A temporally and spatially explicit, data-driven estimation of airborne ragweed pollen concentrations across Europe

Ongoing and future climate change driven expansion of aeroallergen-producing plant species comprise a major human health problem across Europe and elsewhere. There is an urgent need to produce accurate, temporally dynamic maps at the continental level, especially in the context of climate uncertainty. This study aimed to restore missing daily ragweed pollen data sets for Europe, to produce phenological maps of ragweed pollen, resulting in the most complete and detailed high-resolution ragweed pollen concentration maps to date. To achieve this, we have developed two statistical procedures, a Gaussian method (GM) and deep learning (DL) for restoring missing daily ragweed pollen data sets, based on the plant's reproductive and growth (phenological, pollen production and frost-related) characteristics. DL model performances were consistently better for estimating seasonal pollen integrals than those of the GM approach. These are the first published modelled maps using altitude correction and flowering phenology to recover missing pollen information. We created a web page (http://euragweedpollen.gmf.u-szeged.hu/), including daily ragweed pollen concentration data sets of the stations examined and their restored daily data, allowing one to upload newly measured or recovered daily data. Generation of these maps provides a means to track pollen impacts in the context of climatic shifts, identify geographical regions with high pollen exposure, determine areas of future vulnerability, apply spatially-explicit mitigation measures and prioritize management interventions.

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

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.

The impact of data assimilation into the meteorological WRF model on birch pollen modelling

We analyse the impact of ground-based data assimilation to the Weather Research and Forecasting (WRF) meteorological model on parameters relevant for birch pollen emission calculations. Then, we use two different emission databases (BASE - no data assimilation, OBSNUD - data assimilation for the meteorological model) in the chemical transport model and evaluate birch pollen concentrations. Finally, we apply a scaling factor for the emissions (BASE and OBSNUD), based on the ratio between simulated and observed seasonal pollen integral (SPIn) to analyse its impact on birch concentrations over Central Europe. Assimilation of observational data significantly reduces model overestimation of air temperature, which is the main parameter responsible for the start of pollen emission and amount of released pollen. The results also show that a relatively small bias in air temperature from the model can lead to significant differences in heating degree days (HDD) value. This may cause the HDD threshold to be attained several days earlier/later than indicated from observational data which has further impact on the start of pollen emission. Even though the bias for air temperature was reduced for OBSNUD, the model indicates a start for the birch pollen season that is too early compared to observations. The start date of the season was improved at two of the 11 stations in Poland. Data assimilation does not have a significant impact on the season's end or SPIn value. The application of the SPIn factor for the emissions results in a much closer birch pollen concentration level to observations even though the factor does not improve the start or end of the pollen season. The post-processing of modelled meteorological fields, such as the application of bias correction, can be considered as a way to further improve the pollen emission modelling.

New treatment options for acute rhinosinusitis according to EPOS 2020

Acute rhinosinusitis (ARS) is a very common condition and mostly of viral origin. About 0.5–2% of the viral ARS are complicated by a bacterial infection. Due to viral etiology and inflammatory mechanisms of rhinitis and rhinosinusitis, symptomatic treatment including phytotherapy have been used for their treatment for decades. Scientific societies and expert groups recommend the use of herbal medicines in acute viral and acute post-viral rhinosinusitis. In 2021, Polish patients gained access to a new therapeutic option for acute sinusitis in the form of a drug containing a distillate of a mixture of rectified essential oils of eucalyptus, sweet orange, myrtle and lemon common.

Extension of WRF-Chem for birch pollen modelling-a case study for Poland

In recent years, allergies due to airborne pollen allergens have shown an increasing trend, along with the severity of allergic symptoms in most industrialized countries, while synergism with other common atmospheric pollutants has also been identified as affecting the overall quality of citizenly life. In this study, we propose the state-of-the-art WRF-Chem model, which is a complex Eulerian meteorological model integrated on-line with atmospheric chemistry. We used a combination of the WRF-Chem extended towards birch pollen, and the emission module based on heating degree days, which has not been tested before. The simulations were run for the moderate season in terms of birch pollen concentrations (year 2015) and high season (year 2016) over Central Europe, which were validated against 11 observational stations located in Poland. The results show that there is a big difference in the model's performance for the two modelled years. In general, the model overestimates birch pollen concentrations for the moderate season and highly underestimates birch pollen concentrations for the year 2016. The model was able to predict birch pollen concentrations for first allergy symptoms (above 20 pollen m^-3) as well as for severe symptoms (above 90 pollen m^-3) with probability of detection at 0.78 and 0.68 and success ratio at 0.75 and 0.57, respectively for the year 2015. However, the model failed to reproduce these parameters for the year 2016. The results indicate the potential role of correcting the total seasonal pollen emission in improving the model's performance, especially for specific years in terms of pollen productivity. The application of chemical transport models such as WRF-Chem for pollen modelling provides a great opportunity for simultaneous simulations of chemical air pollution and allergic pollen with one goal, which is a step forward for studying and understanding the co-exposure of these particles in the air.

Drug-induced diseases in otolaryngology - causes, clinical signs, treatment

<b>Introduction:</b> In the daily practice of an otolaryngologist, we encounter cases where the symptoms are not the result of disease but result from pharmacotherapy. In the case of symptoms such as hearing loss, tinnitus, or dizziness, polytherapy may be used as the basis for their occurrence, which, due to the lack of rationality in combining drugs, leads to symptoms that the patient and the doctor very often interpret as a new disease syndrome. <br><b>Aim:</b> The aim of the study is to show and to raise awareness of the fact that the symptoms of hearing organ impairment are frequently drug-related and only a modification of the currently used pharmacotherapy is a rational procedure in such cases. <br><b>Material:</b> This paper describes 30 cases who developed side effects of polypharmacy in the form of hearing disorders, dizziness, and tinnitus. The causes of drug-related complications were discussed, as well as effective methods of their prevention.

