existence of a relationship was investigated between occurrence of tonsillar Actinomyces and age, sex, body mass index, and medical condition (obstructive sleep apnea, chronic palatine tonsillitis), respectively. The size of the removed tonsils was assessed and compared depending on the presence of the bacteria.

RESULTS

patients aged 18 years and older had a higher probability of presenting Actinomyces. The estimated odds ratio for the presence of the bacteria per year of age was 1.023 [1.007, 1.041]. No statistically significant results were found for the other variables. The co-occurrence of the bacteria and halitosis was close to statistical significance (p = 0.064).

CONCLUSIONS

multivariate analysis of the role of Actinomyces in tonsillar pathology showed that these microorganisms should be considered saprophytes of the oropharyngeal microflora that had no significant relationship with the pathology of palatine tonsils. Further studies on their influence on halitosis are warranted.

The Analysis of Selected miRNAs and Target MDM2 Gene Expression in Oral Squamous Cell Carcinoma

MiRNAs could play an important role in tumorigenesis and progression. The oncoprotein MDM2 (murine double minute 2) was identified as a negative regulator of the tumour suppressor p53. This study aims to analyse the expression of the MDM2 target miRNA candidates (miR-3613-3p, miR-371b-5p and miR-3658) and the MDM2 gene in oral squamous cell carcinoma tumour and margin samples and their association with the selected socio-demographic and clinicopathological characteristics. The study group consisted of 50 patients. The miRNAs and MDM2 gene expression levels were assessed by qPCR. The expression analysis of the miRNAs showed the expression of only one of them, i.e., miR-3613-3p. We found no statistically significant differences in the miR-3613-3p expression in tumour samples compared to the margin samples. When analysing the effect of smoking on miR-3613-3p expression, we demonstrated a statistically significant difference between smokers and non-smokers. In addition, we showed an association between the miR-3613-3p expression level and some clinical parameters in tumour samples (T, N and G). Our study demonstrates that miR-3613-3p overexpression is involved in the tumour progression of OSCC. This indicates that miR-3613-3p possesses potential prognostic values.

Erbium:Yttrium Aluminum Garnet (Er:YAG) Laser: A Minimally Invasive Treatment Method in Selected Patients with Impaired Breathing During Sleep-The Assessment of Treatment Effectiveness After 4 Years

Objective: The aim of this study was to assess the long-term outcomes of nonablative Er:YAG laser treatment for snoring. Background data: Nonablative Er:YAG laser treatment has been shown to improve subjective quality of sleep without serious adverse effects, but long-term data are lacking. Materials and methods: Twenty-four patients with snoring problems due to soft palate hypertrophy were treated with three treatment procedures with Er:YAG laser performed at 2-week intervals. Subjective (questionnaires) and objective (polygraph) outcome measures were assessed at baseline, 3 months, and 4 years after the final laser treatment. Results: Twenty patients returned for the 4 years follow-up. The significant improvement in subjective sleep outcomes observed 3 months after Er:YAG laser treatment was still significant 4 years after treatment. No significant improvement or deterioration in objective polygraph outcome measures was observed during the 4 years of follow-up in our study. No side effects of laser treatment were observed. Conclusions: The Er:YAG laser treatment presents a safe and well-tolerated snoring treatment alternative for patients with airway obstruction in the oropharynx with improvement in subjective sleep outcomes lasting up to 4 years.

Sequencing Analysis of MUC6 and MUC16 Gene Fragments in Patients with Oropharyngeal Squamous Cell Carcinoma Reveals Novel Mutations: A Preliminary Study

The growing incidence of oropharyngeal squamous cell carcinoma (OPSCC) calls for better understanding of the mutational landscape of such cases. Mucins (MUCs) are multifunctional glycoproteins expressed by the epithelial cells and may be associated with the epithelial tumour invasion and progression. The present study aimed at the analysis of the sequence of selected MUC6 and MUC16 gene fragments in the tumour, as well as the margin, samples obtained from 18 OPSCC patients. Possible associations between the detected mutations and the clinicopathological and demographic characteristics of the study group were analysed. Sanger sequencing and bioinformatic data analysis of the selected MUC6 and MUC16 cDNA fragments were performed. Our study found 13 and 3 mutations in MUC6 and MUC16, respectively. In particular, one novelty variant found that the MUC6 gene (chr11:1018257 A>T) was the most frequent across our cohort, in both the tumour and the margin samples, and was then classified as a high impact, stop-gain mutation. The current study found novel mutations in MUC6 and MUC16 providing new insight into the genetic alternation in mucin genes among the OPSCC patients. Further studies, including larger cohorts, are recommended to recognise the pattern in which the mutations affect oropharyngeal carcinogenesis.

Low Prevalence of HSV-1 and Helicobacter pylori in HNSCC and Chronic Tonsillitis Patients Compared to Healthy Individuals

Recent studies identified viral and bacterial factors, including HSV-1 and H. pylori, as possible factors associated with diseases such as chronic tonsillitis and cancers, including head and neck squamous cell carcinoma (HNSCC). We assessed the prevalence of HSV-1/2 and H. pylori in patients with HNSCC, chronic tonsillitis, and healthy individuals using PCR after DNA isolation. Associations were sought between the presence of HSV-1, H. pylori, and clinicopathological and demographic characteristics and stimulant use. HSV-1 and H. pylori were most frequently identified in controls (HSV-1: 12.5% and H. pylori: 6.3%). There were 7 (7.8%) and 8 (8.6%) patients with positive HSV-1 in HNSCC and chronic tonsillitis patients, respectively, while the prevalence of H. pylori was 0/90 (0%) and 3/93 (3.2%), respectively. More cases of HSV-1 were observed in older individuals in the control group. All positive HSV-1 cases in the HNSCC group were associated with advanced tumor stage (T3/T4). The prevalence of HSV-1 and H. pylori was highest in the controls compared to HNSCC and chronic tonsillitis patients, which indicates that the pathogens were not risk factors. However, since all positive HSV-1 cases in the HNSCC group were observed only in patients with advanced tumor stage, we suggested a possible link between HSV-1 and tumor progression. Further follow-up of the study groups is planned.

Assessment of Osteoporosis and Vitamin D3 Deficiency in Patients with Idiopathic Benign Paroxysmal Positional Vertigo (BPPV)

Background and objectives: Osteoporosis and vitamin D3 deficiency may be risk factors of benign paroxysmal positional vertigo (BPPV). The aim of this study was to assess the prevalence of osteoporosis and 25(OH) vitamin D3 deficiency in a group of patients with idiopathic benign paroxysmal positional vertigo. Materials and Methods: Thirty-five patients (twenty-eight women and seven men) with posterior semicircular canal BPPV were enrolled in the study. The subjects underwent hearing assessment (tonal audiometry and impedance audiometry) and the Dix-Hallpike maneuver. Serum 25(OH) vitamin D3 levels were determined and lumbar spine bone densitometry was performed. The relationships between sex, age, height, Body Mass Index (BMI), vitamin D3 levels and bone densitometry results were assessed. Results: The diagnosis of osteoporosis was confirmed in 1 patient (3%), 3 subjects were osteopenic (8.6%), and normal bone densitometry was found in 31 (88.6%) patients. Conclusions: We found no statistically significant relationships between age, BMI or vitamin D3 levels and bone densitometry results in patients with idiopathic BPPV.

The Potential Association between E2F2, MDM2 and p16 Protein Concentration and Selected Sociodemographic and Clinicopathological Characteristics of Patients with Oral Squamous Cell Carcinoma

BACKGROUND

E2F transcription factor 2 (E2F2), murine double minute 2 (MDM2) and p16 are some of the key proteins associated with the control of the cell cycle. The aim of this study was to evaluate E2F2, MDM2 and p16 concentrations in the tumour and margin samples of oral squamous cell carcinoma and to assess their association with some selected sociodemographic and clinicopathological characteristics of the patients.