Drug-induced diseases in otolaryngology - causes, clinical signs, treatment

In the daily practice of an otolaryngologist, we encounter cases where the symptoms are not the result of disease but result from pharmacotherapy. In the case of symptoms such as hearing loss, tinnitus, or dizziness, polytherapy may be used as the basis for their occurrence, which, due to the lack of rationality in combining drugs, leads to symptoms that the patient and the doctor very often interpret as a new disease syndrome. The aim of the study is to show and to raise awareness of the fact that the symptoms of hearing organ impairment are frequently drug-related and only a modification of the currently used pharmacotherapy is a rational procedure in such cases. This paper describes 30 cases who developed side effects of polypharmacy in the form of hearing disorders, dizziness, and tinnitus. The causes of drug-related complications were discussed, as well as effective methods of their prevention.

Intranasal steroid therapy - EPOS 2020

INTRODUCTION

Due to their strong, multidirectional anti-inflammatory activity, intranasal glucocorticoids are the mainstay of treatment in rhinosinusitis, including acute rhinosinusitis, chronic rhinosinusitis, and chronic rhinosinusitis with nasal polyps, as well as allergic rhinitis. Owing to its high systemic safety and high anti-inflammatory efficacy, mometasone furoate - a new-generation intranasal glucocorticoid - was approved in 2019 as an over-the-counter medication for Polish patients diagnosed with allergic rhinitis. Scientific societies and expert groups recommend the use of intranasal glucocorticoids in a much broader range of indications. In February 2020, an updated version of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) was published.

AIM

This article discusses the role of nasal glucocorticoids in regimens used in the treatment of nasal sinusitis as published in EPOS 2020 with Polish country-specific realities being taken into account.

Goosefoot – a plant that likes drought. The goosefoot family pollen season in 2019 in Poland, Hungary and Slovakia

Almost all the species of the Chenopodiaceae family present in our flora flower from July–August to the autumn. Unfortunately, allergies do not take a vacation. Warm, dry July and August weather should limit pollen emissions. However, similarly to most plants in dry habitats, goosefoot are well adapted to such conditions and does not provide even a short reprieve to pollen allergic patients. However, goosefoot pollen does not have a very large allergenic significance; despite the long pollen season lasting about 3 months, pollen concentrations in the air are low and very rarely exceed the concentration of 30 grains/m3. This study compares Chenopodiaceae pollen seasons in Poland, Hungary and Slovakia in 2019. The investigations were carried out using the volumetric method (Hirst type pollen sampler). Seasonal pollen index was estimated as the sum of daily average pollen concentrations in the given season. The pollen season ranges from June to September, depending on the geographical latitude. In Hungary and Slovakia there are much longer pollen seasons than in Poland. Pollen of goosefoot family contains the panallergen profilins, which are responsible for cross-reactivity among pollen-sensitized patients. In 2019 the pollen season of goosefoot started first in Hungary, in Kaposvar on June 7th and in Slovakia, in Žilina, on June 8th; in Poland pollen season started much later, on June 14th in Szczecin and Opole. At the latest, a pollen season ended in Nitria (Slovakia) on October 16th; in Kecskemet (Hungary) on October 3rd. In Poland the season ended much earlier than in Hungary and Slovakia already on August 25th. The differences of pollen season durations are considerable, the number of days ranged from 72 to 128. The dynamics of the pollen seasons of goosefoot family show similarities within a given country and considerable differences between these countries. However, the differences of the highest airborne concentration between the countries are not considerable (25 pollen grains/m3 in Poland, 49 pollen grains/m3 in Hungary, and 30 pollen grains/m3 in Slovakia. The maximum values of seasonal pollen count in Polish cities occurred between July 26th and August 29th, in Hungarian cities between August 27th and 30th, and in Slovakian cities between August 7th and 28th. Pollen season was characterized by extremely different total annual pollen SPI, in Poland from 116 to 360; in Hungary and Slovakia within the limits 290 to 980. Droughts that occur more frequently during the summer facilitate the spread of species of the goosefoot family due to the possibility of these plants gaining new habitats.

Impact of physicochemical properties of nasal spray products on drug deposition and transport in the pediatric nasal cavity model

The study is focused on the analysis of physicochemical properties of selected nasal sprays of mometasone furoate, and the influence of these properties on aerosol quality and penetration in the pediatric nose. After the determination of drugs surface tension and viscosity, spray geometry and size distribution of aerosol droplets, the topical delivery of each drug to different parts of the pediatric model of the nose with the flexible vestibule was evaluated by colorimetric visualization. All tested drugs are pseudo-plastic liquids, showing some differences in flow consistency constant k (range 714-1422) and flow behavior index n (range 0.16-0.31). At no-flow conditions, all sprays are deposited mainly in the anterior of the nasal cavity and the septum (2-3 cm from the nostril), as a result of inertial impaction of large droplets. The deposition range is slightly influenced by the geometry of the aerosol cloud, which, in turn, depends both on drug properties and the type of the spraying nozzle. Deposition experiments accompanied by the airflow show an enhancement of drug transport to deeper parts of the nasal cavity (up 4-6 cm from the vestibule), and this effect can be attributed to the secondary effects of spreading of the deposited liquid layer along the narrow air passages in the nose. Plume geometry, dose volume and rheological properties of the drug were shown to be important factors in the spray penetration pattern in the pediatric nose. The deepest delivery can be expected for drugs of low viscosity and short aerosol plumes.

A study on the spatial and temporal variability in airborne Betula pollen concentration in five cities in Poland using multivariate analyses

During the spring period, Betula pollen is the main cause of inhalant allergies in Poland and therefore it is important to monitor and forecast airborne pollen concentrations of this taxon. This study conducted a comparative analysis of the basic characteristics of Betula pollen seasons at the regional scale. The study was carried out from 2001 to 2016 in five cities in Poland: Lublin, Warsaw, Cracow, Sosnowiec, and Szczecin. To find the attributes of birch pollen seasons that mostly differentiated the individual cities, a general discriminant analysis (GDA) was performed, while a principal component analysis (PCA) allowed us to reduce the data space and present a scatterplot of PCA scores in order to compare pollen seasons in the individual cities. The contingency table was also analyzed to check whether there was a significant relationship between pollen counts in the studied years and cities. At most of the sites, biennial cycles of low and high pollen concentrations can be observed. Due to the high variation in seasons in each of these cities, two data groups were distinguished: Group 1 was composed of seasons with high pollen deposition (2001, 2003, 2006, 2008, 2010, 2012, 2014, 2016), and Group 2 comprising the other seasons. Multivariate analyses were performed on both these groups as well as in the entire dataset. End98, Peak Value, and Annual Total had the highest discriminant power. In Group 1, Warsaw and Sosnowiec differed the most in the investigated parameters, while Cracow and Szczecin differed the least. In both groups, most seasons with the highest pollen birch concentration were observed in Lublin, followed by Warsaw, while in Cracow, the number of such seasons was the smallest.

The dynamics of pollen seasons of the most allergenic plants - 15-year observations in Warsaw

INTRODUCTION

Allergic rhinitis concerns nearly 25% of the Polish population. Among pollen allergens, the most common reasons for allergic rhinitis are: grass, birch and mugwort. Knowledge of the characteristics of pollen seasons is necessary in diagnostics, monitoring of therapy and prevention of allergic rhinitis. P urpose: This work aims to analyze pollen seasons of the most allergenic plants in the Polish population; grass, birch and mugwort in the years 2003-2017 in Warsaw. M aterial and methods: Measurements of pollen concentration were carried out using Burkard volumetric spore trap operating in continuous mode. Analysis of pollen seasons was conducted based on the following characteristics: beginning, end, and length of season, the seasonal pollen index (SPI), defined as the sum of average daily pollen concentrations over the year, maximum daily concentration, number of days with maximum and threshold concentration. Linear regression together with the Pearson correlation coefficient were used in statistical analysis to study the relationship between variables; furthermore, descriptive characteristics of distributions studied were determined. R esults: The average beginning of the birch pollen season in the analyzed period is April 10th, and it belongs to seasons of average length (47 days on average). Birch pollen count above 75 grains/m3, when most allergic people develop symptoms, was recorded for an average of 18 days. The highest daily birch pollen count reaching 6321 grains/m3 (2012) exceeded the lowest value of the maximum concentration by almost 20 times (2015). Among the taxa analyzed, the highest values of daily counts and annual sums were recorded for birch pollen. The average date for the beginning of grass pollination season is on May 13th. It is the longest pollen season (on average 134 days), and the period when concentration exceeded 50 grains/m3 covered an average of 26 days. The highest daily grass pollen counts reaching 496 grains/m3 (2007) exceeded the lowest value of maximum concentration by 3.5 times (2016). The average date of the beginning of mugwort pollen season is July 16th. The season lasts 65 days on average, when concentration exceeding 30 grains /m3 was registered for an average of 12 days. The highest daily mugwort pollen count reaching 154 grains/m3 (2007) exceeded the lowest value of maximum concentration by 4 times (2013). For all analyzed taxa, the strongest correlated variables are the sum of average daily pollen concentrations over the year (SPI ) and daily maximum concentration (correlation for birch pollen = 0.92, for grass pollen = 0.88, and for mugwort pollen = 0.91).

CONCLUSIONS

Periods of pollen in the air show certain variation in the analyzed 15-year period. The maximum concentration in the pollen season for the analyzed taxa and the the sum of average daily pollen concentrations over the year show the highest variability, particularly strongly expressed in the case of birch pollen. There is a linear relationship between the sum of average daily pollen concentrations over the year and the maximum concentration value as well as the number of days with the threshold concentration for all analyzed taxa. Variability of parameters describing the dynamics of pollen seasons indicates the need to monitor, both by patients with hay fever and physicians, the current information on the concentration of pollen in the air during the pollen season.

Treatment strategy of allergic rhinitis in the face of modern world threats

Allergic rhinitis (AR) is the most common form of allergy, which - as epidemiological research has shown - applies to nearly 25% of the population. AR significantly affects the quality of life of the patient, and the more severe the disease, the greater the risk of developing bronchial asthma. One of the factors affecting the severity of symptoms and the degree of their control is air pollution. In some patients, despite proper treatment, persistence or only partial remission of symptoms (uncontrolled allergic rhinitis) is observed. This can lead to an increase in comorbidities - inflammation of the paranasal sinuses, otitis media and asthma - both in children and in adults. The treatment of allergic rhinitis, in accordance with the standards, consists in: education of the patient, elimination of the allergen from the environment and factors intensifying the course of the disease, selection of proper pharmacotherapy and specific allergen immunotherapy. Many factors influence the selection of the antihistamine used, e.g., the opportunity of safe increase of the dosage.

A six-month analysis of frontal sinus drainage pathway in patients with frontal sinusitis after balloon sinuplasty

BACKGROUND

The balloon catheter has been used for a decade to dilate paranasal sinus outflow tracts. The question is: how wide and how durable is the dilation of drainage pathways in patients in long-term observations after this procedure?

OBJECTIVE

The objective of our study was to observe the changes occurring in the frontal sinus drainage pathway (FSDP) in patients with frontal sinusitis at least 6 months after surgery using balloon catheters in an isolated procedure.

MATERIALS AND METHODS

We analyzed and measured the FSDP width on computed tomography (CT) of 23 images before and after the use of balloon catheters. We also assessed mucosal changes using Zinreich's scale, and symptom improvements with the Sino-Nasal Outcome Test (SNOT-20).

RESULTS

A statistically significant difference in the width of the FSDP was found before and after sinuplasty in the study group (p ≤ .0016). On average, the FSDP increased by 24.1%. Clinically meaningful and statistically significant (p ≤ .0002) symptom improvement as indicated by the mean SNOT-20 score was observed. Mucosal changes were also statistically significant (p ≤ .0018) after surgery.

CONCLUSION

The findings at least 6 months after follow-up indicated that the use of balloon catheters in an isolated procedure allowed durable modeling of FSDP and was associated with radiological and clinical improvements.