METHODS

The study group consisted of 73 patients. Protein concentrations were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

There were no statistically significant differences in the levels of E2F2, MDM2 or p16 in the tumour samples as compared to the margin specimens. We found that patients with N0 showed significantly lower E2F2 concentrations than patients with N1 in the tumour samples and the median protein concentration of E2F2 was higher in HPV-negative patients in the tumour samples. Moreover, the level of p16 in the margin samples was lower in alcohol drinkers as compared to non-drinkers. Similar observations were found in concurrent drinkers and smokers compared to non-drinkers and non-smokers.

CONCLUSIONS

E2F2 could potentially promote tumour progression and metastasis. Moreover, our results showed a differential level of the analysed proteins in response to alcohol consumption and the HPV status.

Non‑viral transfection methods optimized for miRNA delivery to human dermal fibroblasts

Fibroblasts are beneficial model cells for in vitro studies and are frequently used in tissue engineering. A number of transfection reagents have been employed to deliver microRNAs (miRNAs/miRs) into cells for genetic manipulation. The present study aimed to establish an effective method of transient miRNA mimic transfection into human dermal fibroblasts. The experimental conditions included three different methods: Physical/mechanical nucleofection, and two lipid‑based methods, Viromer^® Blue and INTERFERin^®. To evaluate the impact of these methods, cell viability and cytotoxicity assays were performed. The silencing effect of miR‑302b‑3p was revealed to alter the expression levels of its target gene carnitine O‑octanoyltransferase (CROT) by reverse transcription‑quantitative PCR. The present study showed that all selected non‑viral transient transfection systems exhibited good efficiency. It was also confirmed that nucleofection, for which a 21.4‑fold decrease in the expression of the CROT gene was observed 4 h after 50 nM hsa‑miR‑302b‑3p transfection, was the most effective method. However, these results indicated that lipid‑based reagents can maintain the silencing effect of miRNAs up to 72 h after transfection. In summary, these results indicated that nucleofection may be the optimal method for the transport of small miRNA mimics. However, lipid‑based methods allow for the use of lower concentrations of miRNA and maintain longer‑lasting effects.

Salvage surgery in laryngeal cancer after radiotherapy and partial surgery - comparative results

Objective

The study is a retrospective comparison of the usefulness of salvage surgery between a group of previously radiotherapy-treated patients (RTPs) and a group of patients who previously underwent partial surgery with both local and ± nodal recurrence.

Study Design

Retrospective study.

Setting

Multi-center academic hospital.

Materials and Methods

The former group was comprised 30 previously RTPs, whereas the latter group consisted of 20 patients after partial laryngeal surgery with optional subsequent adjuvant radiotherapy (PSPs). Treatment efficacy was compared in both groups in relation to overall survival (OS) and the locoregional control rate (LCR). Local and ± nodal recurrence was considered primary treatment failure. All patients underwent total laryngectomy.

Results

The updated 5-year OS in the PSPs was 31%, while the percentage of the updated 5-year LCR was 42%. In the RTPs the updated 5-year OS was 21%, and the percentage of 5-year LCR was 38%. No statistically significant differences were found in terms of the comparison of OS or the comparison of LCR results in both groups (P = 0.427, P = 0.704, respectively).

Conclusions

Based on the analysis, it was found that irrespective of the initial treatment, salvage surgery was associated with decreased survival and cure rates (by 50%) compared to the group of patients with advanced laryngeal cancer who underwent primary total laryngectomy.

miR-125b-5p, miR-155-3p, and miR-214-5p and Target E2F2 Gene in Oral Squamous Cell Carcinoma

It is known that E2F2 (E2F transcription factor 2) plays an important role as controller in the cell cycle. This study aimed to analyse the expression of the E2F2 gene and E2F2 protein and demonstrate E2F2 target microRNAs (miRNAs) candidates (miR-125b-5p, miR-155-3p, and miR-214-5p) in oral squamous cell carcinoma tumour and margin samples. The study group consisted 50 patients. The E2F2 gene and miRNAs expression levels were assessed by qPCR, while the E2F2 protein was assessed by ELISA. When analysing the effect of miRNAs expression on E2F2 gene expression and E2F2 protein level, we observed no statistically significant correlations. miR-125b-5p was downregulated, while miR-155-3p, and miR-214-5p were upregulated in tumour samples compared to margin. We observed a difference between the miR-125b-5p expression level in smokers and non-smokers in margin samples. Furthermore, HPV-positive individuals had a significantly higher miR-125b-5p and miR-214-5p expression level compared to HPV-negative patients in tumour samples. The study result showed that the E2F2 gene is not the target for analysed miRNAs in OSCC. Moreover, miR-155-3p and miR-125b-5p could play roles in the pathogenesis of OSCC. A differential expression of the analysed miRNAs was observed in response to tobacco smoke and HPV status.

Selected SNPs of FCN2 Associated with Chronic Tonsillitis in the Polish Adult Population

Chronic tonsillitis is a problem related to bacterial and viral infections. Ficolins play a key role in the defence against various pathogens. In the present study, we investigated the associations between the selected single nucleotide polymorphisms (SNPs) of the FCN2 gene and chronic tonsillitis in the Polish population. The study included 101 patients with chronic tonsillitis and 101 healthy individuals. The selected SNPs of FCN2 (rs3124953, rs17514136 and rs3124954) were genotyped using TaqMan SNP Genotyping Assays (Applied Biosystem, Foster City, CA, USA). The analysis of rs17514136 and rs3124953 showed no significant differences in genotype frequencies between the chronic tonsillitis patients and controls (p > 0.01). The CT genotype of rs3124954 was significantly more frequent, while the CC genotype was less frequent in chronic tonsillitis patients (p = 0.003 and p = 0.001, respectively). The frequency of the A/G/T haplotype (rs17514136/rs3124953/rs3124954) was significantly more common in chronic tonsillitis patients (p = 0.0011). Moreover, the FCN2 CT genotype of rs3124954 was associated with a higher risk of chronic tonsillitis, while the CC genotype of rs3124954 decreased this risk. Our findings demonstrate that FCN2 rs3124954 may be associated with chronic tonsillitis in the Polish adult population.

Low intensity whole-body oxidative stress in patients with parotid gland tumors

Recently, there has been a significant increase in the number of patients hospitalized and undergoing surgery due to parotid gland tumors. We have observed an increase in the total number of salivary gland tumors, and hence an increased number of malignant tumors. Etiological factors of salivary gland tumors are still unknown. Oxidative stress (OS) has been suggested to be an important indicator of carcinogenesis in some tumors. Therefore, the aim of our study was to assess the state of OS in patients with selected benign and malignant parotid gland tumors. After final postoperative histological diagnosis of the tumor, patients were divided into the following groups i.e. pleomorphic adenoma 35 patients, Warthins tumor (WT) - 17 patients, mucoepidermoid carcinoma - 9 patients and 45 controls. The final study group included 106 patients. We found an increase in plasma lipofuscin levels in patients with all investigated parotid gland tumors. Furthermore, the activity of Cu/Zn-SOD in Warthins tumor patients was statistically lower compared to the controls, pleomorphic adenoma or mucoepidermoid carcinoma.In conclusion, we sustain the hypothesis on the presence of a low intensity whole-body OS in patients with parotid gland tumors. Furthermore, LPS may be a useful marker of OS in patients with benign and malignant tumors. Moreover, pathological mechanisms connected with WT seem to be different compared to malignant neoplasms and other benign tumors. It seems that Cu/Zn-SOD, as an antioxidative enzyme, may play an important role in those mechanisms taking part in WT.

Omalizumab added to allergen immunotherapy increased the effect of therapy in patients with severe local allergic rhinitis

BACKGROUND

Allergen immunotherapy (AIT) is effective in patient with local allergic rhinitis (LAR). However, AIT may not always achieve the optimal treatment effect.