Lyophilized Cyclamen europaeum tuber extract in the treatment of rhinosinusitis

Nasal and sinus mucositis is a significant health problem associated with significant organizational and financial burden for the health care system. In recent years, several important guidelines and positions of expert groups and scientific associations have been published with regard to the diagnostics and treatment of rhinosinusitis, including European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2012) [1] and Polish Standards for the Treatment of Rhinitis (PoSLeNN 2013) [2]. The management of viral and postviral rhinosinusitis involves systemic treatment including administration of plant origin products. The goal of this article is to present the current knowledge on the use of intranasal preparations containing natural saponin fractions from the rhizomes of Alpine cyclamen (Cyclamen europaeum). Saponins contained in the extract of Alpine cyclamen (Cyclamen europaeum) rhizomes are surface-active compounds that reduce the surface tension on the nasal mucosal cells while simultaneously stimulating the trigeminal nerve receptors leading to increased production of seromucous secretion and extensive drainage of the nasal and sinus cavities. The analysis of published studies on the efficacy and safety of intranasal products containing lyophilized extracts from Cyclamen europaeum tuber warrants the conclusion that these products are useful in the management of nasal and sinus mucositis due to their beneficial impact on the course of the treatment of acute rhinosinusitis. When used in patients with acute rhinosinusitis, an intranasal preparation containing lyophilized extracts from Cyclamen europaeum tuber efficiently reduces the symptoms, particularly the feeling of pressure and pain in the face. According to the authors of PROSINUS study, single-agent treatment using Cyclamen europaeum extracts is more efficient (in terms of the percentage of success) than other monotherapy or combination regimens.

Deposition of intranasal glucocorticoids--preliminary study

INTRODUCTION

Intranasal glucocorticoids are the treatment of choice in the therapy of rhinitis. The differences in efficiency of particular medications proven by therapeutic index may result from differences in composition of particular formulations as well as from diverse deposition in nasal cavities. Intranasal formulations of glucocorticoids differ in volume of a single dose in addition to variety in density, viscosity and dispenser nozzle structure. The aim of this report was to analyze the deposition of most often used intranasal glucocorticoids in the nasal cavity and assessment of the usefulness of a nose model from a 3D printer reflecting anatomical features of a concrete patient.

MATERIAL AND METHODS

Three newest and most often used in Poland intranasal glucocorticoids were chosen to analysis; mometasone furoate (MF), fluticasone propionate (FP) and fluticasone furoate (FF). Droplet size distribution obtained from the tested formulations was determined by use of a laser aerosol spectrometer Spraytec (Malvern Instruments, UK). The model of the nasal cavity was obtained using a 3D printer. The printout was based upon a tridimensional reconstruction of nasal cavity created on the basis of digital processing of computed tomography of paranasal sinuses. The deposition of examined medications was established by a method of visualization combined with image analysis using commercial substance which colored itself intensively under the influence of water being the dominant ingredient of all tested preparations. On the basis of obtained results regions of dominating deposition of droplets of intranasal medication on the wall and septum of the nasal cavity were compared.

RESULTS

Droplet size of aerosol of tested intranasal medications typically lies within the range of 25-150 µm. All tested medications deposited mainly on the anterior part of inferior turbinate. FP preparation deposited also on the anterior part of the middle nasal turbinate, marginally embracing a fragment of the central part of this turbinate as well together with deposition in the middle and superior nasal meatus reaching the region of nasal ceiling and olfactory field. MF preparation deposited on the anterior part of the inferior turbinate and central part of this turbinate alike. The area of mucous membrane of lateral wall of nasal cavity on which MF deposited was similar to the area achieved after the application of FP preparation but much greater than in the case of FF preparation. FF drug deposition concentrates only on the anterior part of the inferior turbinate. Despite directing the drug to the lateral wall of the nasal cavity a great proportion of examined preparations deposit also on the nasal septum.

CONCLUSIONS

The practical application of tridimensional representation (3D printout) of actual geometry of nasal cavity to establish the deposition of inGKS was proven. Droplet size and the geometry of the aerosol cloud introduced into the nostril determine the significant deposition of medication droplets in the anterior part of the nasal cavity. Both physical properties of the drug as well as spraying system applied influence spatial distribution of the drug. The interaction of the air flow with the layer of deposited fluid plays a major role in the deposition of the drug in the nasal cavity, therefore it is so important that the drug does not drain by gravity but remains at the site of deposition which may be reinforced by thixotropic properties of the preparation.

Progress in the Diagnosis and Control of Ebola Disease

Ebola hemorrhagic fever is one of numerous viral hemorrhagic fevers. It is a severe, often fatal disease in humans and nonhuman primates (gorillas and chimpanzees). This article discusses the history of Ebola disease, already known routes of infection together with defining prevention methods and treatment trials. The importance of increasing awareness of the risk of disease among people who do not inhabit endemic regions is emphasized. This risk is associated especially with the increasing popularity of tourism to African countries, even to those where the virus is endemic. The research conducted over the years shows that three species of frugivorous bats are subjected to contamination by Ebola, but the infection is asymptomatic in them. It is believed that the saliva of these mammals and other body fluids may be a potential source of infection for primates and humans. In the laboratory, infection through small-particle aerosols has been demonstrated in primates, and airborne spread among humans is strongly suspected, although it has not yet been conclusively demonstrated. The importance of this route of transmission remains unclear. Poor hygienic conditions can aid the spread of the virus. These observations suggest approaches to the study of routes of transmission to and among humans.

Long-term intense exposure to grass pollen can mask positive effects of allergenic immunotherapy on non-specific bronchial hyperresponsiveness

INTRODUCTION

There are many potential factors that can modulate bronchial reactivity, including exposure to allergens, viral infections, and medications. The aim of this study was to analyze the effect of grass pollination intensity on the bronchial reactivity in seasonal allergic rhinitis (SAR) patients subjected to subcutaneous allergenic immunotherapy (SCIT).

MATERIAL AND METHODS

This study, performed between 2005 and 2008, included 41 patients with confirmed sensitivity to grass pollens and predominating symptoms of SAR, randomly assigned to desensitization by pre-seasonal or maintenance SCIT. Bronchial provocation challenge with histamine was performed before the onset of immunotherapy, and repeated three times after each pollen season covered by this study. Bronchial reactivity was analyzed with regard to grass pollination intensity in 2005-2008 (air concentration of grass pollen grains, seasonal number of days when air concentration of grass pollen reached at least 20 or 50 grains per 1 m(3)).

RESULTS

After 3 years of SCIT, a significant decrease in bronchial responsiveness was observed in the analyzed group as confirmed by an increase in PC20 FEV1 histamine values (p = 0.001). An inverse tendency was observed after 2 years of SCIT, however. This second year of SCIT corresponded to the 2007 season, when a significantly higher number of days with at least 50 grains of pollen per 1 m(3) of air was recorded.

CONCLUSIONS

FLUCTUATIONS IN POLLINATION INTENSITY OBSERVED DURING CONSECUTIVE YEARS OF IMMUNOTHERAPY CAN INFLUENCE BRONCHIAL REACTIVITY IN PATIENTS SUBJECTED TO SCIT (ISRCTN REGISTER: ISRCTN 86562422).

Allergenic immunotherapy and seasonal changes in nitric oxide concentration in exhaled air in seasonal rhinitis patients

BACKGROUND

Concentration of nitric oxide in exhaled air (FeNO) was revealed to decrease as a result of immunotherapy. However, individuals who are exposed to environmental allergens are characterized by elevated values of FeNO. The aim of this study was to analyze the effects of subcutaneous immunotherapy (SCIT) on the dynamics of FeNO determined during consecutive pollination seasons.

METHODS

This study, performed between 2005 and 2008, included 41 patients with confirmed sensitivity to grass pollens and predominating symptoms of seasonal allergic rhinitis, randomly assigned to desensitization by preseasonal or maintenance SCIT. FeNO was measured prior to and during each pollen season (November-January and May-July, respectively). The results were conferred to data on grass pollination intensity in 2006-2008 (air concentration of grass pollen grains, seasonal number of days when air concentration of grass pollen reached at least 50 grains per 1 m(3)).

RESULTS

Median content of FeNO in exhaled air was significantly higher in 2007 compared to 2006 and 2008 pollen seasons. During 2007 and 2008 pollen seasons, significant increase in FeNO was observed compared to the respective preseasonal values. Median number of days with air concentration of grass pollen ≥ 50 grains per 1 m(3) of air during 4 weeks preceding seasonal FeNO measurement was significantly higher in 2007, corresponding to higher FeNO value recorded during this pollen season. However, no significant correlation was observed between seasonal number of days with ≥ 50 grass pollen grains per 1 m(3) of air and FeNO in exhaled air (r=0.09, p=0.362).

CONCLUSIONS

Most seasonal allergic rhinitis patients show physiological levels of FeNO prior to the pollen seasons and a marked increase in this parameter, probably proportional to pollination intensity, is observed within the seasons. ISRCTN Registry: ISRCTN86562422.

[Use of isotonic NaCl solution in patients with acute rhinosinusitis]

The mucous membrane of the nose and paranasal sinuses has several important physiological functions. Inflammation of the nose and paranasal sinuses impairs filtration, humidification and warming of the inhaled air. It also affects the beating of cilia and the mucociliary clearance within the nose and lumen of the sinuses. The result is impairment of the mechanism by which the removal of the stagnant pathological discharge from the paranasal sinuses and of foreign matter (environmental pollutants) from the nasal mucosa would be otherwise effected. The use of special products to cleanse the nasal mucosa may considerably improve its function. Day-to-day ENT practice offers evidence of beneficial effects of nasal douching with isotonic sea water solutions. Products which cleanse nasal mucosa are now used as an adjunct to treatment of rhinosinusitis and rhinitis co-existing with nasal polyps.

THE AIM OF THE STUDY

was a retrospective assessment of symptoms in patients with acute rhinosinusitis depending on the therapeutic modality used, especially in a group of patients using an isotonic solution (0.9% NaCl) in addition to standard treatment.

MATERIAL AND METHOD

Medical records of 80 patients, males and females with symptoms of acute rhinosinusitis were included in the final evaluation. The following medical records including fully documented medical history and physical findings in compliance with the EP3OS were randomly selected from the medical records at the ENT Outpatient Clinic: 40 patients with acute rhinosinusitis treated symptom-relieving medication (Group A) and symptom-relieving medication with topical nasal corticosteroids (Group C); 40 patients with acute rhinosinusitis treated symptom-relieving medication plus isotonic NaCl solution twice a day (Group B) and symptom-relieving medication with topical nasal corticosteroids plus isotonic NaCl solution twice a day (Group D).

RESULTS

Seven-days-treatment resulted in the decreasing of severity of the disease by 39.59% in control group and by 73.62% in patients using isotonic solution NaCl. The use of isotonic NaCl solutions as an adjunct to the treatment of acute rhinosinusitis results in highly statistically significant improvement of nasal patency (by 45.1% in control group and by 72.0% in patients using isotonic solutions) due to decreased swelling of the mucosa of the nasal turbinate. The use of isotonic NaCl solutions as an adjunct to the treatment of acute rhinosinusitis results in a highly statistically significant improvement in function of smell. Treatment with local nasal corticosteroids in combination with isotonic NaCl solutions produces a significant reduction in the severity of symptoms in patients with rhinosinusitis. The therapeutic effect in these patients is statistically significantly better than in patients treated with local nasal corticosteroids alone.

CONCLUSIONS

The findings of the present study support the investigators' opinion that the isotonic solution (0.9% NaCl) should be recommended for nasal douching may be a valuable adjunct to the standard medical treatment of acute rhinosinusitis.

[The use of hypertonic sea-water solution in patients after surgery of the nose and paranasal sinuses]

Surgical operations on the nose are very common otorhinolaryngological procedures. The surgical outcome depends not only on the performance of the procedure itself but also on the postoperative care of the nasal cavities. Clinicians continue their search for agents which would promote cleansing of the nasal cavities and regeneration of the nasal mucosa postoperatively.

THE AIM OF THE STUDY

was a retrospective evaluation of the effect of the product Marimer Hypertonic on symptoms in patients who had undergone nasal surgery (septoplasty, functional endoscopic sinus surgery, surgical removal of nasal polyps).

MATERIAL AND METHOD

The medical records included details of full history and physical examination on postoperative days 1, 7 and 14.The medical records of 120 patients were randomly selected from all records. The records were consecutively selected using the following criteria: 1-Operation type; septoplasty group A and B, FESS group C and D or classical surgical removal of nasal polyps group E and F , 2- Use (group B, D, F) or non-use (group A, C, E) of the hypertonic sea water solution aerosol for nasal douching (Marimer Hypertonic 2.2% sea-water solution). All patients included in the postoperative follow-up at the ENT Outpatient Clinic assess their symptoms by completing a standard self-assessment chart. The symptoms include nasal obstruction, discharge and crusting in the nasal cavities, pain in the nose and paranasal sinuses, reduction of smell, and general health (disease severity) and are assessed on day 1 after removal of nasal packing and on treatment days 7 and 14. At the same time, a clinician assesses their condition, including general health, nasal blockage, discharge and crusting in the nasal cavities, appearance of the nasal mucosa, and sense of smell evaluated by a scratch test using a smell book and a felt-tip pen test.