OBJECTIVE

To present short study with clinical cases of LAR combined therapy with sublingual immunotherapy (SLIT) and omalizumab in patients with house dust mite (HDM) allergy and compared it to therapy with omalizumab alone.

METHODS

Patients with severe LAR and hypersensitivity to HDMs were included. SLIT for HDMs was launched in a perennial protocol using SQ-HDM SLIT tablets with omalizumab. The total rhinitis symptom score (TRSS), total medication score (TMS) and combined total score (CTS) were assessed after one year.

RESULTS

After 12 months, significant improvements in all analyzed parameters in the patients on SLIT+ omalizumab therapy were observed: a reduction in the TRSS from 1.21 ± 0.33 to 0.6 ± 0.28 (p < .05), a reduction in the TMS from 2.25 ± 1.05 to 0.88 ± 0.31 (p < .05) and a reduction in the CTS from 3.46 ± 0.57 to 1.48 ± 0.51 (p < .05). This improvement in TRSS, TMS also in CTS was significantly greater than in the rest of the group with SLIT alone or omalizumab alone.

CONCLUSION

Omalizumab may be a valuable treatment that increases the effectiveness of immunotherapy in patients with severe LAR.

Prospective Assessment of Risk Factors Influencing Facial Nerve Paresis in Patients after Surgery for Parotid Gland Tumors

Background and objectives: Facial weakness is the most important complication of parotid gland tumor surgery. The aims of this study are as follows: (1) assessment of the prevalence of postparotidectomy facial nerve dysfunction; (2) clinical and electrophysiological assessment of the facial nerve function before parotidectomy and at 1 and 6 months postoperatively; (3) assessment of the association of postoperative facial palsy with selected risk factors; and (4) assessment of the correlation between the results of clinical and neurophysiological assessments of facial nerve function. Materials and Methods: This study comprised 50 patients (aged 24-75 years) who underwent parotidectomy at the Department of Otolaryngology and Laryngological Oncology in Zabrze, Poland between 2015 and 2017. The evaluation included neurological, clinical and electrophysiological assessments of the facial nerve prior to surgery and at 1 and 6 months postoperatively. Results: No facial palsy was found preoperatively or 6 months postoperatively. Facial nerve dysfunction was found in 74% of patients 1 month postoperatively. In most cases (54%), paresis was mild or moderate (House-Brackmann grades II and III). The results of electrophysiological tests before parotidectomy were either normal or showed some mild abnormalities. We found a statistically significant correlation between the clinical assessment of the facial nerve function (based on the House-Brackmann scale) one month postoperatively and the latency of the CMAP response from the orbicularis oculi and orbicularis oris muscles. In all three studies, a statistically significant correlation was found between the amplitude of the compound muscle action potential (CMAP) of the orbicularis oris muscle and the degree of facial nerve weakness. Conclusions: The factors that may influence the risk of postoperative facial nerve paralysis (prolonged surgical time and the size and location of the tumor other than in the superficial lobe only) may indirectly suggest that surgery-related difficulties and/or surgeon experience could be crucial to surgery safety.

Expression Profiles of CDKN2A, MDM2, E2F2 and LTF Genes in Oral Squamous Cell Carcinoma

BACKGROUND

Oral squamous cell carcinoma (OSCC) is one of the most commonly detected neoplasms worldwide. Not all mechanisms associated with cell cycle disturbances are known in OSCC. Examples of genes involved in the control of the cell cycle are CDKN2A, MDM2, E2F2 and LTF. The aim of this study was to examine the possible association between CDKN2A, MDM2, E2F2 and LTF mRNA expression and influence on clinical variables.

METHODS

The study group consisted of 88 Polish patients. The gene expression levels were assessed by quantitative reverse transcription PCR.

RESULTS

We found no statistically significant differences in the expression level of CDKN2A, MDM2, E2F2 and LTF genes in tumour samples compared to margin samples. No association was found between the gene expression levels and clinical parameters, except E2F2. The patients with G2 tumours had a significantly higher gene expression level of E2F2 than patients with low-grade G1 tumours.

CONCLUSIONS

We have not demonstrated that a change in expression profiles of genes has a significant impact on the pathogenesis of OSCC. It may also be useful to conduct further studies on the use of E2F2 expression profile changes as a factor to describe the invasiveness and dynamics of OSCC development.

Analysis of the Effectiveness of Arytenoidectomy and Posterior Cordectomy with the Use of CFD Airflow Measurements in Patients with BVFP: A Retrospective Study

PURPOSE

Bilateral vocal fold paralysis (BVFP) is a rare larynx disease manifested by dyspnea, which often requires surgical treatment. The aim of the study is to determine the effectiveness of unilateral arytenoidectomy with posterior cordectomy in the treatment of BVFP using the computational fluid dynamics (CFD) method.

METHODS

This study included 33 patients with BVFP who underwent unilateral laser arytenoidectomy with posterior cordectomy. Glottis area measurements and spirometry, as well as a self-assessment of respiratory efficiency were performed before the surgery and after the recovery period. Using the CFD method, computer models of the glottis were made. Then, changes in air pressure gradient and maximum air velocity at the level of glottis were calculated, and local fields of pressure and air velocities were obtained.

RESULTS

The values of glottal surface area (S), spirometry parameters (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF)), inlet air velocity at the glottal level as well as patients self-assessment of respiratory efficiency turned out to be significantly higher after the operation. The values of maximum velocity at the glottal level, pressure gradient at the glottal level turned out to be significantly lower after the surgery. We observed that the greater the increase in glottal surface area, the greater the decrease in self-assessment scales (visual analogue scale (VAS) and Medical Research Council (MRC)). Increased levels of spirometry parameters after the surgery correlated with smaller decrease of PEF-dependent pressure gradient at the glottal level (PEFΔP CFD).

CONCLUSION

Unilateral laser arytenoidectomy with posterior cordectomy is an effective method for the treatment of BVFP. CFD is a useful tool to determine and visualize the effectiveness of surgical treatment in BVFP.

Factors Associated with Outcomes Following Salvage Surgery for Recurrent Laryngeal Cancer: A Retrospective Study of 50 Cases from a Single Center in Poland

BACKGROUND This retrospective study from a single center in Poland aimed to identify factors associated with outcomes following salvage surgery in 50 patients with recurrent laryngeal cancer. MATERIAL AND METHODS The study group consisted of 50 patients with recurrent laryngeal cancer after primary organ preservation treatment (12 patients after partial surgery, 30 patients after radiation therapy, and 8 patients after prior treatment using both methods). None of the patients received chemotherapy before salvage surgery. All patients with recurrence of laryngeal cancer underwent total laryngectomy with elective bilateral nodal surgery. Local and/or nodal recurrence was considered the failure of primary organ preservation treatment. Efficacy of treatment was assessed in relation to overall survival (OS), disease-free survival (DFS), local control (LC), and locoregional control (LRC). RESULTS Treatment results showed a poor prognosis in patients with local and/or nodal recurrence of laryngeal cancer. In the study group, the updated 5-year rates were as follows: OS rate of 26%; DFS rate of 25%; LC rate of 44%; and LRC rate of 39%. Univariate analysis showed that the stage before primary treatment was a predictive factor of OS (P=0.012). CONCLUSIONS The findings from this retrospective study of 50 patients with recurrent laryngeal carcinoma showed that salvage surgery following organ preservation treatment resulted in a 5-year OS rate of 26%.

Tracking of the biochemical changes upon pleomorphic adenoma progression using vibrational microspectroscopy

Head and neck tumors can be very challenging to treat because of the risk of problems or complications after surgery. Therefore, prompt and accurate diagnosis is extremely important to drive appropriate treatment decisions, which may reduce the chance of recurrence. This paper presents the original research exploring the feasibility of Fourier transform infrared (FT-IR) and Raman spectroscopy (RS) methods to investigate biochemical alterations upon the development of the pleomorphic adenoma. Principal component analysis (PCA) was used for a detailed assessment of the observed changes and to determine the spectroscopic basis for salivary gland neoplastic pathogenesis. It is implied that within the healthy margin, as opposed to the tumoral tissue, there are parts that differ significantly in lipid content. This observation shed new light on the crucial role of lipids in tissue physiology and tumorigenesis. Thus, a novel approach that eliminates the influence of lipids on the elucidation of biochemical changes is proposed. The performed analysis suggests that the highly heterogeneous healthy margin contains more unsaturated triacylglycerols, while the tumoral section is rich in proteins. The difference in protein content was also observed for these two tissue types, i.e. the healthy tissue possesses more proteins in the anti-parallel β-sheet conformation, whereas the tumoral tissue is dominated by proteins rich in unordered random coils. Furthermore, the pathogenic tissue shows a higher content of carbohydrates and reveals noticeable differences in nucleic acid content. Finally, FT-IR and Raman spectroscopy methods were proposed as very promising methods in the discrimination of tumoral and healthy tissues of the salivary gland.

Etiology, Early Diagnosis and Proper Treatment of Silent Sinus Syndrome Based on Review of the Literature and Own Experience

PURPOSE

The authors' aim was to review the literature in terms of the etiology of the syndrome, the frequency of Silent Sinus Syndrome (SSS) and surgical procedure, as well as to present their own experience.

METHODS

The authors used PubMed, Medline, and Science Direct websites to find and review the most significant papers related to SSS. The case reports of SSS published between 2010 and 2020 were reviewed. A retrospective case review of 8 patients with SSS treated at the authors' departments was done.

RESULTS

The silent sinus syndrome has been reported in both children and adults. It is relatively rare and should be differentiated from congenital sinus hypoplasia or atelectasis. It most often affects the maxillary sinus. SSS is usually diagnosed when facial asymmetry or vision problems occur. Late diagnosis requires endoscopic sinus surgery, involving orbital wall reconstruction. The etiology of the syndrome, including the role of bacterial flora found in the sinuses, is unclear.

CONCLUSION

Early diagnosis of SSS enables avoiding orbital complications and limits surgical intervention to endoscopic surgery. Further research into bacteriology may help to understand the pathophysiology of the silent sinus syndrome.

Randomised clinical trial on 7-days-a-week postoperative radiotherapy vs. concurrent postoperative radio-chemotherapy in locally advanced cancer of the oral cavity/oropharynx

OBJECTIVE

To compare the efficacy and tolerance of 7-days-a-week accelerated postoperative radiotherapy (p-CAIR) vs postoperative radio-chemotherapy (p-RTCT).

METHODS

Between September 2007 and October 2013, 111 patients were enrolled and randomly assigned to receive 63 Gy in 1.8 Gy fractions 7-days-a-week (n = 57, p-CAIR) or 63 Gy in 1.8 Gy fractions 5-days-a-week with concurrent cisplatin 80-100 mg per square meter of body-surface area on days 1, 22 and 43 of the radiotherapy course (p-RTCT). It represents approximately 40% of the intended trial size, that was closed prematurely due to slowing accrual. Only high-risk patients with squamous cell cancer of the oropharynx/oral cavity, considered fit for concurrent treatment were enrolled.

RESULTS

The rate of locoregional control (LRC) did not differ significantly between treatment arms (p = 0.18, HR = 0.56), 5 year LRC tended, however, to favour p-RTCT (81%) vs p-CAIR (62%). There was no difference in overall survival between treatment arms (p = 0.90, HR = 1.03).The incidence and severity of acute mucosal reactions and late reactions did not differ significantly between treatment arms. Haematological toxicity of p-RTCT was, however, considerably increased compared to p-CAIR.

CONCLUSION

Concurrent postoperative RTCT tended to improve locoregional control rate as compared to p-CAIR. This, however, did not transferred into improved overall survival. Postoperative RTCT was associated with a substantial increase in haematological toxicity that negatively affected treatment compliance in this arm.

ADVANCES IN KNOWLEDGE

To our knowledge, this is the first trial that compares accelerated radiotherapy and radio-chemotherapy in postoperative treatment for oralcavity/oropharyngeal cancer.

Natural Killer (NK)//T-Cell Lymphoma, Nasal Type, with Periorbital Involvement: A Case Report and Literature Review

Patient: Female, 36-year-old

Final Diagnosis: NK/T-cell lymphoma

Symptoms: Nasal congestion • rhinorrea • sinus congestion

Medication: —

Clinical Procedure: —

Specialty: Otolaryngology

Nanoscale infrared probing of amyloid formation within the pleomorphic adenoma tissue

BACKGROUND

The process of malignant transformations of many tumour cases is still unclear and more specific experimental approaches are necessary. The detailed identification of the pathological changes may help in the therapy progression through the development of drugs with more selective action.

METHODS

In this study, the AFM-IR nanospectroscopy was applied for the first time to the pleomorphic adenoma (TM) and the marginal tissue characterizations. In order to verify the obtained spectral information, conventional FT-IR investigations were also performed.

RESULTS

The AFM-IR data (topographies, intensity maps, and spectra) show structural changes observed for the margin and TM samples. Additionally, within the tumour tissue the fibril-like areas, characteristic for amyloid diseases, were distinguished.

CONCLUSIONS

The application of AFM-IR allows to determine changes in the protein secondary structures between the fibrils and the regions outside them. It has been proved that, for the former areas, the α-helix/random coil/ β-sheet components dominate, while for the latter regions the α-helix/random coil indicate the main contribution to the protein composition.

GENERAL SIGNIFICANCE

The FT-IR results remain in good agreement with the AFM-IR data recorded for the areas outside the fibrils of the TM. This observation confirms that by means of the conventional FT-IR method the identification of the considered fibrils structure would be impossible. Only application of the AFM-IR nanospectroscopy allow for characterization and visualization of the fibrillization process occurring within the investigated tumour tissue.

Selected CDKN2A and MDM2 polymorphisms in oral cavity cancer

The head and neck squamous cell carcinoma (HNSCC) is an aggressive human malignancy diagnosed in more than 800 000 new cases worldwide, and mostly arises in the oral cavity, oropharynx, larynx, hypopharynx, and nasopharynx. The study presented here aimed to determine a possible association of rs11515 and rs3088440 gene polymorphisms in the CDKN2A gene (cyclin dependent kinase inhibitor 2A), as well as rs769412 and rs937283 in the MDM2 gene (murine double minute 2), with oral cavity cancer in a sample of Polish population; CDKN2A is crucial in regulating the cell cycle while MDM2 is an oncogene involved in regulating cell proliferation and apoptosis. The study included 95 primary tumor samples following surgical resection from patients, and the control group consisted of 100 healthy individuals. DNA samples were genotyped by employing the 5' nuclease assay for allelic discrimination using TaqMan SNP Genotyping Assays (Applied Biosystems, USA). There was no significant association between any of the polymorphism (rs11515, rs3088440, rs769412 and rs937283) and the oral cavity cancer risk. We found that the AA homozygotes for rs3088440 were significantly more frequent in the control group (OR=0.046, p<0.0001). In addition, the GG genotype of rs769412 was not found in any group. We found no influence of the examined genotypes on clinicopathological parameters, such as T, N and grading values in patients with oral cavity cancer. The results of this study indicate that none of the investigated polymorphisms were associated with the risk of oral cavity cancer in the examined sample of the Polish population.