RESULTS

A statistically significance difference in the severity of disease between group A (control) and group B (using Marimer Hypertonic) indicates a statistically significant beneficial effect of nasal douching with Marimer Hypertonic after septoplasty. As early as day 7 after surgery, the disease severity rated by the participants was reduced by 58% in patients usining Marimer Hypertonic compared to 25% in controls. On day 14, the reduction was by 84% and by 51% respectively. The use of Marimer Hypertonic after septoplasty produced a much faster relief of nasal obstruction/blockage as assessed by both patients and clinicians. In the opinion of patients using Mariner Hypertonic, on day 7 and day 14 nasal obstruction/blockage was reduced by 73% and by 87% respectively while in controls the corresponding values were 14% and 48%. Nasal douching with Marimer Hypertonic produced faster relief of discomfort caused by the accumulation of abnormal nasal discharge and crusting. In the assessment of patients from the control group, 14 days after surgery abnormal nasal discharge and crusting persisted at a level similar to that reported immediately after septoplasty. In the group using Marimer Hypertonic, the symptoms reported by patients subsided by 58% and 88% by day 7 and day 14 respectively. As assessed by clinicians using rhinoscopy and endoscopy, the improvement of nasal discharge and crusting was significantly faster and more effective in patients using Marimer Hypertonic (by 70% on day 7 and 95% on day 14) compared to controls (15% and 45% respectively). The use of Marimer Hypertonic after FESS produced a much faster relief of nasal obstruction/blockage as assessed by both patients and clinicians. In the opinion of patients using Mariner Hypertonic, on day 7 and day 14 nasal obstruction/blockage was reduced by 73% and by 87% respectively while in controls the corresponding values were 23% and 61%. Nasal douching with Marimer Hypertonic was found to produce an obvious statistically significant beneficial effect resulting in the relief of discomfort caused by crusting and accumulation of abnormal nasal discharge after FESS. By day 7 the symptoms reported by patients subsided by 78% in patients using Marimer Hypertonic and by 88% in controls. By day 14 the symptoms decreased by 93% and 47 % respectively. As assessed by clinicians using rhinoscopy and endoscopy, the improvement of nasal discharge and crusting was significantly faster and more effective in patients using Marimer Hypertonic (by 84% on day 7 and 95% on day 14) compared to controls (11% and 26% respectively). The use of Marimer Hypertonic after polypectomy produced a much faster relief of nasal obstruction/blockage as assessed by both patients and clinicians. On day 7 nasal obstruction/blockage was reduced by 73% in patients using Marimer Hypertonic and by 14% in controls. On day 14 the corresponding values were 89% and 50%.

CONCLUSIONS

The findings of the present study support the investigators' opinion that the use of hypertonic sea-water solution, i.e. the product Marimer Hypertonic should be recommended for nasal douching after corrective nasal septal surgery (septoplasty), functional endoscopic sinus surgery (FESS) and surgical removal of nasal polyps (polypectomy). The use of Marimer Hypertonic facilitates maintenance of normal patency of the nasal cavities, reduces the amount of abnormal nasal discharge and crusting and speeds up healing of iatrogenic injuries of the mucous membrane of the nose.

[Taste perception in patients with chronic rhinosinusitis with nasal polyps treated with oral glucocorticosteroid therapy]

BACKGROUND

Chronic rhinosinusitis with nasal polyps is observed in 1-4% persons during rhinoscopy. While the occurrence of their problems is connected with smell sense, still not enough attention is paid to the malfunctioning of their taste sense.

AIM

The purpose of this study was estimation of taste sense functioning in patients with chronic rhinosinusitis with nasal polyps, treated with oral glucocorticosteroid.

MATERIAL AND METHODS

The study included 82 persons. The 31 of them were patients of Otolaryngology Department of Warsaw Military Institute with chronic rhinosinusitis with nasal polyps' diagnosis, who were treated with systemic--oral glucocorticosteroid for three weeks. There were 51 healthy people as a control group. Both prior to the treatment and one month after it was finished, all patients had the taste examination. The taste functioning was examined with two methods: the gustometry by Bornstein and impulse bipolar electrogustometry method. Subjective nasal patency was noted based on analogical scale. The smell function was assessed with the Elsberg-Levy olfactometry in Pruszewicz's modification.

RESULTS

Before treatment the taste disturbances were observed, depending on kind of taste, in 6-16 cases (19.4-51.6%) in gustometry and for 10 patients (32.26%) in electrogustometry. Before treatment the taste examination results in chronic rhinosinusitis with nasal polyps' cases were statistically significantly different than in the control group. After treatment with glucocorticosteroid the taste disturbances were observed, depending on kind of taste, in 0-9 cases (0-29%) in gustometry and for 4 patients (12.9%). in electrogustometry. Statistically, glucocorticosteroid therapy also decreased the smell threshold and was effective in restoration of the nose patency.

CONCLUSIONS

Statistically, therapy with glucocorticosteroid significantly improved both the taste and smell perception in patients with chronic rhinosinusitis with nasal polyps

[Universal electrogustometer EG-1]

Electrogustometry has been used as a clinical tool for diagnosis and assessment of a variety of conditions. Since the lack of versatile electrogustometer for research and diagnosis, the new electrogustometer EG-1 was developed in 2006. It was done in cooperation between Warsaw University of Technology and Military Institute of Medicine in Warsaw. EG-1 allows quantitative estimation of taste perception threshold using both static and impulse electrogustometry with bipolar electrode. It is a fully autonomous, battery powered and portable instrument. Because of small size and weight, it can be easily placed in any environment. Microprocessor controlled measurement system and user-friendly interface (LCD display with simple keyboard) make EG-1 electrogustometer very handy and flexible in operation. Data obtained during measurements is stored in the internal device memory. After taste examinations measurement data can be transferred to a personal computer via inbuilt USB port for further analysis and storage. EG-1 can generate three predefined variously shaped current impulses: sinus-, saw- and rectangle-shaped. There is an optional possibility of creating own shapes of stimulus puls by the user. The electrical parameters of generated pulses are as follow: current amplitude 1-2000 microA regulated with 1 microA step, stimulus frequency 0(DC)-500 Hz regulated with 5 Hz step, controlable fulfillment factor and signal rise time (optional for automatic measurements). The operator can trigger the stimuli via a hand switch on the bipolar electrode (with gold-plated endings), via keyboard or via additional independent hand switch. Three years of experience collected during EG-1 exploitation allowed to design a new version of electrogustometer EG-2 with a touch panel and color graphical display.