Genuine halitosis in patients with dental and laryngological etiologies of mouth odor: severity and role of oral hygiene behaviors

The aims of the study were to determine the severity of halitosis and the association between oral hygiene practices and the severity of malodor in patients with dental and laryngological etiologies of genuine halitosis. Thirty-five laryngological and 40 dental patients with halitosis completed a structured interview and underwent laryngological and dental examinations. Halitosis was assessed using organoleptic and halimeter tests. Greater halitosis severity in laryngological patients was associated with worse clinical status of the palatine tonsils, less frequent toothbrushing, less frequent use of tongue cleaners, fewer daily meals, and increased use of mouthrinses. Among dental patients, more severe halitosis was associated with worse clinical status of the periodontium, more tongue coating, less saliva secretion, and less frequent use of dental floss, interdental toothbrushes, and tongue cleaners. Oral hygiene was found to be a key moderator of the relationship between status of the periodontium or tonsils and severity of halitosis. The severity of halitosis in laryngological patients and dental patients is essentially similar; however, oral hygiene routines are associated with different effects in each group. Consequently, individual recommendations for patients with halitosis should be adjusted for the underlying disease and emphasize the role of effective specific hygiene behaviors.

Computational fluid dynamics in the assessment of patients' postoperative status after glottis-widening surgery

BACKGROUND

Computational fluid dynamics (CFD), a rapidly developing instrument with a number of practical applications, allows calculation and visualization of the changing parameters of airflow in the upper respiratory tract.

OBJECTIVES

The aim of this study was to demonstrate the advantages of CFD as an instrument for noninvasive tests of the larynx in patients who had undergone surgical treatment due to bilateral vocal fold paralysis.

MATERIAL AND METHODS

Surface measurements of the glottic space were made during maximum adduction of the vocal folds. Additionally, the following spirometric parameters were determined: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and peak expiratory flow (PEF) rate. Based on the measurements, commercial mesh generation software was used to develop a geometrical model of the glottic space. The computations were carried out using a general purpose CFD code. The analysis included patients who were surgically treated for BVFP in the authors' department between 1999 and 2012. The study group consisted of 22 women (91.67%) and 2 men (8.33%).

RESULTS

It was observed that the pressure drop calculated for free breathing depends on the area of the glottis and is independent of its shape. Importantly, for areas below approx. 40 mm2, a sudden rise occurred in the resistance to flow; for the smallest glottic areas studied, the pressure drop was almost 6 times higher than for an area of 40 mm2. Consequently, in cases of areas below 40 mm2 even minor enlargement of the glottic opening can lead to a marked improvement in breathing comfort.

CONCLUSIONS

Computational fluid dynamics is a useful method for calculating and visualizing the changing parameters of airflow in the upper respiratory tract.

The surgical treatment results of otosclerosis at the Department of Otolaryngology Silesian Medical University in Zabrze in years 2000–2010

Background: Otosclerosis is a cause of 5–9% of all hearing loss. The most effective treatment of otoslerosis is stapedotomy. Aim: The aim of this study was to evaluate the results of otosclerosis surgical treatment and to examine the impact of disease stage, time of the signs, age and sex on the results. Material and methods: 105 patients who underwent operation due to otosclerosis at the Department of Otolaryngology University Hospital in Zabrze at the age of 18–65 were analyzed. In 25 patients stapedotomy was bilateral. 130 cases of treated ears were included in the statistical analysis. The state of hearing after operation was evaluated with regard to guidance of Hearing and Balance Committee of American Academy of Otolaryngology – Head and Neck Surgery and with consideration of suggestions made by European Academy of Otolaryngology and Neurootology. Mean values of bone and air conduction, air bone gap before, one year after treatment, and at least 4 years after surgery were compared. The influence of stage of the disease in terms of Shambaugh index, lasting of signs, age and sex were evaluated with regard to change of mean hearing loss according to Bell Telephone Laboratories. Results: On the basis of hearing examination evaluating improvement in air and bone conduction and reduction of cochlear reserve, very good and good treatment results were obtained in over 90% of patients in short and long term observations. No influence of disease stage, time of signs lasting, age and sex on the results of treatment – with regard to change in mean hearing loss was shown.

Is immunohistochemical evaluation of p16 in oropharyngeal cancer enough to predict the HPV positivity?

AIM

Our goal was to determine the expression levels of p16 in the cohort of the OPSCC patients and evaluation of the pathological and clinical differences between these two groups including patients' survival.

BACKGROUND

HPV infection is the main causative factor of oropharyngeal cancer (OPSCC). Identification of HPV status in OPSCC requires positive evaluation of viral DNA integration into host cell however, p16 accumulation in the proliferating cell layers has been accepted as an alternative marker for HPV infection.

MATERIAL AND METHODS

The IHC staining for p16 has been performed in tumor tissue from 382 OPSCC patients. The sample was considered positive based on more than 70% of carcinoma tissue showing strong and diffused nuclear and cytoplasmic immunostaining. The clinicopathological characteristics of the patients including site, age, gender, tumor grade, tumor stage, the nodal status, smoking and survival have been analyzed when comparing p16 positive and p16 negative tumors.

RESULTS

Out of our cohort in 38.2% cases positive staining for p16 has been recorded. Our analysis did not indicate significant differences in the distribution of the p16 positive patients and age of the patients, stage of the disease. Among the patients who have presented with the N+ neck, there were significantly more p16 positive tumors than in the group with N0 neck (p = 0.0062). There was highly significant correlation between the expression of p16 and smoking (p < 0.0001). The significant difference in survival (p < 0.0001) with more favorable prognosis in the p16 positive group has been observed.

CONCLUSIONS

Overexpression of p16 is accepted as a surrogate diagnostic marker for detecting HPV infection in oropharyngeal cancer. However, one should remember about existence of the small subgroups of p16 positive but HPV negative tumors, with relatively worse prognosis. Immunostaining for p16, however useful on everyday basis, should be complemented with other techniques in terms of reliable identification of the HPV infection.

Sex-Related Cochlear Impairment in Cigarette Smokers

Background

A number of studies have documented the influence of cigarette smoking on hearing. However, the association between sex and hearing impairment in smokers as measured by otoacoustic emissions (OAEs) has not been clearly established. The aim of this study was to analyze sex-specific effects of smoking on hearing via conventional and ultra-high-frequency pure tone audiometry (PTA), and OAEs, specifically spontaneous OAEs, click-evoked OAEs, and distortion-product OAEs.

Material/Methods

The study included 84 healthy volunteers aged 25–45 years (mean 34), among them 46 women (25 non-smokers and 21 smokers) and 38 men (16 non-smokers and 22 smokers). The protocol of the study included otoscopic examination, tympanometry, low-, moderate-, and ultra-high-frequency PTA, evaluation of spontaneous click-evoked (CEAOEs) and distortion-product otoacoustic emissions (DPOAEs), assessment of the DP-grams for 2f₁-f₂ (f₁ from 977 to5 164 Hz), and input/output function at L₂ primary tone level of 40–70 dB SPL.

Results

Smokers and non-smokers did not differ significantly in terms of their hearing thresholds assessed with tone audiometry. Male smokers presented with significantly lower levels of CEAOEs and DPOAEs than both male non-smokers and female smokers.

Conclusions

Smoking does not modulate a hearing threshold determined with PTA at low, moderate, and ultra-high frequencies, but causes a significant decrease in OAE levels. This effect was observed only in males, which implies that they are more susceptible to smoking-induced hearing impairment. Sex-specific differences in otoacoustic emissions level may reflect influences of genetic, hormonal, behavioral, and/or environmental factors.

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography

BACKGROUND The aim of the study was to determine the prevalence of petrosquamosal sinus (PSS) and other temporal bone (TB) anatomical variations in various patients using high-resolution computed tomography (CT). MATERIAL AND METHODS We reviewed clinical and consecutively obtained CT data for 276 TBs of 138 patients. The incidence of TB anatomical variations was compared among patients with radiological markers of chronic otitis media (RCOM) and non-RCOM. RESULTS The PSS incidence in our sample was 6.9%, and it was significantly higher in TBs with RCOM (14.6%). Selected anatomical variations of RCOM TBs were observed: lateral sigmoid sinus (14.5%), prominent sigmoid sinus (23.6%), PSS (14.6%), and high jugular bulb (17.3%). Lateral sigmoid sinus and prominent sigmoid sinus (p<0.01), high jugular bulb (p<0.05), and PSS (p<0.01) were observed more often in RCOM than in non-RCOM TBs. CONCLUSIONS The TB vascular and anatomical variations, including PSS, a high jugular bulb, and a laterally and prominent placed sigmoid sinus, were more often observed in TBs with RCOM. Presurgical imaging and CT-based navigation techniques for TB surgery can offer remarkable value for understanding the altered anatomy of this complex structure and can localize rare anatomical variations.

Cell-cycle gene expression analysis using real time PCR in locally advanced squamous-cell head and neck cancer

PURPOSE

The analysis of gene expression, especially those involved in cell cycle control, can help to discover mechanisms determining the outcome of radiation treatment. The main purpose of this study was to examine the expression level of genes responsible for cell cycle regulation in samples of the head and neck cancer, obtained during surgery.

METHODS

Postsurgical samples of SCC of head and neck region were collected. Over 80 genes were analysed using cell cycle quantitative real-time RT-PCR Array method. Presence of 14 high-risk HPV types DNA in frozen or paraffin-embedded tumour pathological samples was also assessed. To correlate gene expression with selected pathological features and clinical outcome we used different hierarchical clustering method.

RESULTS

Hierarchical clustering demonstrated the association between gene expression within certain clusters and gender, tumour site, T stage, N stage, grade, pathological subtype or tumour recurrence.

CONCLUSIONS

Despite some limitations we were able to identify gene clusters that allowed to classify patients according to selected clinical features and occurrence of tumour recurrence. The results of the analysis also confirm that the incidence of HPV infection among the patients from Upper Silesia is relatively low, whereas HPV negative tumours, likely associated with smoking, appeared dominant.

The Efficacy of Perioperative Antibiotic Therapy in Tonsillectomy Patients

BACKGROUND

While the results of early research suggested that perioperative antibiotic prophylaxis in tonsillectomy patients is associated with many benefits, these data were not confirmed by further studies and meta-analyses.

OBJECTIVES

The aim of this study was to investigate the usefulness and efficacy of antibiotic monotherapy in the healing of surgical wounds of patients undergoing bilateral resection of the palatine tonsils, based on an analysis of selected objective and subjective characteristics of wound healing during the postoperative period.

MATERIAL AND METHODS

The study included 50 men and women who underwent routine resection of the palatine tonsils. The patients were randomized into two groups: Group I, undergoing tonsillectomy with cefuroxime prophylaxis (n = 25), and Group II, who were not given perioperative antibiotic therapy (n = 25). The severity of signs and complaints recorded on postoperative days 1-10 was scored on 3- and 10-item scales.

RESULTS

The only significant intergroup differences pertained to problems with swallowing food and fluids on postoperative days 4-6, 8 and 9 (less prevalent in Group II), postoperative use of analgesics on postoperative day 9 (less frequent in Group II), the degree of mucosal swelling in the operated area on postoperative days 3 and 7 (less severe in Group II), and the amount of fibrin covering the tonsillar niches on the third postoperative day (significantly higher in Group I).

CONCLUSIONS

The administration of antibiotics for prevention or control of infection should be preceded by a comprehensive analysis of the potential benefits and risks. Perioperative use of antibiotics is justified only in selected cases, i.e. in individuals with comorbidities.

Refractory chronic spontaneous urticaria and permanent atrial fibrillation associated with dental infection: Mere coincidence or something more to it?

Controversy surrounds the role of dental infection/inflammation in the oral cavity in chronic spontaneous urticaria (CSU) and atrial fibrillation (AF), which is mainly due to scarce literature in this area. Therefore, this case report and review of literature illustrate a possible association between the acute-phase response (APR) and clinical conditions, such as CSU and dental infection/inflammation of oral cavity and AF.We describe a 36-year-old man with an 8-year history of difficult-to-treat, uncontrolled CSU, co-existent with dental infection/inflammatory processes of oral cavity and permanent atrial fibrillation (AF). In the presented case, the most likely triggering or aggravating/maintaining factor of the symptoms was the inflammation/dental infection of the oral cavity because of rapid reduction of the urticarial symptoms, drug doses, and serum CRP levels after the dental therapy. Dental treatment may have a beneficial effect on the systemic inflammatory response, reducing/normalizing the circulating levels of APR markers. APR activation appears to worsen CSU course, early identification and treatment of infectious/inflammatory foci in the oral cavity would form the mainstay of supportive therapy for CU probably through reduction of the systemic inflammatory burden. APR associated with infectious/inflammatory foci in the oral cavity could be taken into account as a predisposing agents to AF.

Endoscopic evidence of reflux disease in the larynx

CONCLUSION

The severity of laryngeal mucosal lesions in patients with gastroesophageal reflux disease (GERD) is significantly greater than in controls. A higher degree of laryngeal mucosal injury is documented in patients in whom GERD is associated with more advanced esophageal lesions.

OBJECTIVES

(1) To confirm the presence of inflammatory lesions in the laryngopharynx of patients with GERD. (2) To analyze the relationship between the severity of laryngopharyngeal and esophageal lesions on the basis of the reflux finding score (RFS) and the Los Angeles (LA) scale of esophageal mucosal injury.

METHODS

The study included 92 subjects, among them 46 patients with GERD and 46 individuals without endoscopic evidence of esophageal lesions, qualified for routine endoscopy due to other indications. The endoscopic images of the inferior pharynx, larynx, and esophagus were analyzed during the video-endoscopic examination of the upper gastrointestinal tract. The laryngeal images were assessed according to RFS criteria and the numeric value of RFS was calculated. The degree of esophageal mucosal injury was described according to the LA scale.

RESULTS

Both global RFS score and the scores of all RFS parameters except the presence of granulomatous tissue were significantly higher in patients with GERD than in the controls. Patients in whom GERD was associated with more severe esophageal lesions (group B according to the LA scale) had significantly higher global RFS score and scores of all analyzed parameters of laryngeal injury except subglottic edema than individuals in whom the degree of esophageal involvement was classified as group A.

[The usefulness of evaluation of: ferritin, ultrasensitive CRP and tissue specific polypeptide 18th (TPS) in assessment of therapy efficacy in patients with nasal polyps]

BACKGROUND

Chronic rhinosinusitis with nasal polyps is social, clinical and cost-effective problem, by reason of bothersome symptoms, chronic nature of the disease, tendency to recur and lack of satisfying treatment.

AIM

The aim of this study is assessment of suitability of hsCRP, ferritin and blood levels in nasal polyps patients in evaluation of treatment efficacy.

METHODS

The study enrolled 38 patients between 20 and 68 years of age. Patients were divided into 2 groups. Levels of ultrasensitive CRP ferritin and TPS have been measured in all patients. The ultrasensitive CRP levels have been measured by chemiluminescence method. Ferritin levels have been measured by MEIA method. The TPS levels have been measured by chemiluminescence method.

RESULTS

Comparison of mean ferritin levels in both study groups in each stage of observation shows the significant difference of mean values in only 6 weeks after surgery. Mean ferritin level is significantly lower in group I than in group II (p<0.05). Mean hsCRP levels vary from one corresponding to ferritin levels. Statistically significant difference between study groups in 2nd and 6th week after surgery has been ascertained (p<0.05). Similarly, like in ferritin levels, the TPS levels are significantly different in 6th week after surgery.

CONCLUSIONS

Analysis of ferritin, hsCRP and TPS serum levels indicates that these may be useful in assessment of treatment efficacy in patients with nasal polyps. Rise of the chosen inflammatory state parameter level in the postoperative monitoring and anti-inflammatory treatment introduction in nasal polyps patients may inhibit the recurrence of the disease.