[The cytokines at maxillary sinuses washings as inflammatory process expression]

INTRODUCTION

In a pathogenetic chain of chronic sinusitis there is a set of cellular and humoral factors that are accepted as characteristic of a chronic inflammatory process. These include mast cells, granulocytes (basophilic and acidophilic), macrophages, lymphocytes, leucotriens (leukotrieny), and some pro-inflammatory cytokines. In the majority of cases these are effector factors that finalise pathogenetic immunological response. By determining concentration of pro-anti-inflammatory and immunoregulatory cytokines present in the place where the disease process is in progress we can distinguish the type of inflammatory condition and thus select the type and duration of treatment.

MATERIAL AND METHODS

The subject of the study was a group of 75 patients aged 18-60 with clinically confirmed chronic sinusitis; the diagnosis was made on the basis of history, physical examination as well as otolaryngological and imaging (CT scans) examination. Measurement of cytokines' activity was based on establishing concentration of cytokines in 1 ml (millilitre) of liquid recovered from puncture of maxillary sinus and subjected to centrifugation (lavage of maxillary sinuses) using ELISA (an immuno-enzymatic method) and kits produced by R&D company (Minneapolis, USA.) The following levels were examined: IL-1beta, IL-1ra, IL-4, IL-6, IL-10.

RESULTS

Depending on the type of inflammatory process (allergic or bacterial), a difference in the level of IL-1beta/IL-1ra and IL-4 i IL-10 concentration was discovered in patients examined. The static analysis focused on how progression of the disease influenced the results obtained.

CONCLUSIONS

Determining the amount of cytokines in maxillary washings allows differentiating chronic sinusitis.

[Treatment of the nasal septal hematoma and abscess in children]

OBJECTIVES

Estimation of the treatment of the nasal septal hematoma and abscess after injury was performed.

MATERIAL AND METHODS

In 1998-2005 in Department of Otolaryngology Children's Hospital in Warsaw 2500 children after nasal injury were examined. Nasal septal hematoma and abscess were diagnosed in 22 (0,9%). They were reviewed retrospectively and some of them were examined 1-8 years after.

RESULTS

In 22 children with nasal septal hematoma and abscess no complication were observed during treatment. In 12 children examined 1-8 year after treatment 1 child developed saddle nose deformity (qualified to observation) and 1 child developed nasal septum deformities with nasal obstruction (qualified to septoplasty).

CONCLUSIONS

Complex treatment of nasal septal hematoma, drainage of the hematoma with septoplasty and reduction of fracture of the nose, makes good functional and cosmetic effect. Drainage of the nasal septal abscess with antibiotic prevent the early complications but it isn't enough functional and cosmetic effect in the future.

[Air temperature measurements in nasal cavities and oral cavity]

AIM

Aim of this study was to check at the hospital the electronic thermometer for fast measurement of air temperature in upper airways. The nose ability of heating of inspired air and heat recovering from expired air was evaluated. Measurements from respiration through the oral cavity were compared.

MATERIAL AND METHODS

The study was carried out in a group of 30 people (6 female and 24 male), age group 18 to 62 (mean age: 33.5 years old). Almost the half of participants had no deviation from normal state in laryngologic examination. The rest of participants had nasal septum deviation (7 persons), nasal vonchae hyperthrophy (3 persons) and grade I nasal polips (2 persons). The measurements of air temperature in upper air ways was done using specially designed and constructed measurement system.

RESULTS

The air inspired through the nose and oral cavity is heated during respiration. For typical external conditions (T = 22 degrees C i RH = 50%) the nose heats inspired air 1,5 times better then oral cavity (short time range of measurement approximately 1 min.). Heat from expired air is recovered for both nasal cavities and oral cavity. Nasal cavities respiration ability for heat recovery from expired air is 3 times higher then oral cavity respiration.

CONCLUSION

The paper concerns the system for inspired and expired temperature measurements by miniature thermometer in different places of upper airways. Presented system can be a useful instrument for evaluation of thermal nasal cavities function.

[Comparison of dissolvable sinus dressings in functional endoscopic sinus surgery]

OBJECTIVES

Nasal packing is commonly practiced in postoperative care after nose and sinus surgery, not only for haemostasis but also as internal stabilisation and synechia formation control. The aim of our study was to compare the pain level, adhessions and haemostatic properties of Stammberger sinus dressing (SSD) with Dissolvable Sinu-Knit (DSK) and routine nasal packing in latex gloves finger (RNP) after FESS in adult patients.

METHODS

45 patients with bilateral chronic rhinosinusitis (CRS) (totally 90 sides) were recruited into our trial. All patients underwent bilateral FESS without septoplasty. Following completion of surgery, every single nasal cavity side was packed with one of the studied dressing chosen randomly. In 41 sides nasal cavities were packed with Stammberger Sinus Dressing (SSD) in 26 sides packed with Dissolvable Sinu-Knit and 23 sides were filled with routine nasal packing in latex gloves finger (RNP). Haemostatic effect was assessed during the recovery period, pain level was recorded by the patients on a visual analogue scale 24 hours after surgery. Tendency to postoperative middle meatal synechia formations was assessed during control visits in the 1, 2, 4 and 8 week postoperatively.

RESULTS

Three (7.3%) of sides packed with SSD and four (15.3%) packed with DSK had primary postoperative bleeding that required additional packing. Finally 3D patients were packed with RNP. In patients packed with RNP bleeding didn't appear. Mean pain level for SSD was 0.85 (range from 0 to 3) and for DSK 2.1 (range 0 to 5) whereas for RNP was 5.6 (range from 2 to 9). Five (13.1%) of thirty-eight sides with SSD and five (22.7%) of twenty-two sides with DSK had synechia in middle meatus whereas eight (26.6%) of total thirty sides packed with RNP had synechia at any one of the control visits.