The influence of selected preoperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis

BACKGROUND

Epidemiological data shows the increasing prevalence of chronic rhinosinusitis which poses significant health, social and economic problems in today's world. Endoscopic paranasal sinus surgery is currently the method of choice in the treatment of chronic rhinosinusitis when conservative treatment methods fail. Therefore, maintaining a high percentage of therapeutic success with a constantly growing number of surgical procedures poses the major challenge to otolaryngologists. Appropriate surgical conditions have a great influence on the course of surgical procedure, the risk of complications and postoperative outcomes.

OBJECTIVES

The aim of this study was to analyse the influence of selected perioperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis.

MATERIAL AND METHODS

A group of 212 patients (105 women and 107 men) aged 19 to 74 (mean age 46.5) diagnosed with chronic rhinosinusitis were enrolled in the retrospective study. All patients underwent endoscopic sinus surgery. The analysis was concerned with the impact of such factors and clinical parameters as gender and age of patients, disease progression, previous (conservative and surgical) treatment, comorbidities, detrimental external factors, the scope of surgical treatment influencing the duration of surgery, bleeding in the surgical field and the total blood loss during surgery.

CONCLUSIONS

It was found that the mean duration of surgery in the study group was 40.2 min, the mean blood loss was 312.17 mL and the mean degree of intraoperative bleeding scale reached 2.15. The intraoperative conditions deteriorate together with the increasing age of patients. Selected factors and clinical parameters, such as impaired nasal patency, olfactory disorders, the occurrence of nasal polyps, prior surgical treatment, the presence of aspirin-induced asthma and cardiovascular diseases, intranasal glucocorticoid therapy, a high degree of inflammatory changes in the sinuses and a large extent of surgery substantially influence the deterioration in intraoperative conditions. Knowledge of these factors and their impact on surgery enables more thorough, multidisciplinary preparation of patients for surgery, and thus enables the optimisation of surgical conditions.

Beryllium concentration in pharyngeal tonsils in children

Power plant dust is believed to be the main source of the increased presence of the element beryllium in the environment which has been detected in the atmospheric air, surface waters, groundwater, soil, food, and cigarette smoke. In humans, beryllium absorption occurs mainly via the respiratory system. The pharyngeal tonsils are located on the roof of the nasopharynx and are in direct contact with dust particles in inhaled air. As a result, the concentration levels of beryllium in the pharyngeal tonsils are likely to be a good indicator of concentration levels in the air. The presented study had two primary aims: to investigate the beryllium concentration in pharyngeal tonsils in children living in southern Poland, and the appropriate reference range for this element in children's pharyngeal tonsils. Pharyngeal tonsils were extracted from a total of 379 children (age 2-17 years, mean 6.2 ± 2.7 years) living in southern Poland. Tonsil samples were mineralized in a closed cycle in a pressure mineralizer PDS 6, using 65% spectrally pure nitric acid. Beryllium concentration was determined using the ICP-AES method with a Perkin Elmer Optima 5300DVTM. The software Statistica v. 9 was used for the statistical analysis. It was found that girls had a significantly greater beryllium concentration in their pharyngeal tonsils than boys. Beryllium concentration varies greatly, mostly according to the place of residence. Based on the study results, the reference value for beryllium in pharyngeal tonsils of children is recommended to be determined at 0.02-0.04 µg/g.

The influence of nasopharyngeal patency on the morphology of nasomaxillary complex

OBJECTIVE

The aim of this study was to compare the nasomaxillary complex in subjects with nasopharyngeal obstruction symptoms and the group with normal nasopharyngeal patency.

MATERIALS AND METHODS

The study analyzed lateral cephalograms and dental plaster casts of 229 orthodontic subjects from the orthodontic clinic, i.e. 129 (56%) females and 100 (44%) males, age range of 6-30 years (mean age = 13.79). The analysis of radiographs and cephalometric measurements were performed using Orto-TestPor-ZPaluch software. The study population examined according to the stage of cervical vertebral maturation was divided into three sub - groups [the CVM A group consisted of 57 (24.9%) subjects, the CVM B group consisted of 85 (37.1%) subjects and the CVM C group consisted of 87 (38%) subjects].

RESULTS

In the youngest age group with less than 50% airway patency, smaller values of SNA angle were observed together with diminished anterior palatal width compared with the non-obliterated group. The decrease in the area of the nasomaxillary complex and the decrease in posterior palatal width were observed in the oldest age group with less than 50% airway patency as compared to the subjects with normal patency.

CONCLUSIONS

The nasomaxillary complex morphology in subjects with decreased nasopharyngeal patency pre - disposes to air flow impediment through nasal respiratory passage. Non-extraction treatment of the upper dental arch and possible maxillary expansion can be considered when orthodontic treatment is planned in subjects with decreased patency of < 50% and CVM A.

[Results of radical surgery in group of 355 patients with advanced laryngeal cancer]

INTRODUCTION

The aim of the study was to evaluate the results of radical surgery in group of 355 patients with advanced laryngeal cancer.

MATERIAL AND METHOD

The paper presents results of treatment in group of 355 patients with advanced laryngeal cancer treated in the ENT Clinical Department in Zabrze in the following years 1998-2007. The advancement stage was defined as III in 147 patients (42%), as IV in 208 patients (58%). Group of 250 patients (70%) underwent total laryngectomy and group of 105 patients (30%) underwent pharyngolaryngectomy. In the group of 327 patients (92%) operation was performed microscopically radically. 298 patients (84%) underwent postoperative radiotherapy. Median follow-up period was 5 years. Local recurrence, nodal recurrence and distant metastasis were rated as treatment failure. Treatment effectiveness was evaluated in relation to overall survival, disease-free survival, local control, locoregional control and observation free from metastases. All of these parameters were analyzed with the method of updated percentages.

RESULTS

During observation period 177 patients (50%) died. Local recurrence occurred in 47 patients (13%), nodal recurrence occurred in 19 patients (5%). Distant metastases occurred in 26 patients (7%). 5-year overall survival rate (OS) was 50%. 5-year disease-free survival rate (DFS) was 47%. 5-year local control rate (LC) was 81%. 5-year locoregional control rate (LRC) was 75%. The updated 5-year observation free from metastases rate (FFM) was 89% respectively.

CONCLUSION

Radical surgery is the chance of 5-year survival of 50% of patients with advanced cancer of the larynx and of 5-year locoregional control of 75% patients.

[The influence of selected clinical and morphological factors on treatment results of patients with advanced cancer of the larynx]

INTRODUCTION

The aim of the study was to indicate independent prognostic factors of treatment in group of patients with advanced cancer of the larynx.

MATERIAL AND METHOD

The paper presents results of univariate and multivariate analysis of selected clinical and morphological factors in the group of 355 patients with advanced laryngeal cancer treated in the ENT Clinical Department in Zabrze in the following years 1998-2007. The analysis of the results of treatment in relation to clinical and morphological features of the tumor was based on overall survival, disease-free survival, local control and locoregional control. The results of analysis allowed to indicate the independent prognostic factors for outcome in patients with advanced laryngeal cancer.

RESULTS

Univariate analysis showed that the increase of clinical advancement of laryngeal cancer was associated with worse prognosis, as well as the fact that the primary location of the tumor in supraglottis and infiltration in laryngeal part of pharynx determined the worse outcome. Univariate and multivariate analysis confirmed that the number of lymph node metastases in the surgical specimen and microscopic radical of surgery were the most important prognostic factors for survival and cure in the study group.

CONCLUSION

The strongest independent prognostic significance for all efficacy criteria have: completeness of operation and number of metastatic lymph nodes.

[Usefulness of laser arytenoidectomy and laterofixation in treatment of bilateral vocal cord paralysis]

INTRODUCTION

Bilateral vocal cord paralysis is caused by the damage of both recurrent laryngeal nerves. Such a pathology is not commonplace in the ordinary medical practice. It most often occurs as a complication after the thyroid gland surgery or thyroid re-surgery. In the case of bilateral vocal cord paralysis the treatment of the patient includes performing immediate tracheotomy or one of the surgeries aiming at widening the glottis because of dyspnea caused by the upper respiratory tract obstruction on the glottis level.

AIM

The comparison of efficacy and usefulness of two surgical techniques performed to widen the glottis – laser arytenoidectomy with posterior cordectomy and laterofixation.

MATERIAL AND METHODS

The research was carried out on the group of 57 patients suffering from bilateral vocal cord paralysis who, in the period of 1997–2009, underwent treatment in ENT Department in Zabrze Medical University of Silesia in Katowice. The first group included 36 patients who underwent laser arytenoidectomy with posterior chordectomy. The second group included 21 patients who underwent laterofixation. All of the patients treated with the laser arytenoidectomy with posterior cordectomy and laterofixation were subjected to respiratory system ventilation examinations before the procedure of widening the glottis and after the healing, at least 4 months after the surgery. Making self-evaluation, each of the patients answered a question concerning the improvement of their breathing comfort after the surgery. The patients from both groups underwent the vocal apparatus examination which included: subjective perceptive voice analysis according to GRBAS scale, videolaryngostroboscopy, evaluation of the maximum phonation time, self-evaluation survey of the post-surgical voice quality.

RESULTS

Among 57 patients suffering from bilateral vocal cord paralysis and operated by arytenoidectomy with posterior cordectomy (group I) and laterofixation (group II), a subjective improvement of the comfort of living was achieved which resulted in the possibility of making more physical activities. From the first group, 35 out of 36 patients were decannulated. In the second group, both patients who had previously undergone tracheotomy were successfully decannulated. There were no statistically significant differences in the increase of selected ventilation markers between the patients who underwent laser arytenoidectomy and those who underwent laterofixation. There were no substantial discrepancies in the perceptive voice analysis in GRBAS scale between the patients after laser arytenoidectomy and those treated with the technique of laterofixation. When asked about their post-surgical voice quality, the patients of the first and the second group rated their voice as worse than before the surgery.

CONCLUSION

Both surgical techniques, laser arytenoidectomy with posterior cordectomy and laterofixation, are efficient and useful in widening the glottis in the case of bilateral vocal cord paralysis. The improvement of the ventilation markers allows the growth in the comfort of living, restoration of the physiological respiratory tract and decannulation of the patients who had undergone tracheotomy. The deterioration of the voice quality is characteristic of both surgical techniques.

[The quality of voice in coal-miners after burn/inhalation injury due to methane explosion]

The job as a coal-miner exposes to the greatest risk. One of the most dangerous health hazard is a burn/inhalation injury during the methane explosion. The victims undergo physical trauma, effect of high temperature and inhalation of toxic gases and products of incomplete combustion, As a result of inhalation injury both, upper and lower airways are affected. The aim of the study was to analyse the relationship between burn/inhalation injury and quality of voice in affected coal-miners. A group of 23 patients (men) in age from 28 to 59 (mean 38.5) 3 years after burn/inhalation injury participated in this study. The voice evaluation based on ENT examination, videlaryngostroboscopy, acoustic analysis, MPT parameter and GRBAS analysis was performed. The special control group of coal-miners served as a control. On the basis of the subjective evaluation and the objective acoustic analysis, aerodynamic parameter and videlaryngostroboscopy the worse quality of voice in the group of injured coalminers was shown in comparison to the control group. No substantial correlation between the acoustic parameters, MPT parameter and ventilating rates was found.

[Long-term results of airways' injury after a methane explosion]

Injuries caused by thermal trauma more and more often affect people and they are an important problem of contemporary medicine. It is connected with the civilization development. Burn concerns not only the exterior integuments of the body but also airways, in those cases, the death rate among those who were injured with the thermal trauma increases. The treatment of both the burns and their complications is a long-lasting process, involving many specialists of various disciplines, and not always does it bring the wanted effects. The aim of the study was the assessment of the late morphological sequels inside the larynx and ventilation efficiency as a result of thermal inhalation trauma in the airways of the coal miners after the methane explosion. The methodology of examinations consisted of subjective evaluation of ventilation efficacy by MRC scale and ventilating rate measurement FEV1, FVC, FEV1%, PEF, MEF50, PIF, MIF 50, FIV. The morphological larynx evaluation was conducted based on videolaryngoscopy. 23 injured coal miners, who had been burnt at work in coal mines in 2003 in the methane explosion, were put under scrutiny. All the above mentioned examinations were done to the study group, but also to the specially selected control group, 23 coal miners. During the ventilating rates analysis in the study group, their lower values were noticed in comparison to the control group, however, the values were still within the clinical norms. Videolaryngoscopy showed hypertrophy of the laryngeal tissues.

Molecular mechanisms of glucocorticoids action: implications for treatment of rhinosinusitis and nasal polyposis

Intra-nasal glucocorticoids are the most effective drugs available for rhinosinusitis and nasal polyposis treatment. Their effectiveness depends on many factors and not all of them have been well recognized so far. The authors present the basic information on molecular mechanisms of glucocorticoid action, direct and indirect effects of glucocorticoids on transcription of genes encoding inflammatory mediators. They focus on recently proved nongenomic mechanisms which appear quickly, from several seconds to minutes after glucocorticoid administration and discuss clinical implications resulting from this knowledge. Discovery of nongenomic glucocorticoid actions allows for better use of these drugs in clinical practice.

[Efferent suppression test--sensitivity and specificity]

INTRODUCTION

The amplitude of click evoked otoacoustic emissions can be suppressed (reduced) with contralateral acoustic stimulation (CAS). This is thought to be due to the inhibitory control that the medial efferent auditory nerve exerts on outer hair cell function. One commonly used test of medial olivocochlear (MOC) function in humans involves measuring the degree of suppression of ipsilateral otoacoustic emissions (OAEs) by CAS. This effect is called contralateral suppression, efferent effect or olivocochlear reflex. Aim of the study. The objective of this study was to measure cut-off level of contralateral suppression, sensitivity and specificity of the efferent test.

MATERIAL AND METHODS

To evaluate the function of MOC system click evoked otoacoustic emissions (CEOAEs) with and without continuous contralateral broadband noise (BBN) stimulation were recorded in 14 patients with multiple sclerosis, 16 patients with unilateral cerebello-pontine angle tumor and control group matched for age and gender. BBN was presented at 50 dB SL and otoacoustic emissions were recorded in response to nonlinear clicks at 70 +/- 3 dB SPL.

RESULTS

The cut-off level was established at -1.4 dB. For 1.4 dB cut-off level of contralateral suppression the sensitivity of the efferent test was 90% and specificity was 70%.

CONCLUSIONS

To conclude, assessment of efferent suppression may be a useful addition to the battery test employed in the investigation of multiple sclerosis and cerebello-pontine angle tumors. The MOC suppression test may provide a tool for an early diagnosis of the brainstem pathology.

[Trace elements concentration in pharyngeal tonsils from exposed and unexposed to ETS children in refer to sex and places of living]

The aim of this study was investigation influence sex and place living (industrial region or village) to concentration of: Ca, K, Mg and Na in pharyngeal tonsils (n = 84) from children exposed and unexposed to tobacco smoke and analysis kind of interactions between trace elements. Determination of these elements contents were performed by ICP-AES. It was found higher concentrations of Ca and Na in pharyngeal tonsils from boys (389 microg//g) and girls (356 microg/g) unexposed to tobacco smoke to comparison to expose to ETS boys (304 microg/g) and girls (298 microg/g). Higher concentrations of Ca and Na was found in this samples from children unexposed on ETS, living in industrial area to comparison to unexposed to ETS children living in village region. Higher concentration of K and Mg was found in exposed to ETS girls and boys in comparison to unexposed to ETS children, and higher level of these metals were found in exposed to tobacco smoke children living in industrial region and village.