CONCLUSION

We found that Rapid Rhino Stammberger Sinus Dressing and Dissolvable Sinu-Knit are associated with very low local pain level and with a good effect in postoperative bleeding and synechia formation control.

[Taste and smell senses estimation in patients with nasal polyps]

AIM

The purpose of this study was estimation of taste and smell senses functioning in patients with nasal polyps and the analysis of correlation between taste and smell perception threshold and polyps size.

MATERIAL AND METHOD

The study included 86 persons. The 35 of them were patients of Otolaryngology Department of Warsaw Military Institute with nasal polyps diagnosis. There were 51 healthy people as a control group. The smell perception examination was performed using Elsberg-Levy method in Pruszewicz modification. The gustatory function was investigated using gustatory method by Börstein and electrogustometry. The Börstein method based on four substances (each of them in three increasing concentrations) related to four basic tastes: sweet (glucose), bitter (chininum hydrochloride), sour (citric acid) and salty (sodium chloride). The taste feeling threshold (POS), that meant the lowest concentration of each solution being correctly recognized by a person, was noticed for each taste. For quantitative estimation of taste perception threshold we included impulse electrogustometry with bipolar electrode.

RESULTS

In our study the taste disturbances were observed, depending on kind of taste, in 20-70% cases in gustometry and for 13 patients in electrogustometry. Abnormal olfactory results we diagnosed in more then 57% patients. We did not confirmed correlation between taste perception threshold and polyps size but polyps size influenced on olfactory results.

CONCLUSIONS

Smell and taste disturbances are very often symptoms of nasal polyposis. The taste and olfactory estimation ought to be integral part of routine patient examination in otolaryngology department.

[Influence executed of occupation on self-evaluation disorders of voice]

INTRODUCTION

Loud speech is essential element everyday lives of man. Aim of researches was comparison of self-evaluation existing disorders of voice about averages degree intensifications at ill executing different jobs.

MATERIAL AND METHODS

With research one embraced 60 of persons with similar disturbances of voice caused vocal folds hypertrophy changes. In first group was 30 of persons working with voice, whereas second group embraced 30 ill workers in factories on positions immediately connected with production this institution. Estimations of influence of disorders of voice on quality of life ill one executed by means of self-evaluation polish test.

RESULTS AND CONCLUSIONS

Detailed analysis of tests showed, that exist significant differences among groups in estimation both qualitative as and quantitative. Hoarseness about averages degree intensifications at persons, of which occupation will demand usages of voice in estimation ill has indeed negative influence on their family life, professional and sociable. Patients, of which occupation will not demand in work of voice in spite of bad self-evaluation physical frame of mind did not feel of significantly negative influence of hoarseness on their functional and emotional frame of mind. Part from them noticed worse understanding their speeches in rooms, in of which reigns noise. Is this probably connected with specificity of place of work, and also with heedless articulation and with lack to known of bases of correct emission of voice. Lack of essential influence of disorders of voice on existence examined ill causes unfortunately too often behind time proper treatments, what can have dangerous for their lives of result, if reason talked over dysfunction is neoplasm of larynx. Above-mentioned conclusions are following evidence indicating on necessity of realizing reliable and of exact preventive researches in places of employment, and thanks ago early to detect and efficiently to treat even neoplastic diseases.

[Comparison of ability to humidification of inspired air through the nose and oral cavity using dew point hygrometer]

AIM

Aim of this study was to check at the hospital the dew point hygrometer for fast measurement of air humidity in upper airways. The nose ability to humidification of inspired air and partially recover moisture from expired air was evaluated. Measurements from respiration through the nose and oral cavity were compared.

MATERIAL AND METHODS

The study was carried out in a group of 30 people (8 female and 22 male), age group 18 to 70 (mean age: 37 years old). In 22 of the participants there were no deviation from normal state in laryngologic examination, while in 4 participants nasal septum deviation without imaired nasal; oatency was found, in other 3--nasal vonchae hyperthrophy and in 1--nasal polips (grade I). The measurements of air humidity in upper air ways was done using specially designed and constructed measurement system.

RESULTS

The air inspired through the nose and oral cavity is humidified. For typical external conditions (T = 22 degrees C i RH = 50%) the nose humidifies inspired air two times better then oral cavity (short time range of measurement approximately 1 min). Moisture from expired air through the nose is partially recovered (for patients with regular patency is 25% of the value of humidifying of inspired air). The oral cavity does not have ability to partially recovery moisture form expired air.

CONCLUSION

The paper presented fast dew point hygrometer based on semiconductor microsystems for measurement humidity in inspired and expired air through the nose and oral cavity. Presented system can be a proper instrument for evaluation of nasal functions.

[Threshold pollen count necessary to evoke allergic symptoms]

The purpose of this study was to analyze the relation between clinical picture of allergic disease and the level of pollen count the patients are exposed to.

MATERIAL AND METHOD

We analyzed the severity of allergic rhinitis, conjunctivitis and bronchial asthma in a group of 640 subjects from Warsaw area with hypersensitivity to hazel, alder, grass, mugwort, plantain, nettle, Alternaria and Cladosporium allergens. Aerobiological measurements, patients' symptoms score cards and the results of physical examination were analyzed.

RESULTS

First symptoms in patients allergic to grass were visible during exposure to the concentration of 20 pollen grains in 1 m3 of air (25% subjects sensitised to grass pollen). Symptoms were noted in all the subjects sensitized to grass pollen at a concentration of approximately 50 grains/m3 of air. During exposure to the concentration of 65 pollen grains per m3 the symptoms were strengthened. Several hours' exposure to grass pollen concentration exceeding 120 grains/m3 cause dyspnoea in some patients. Similar intensive symptoms occurred after exposure to alder, birch and mugwort pollen. Patients with positive skin prick tests to plantain and nettle pollen allergens experienced symptoms of low intensity or even none symptoms during pollination period. Subjects with hypersensitivity to Alternaria allergens experienced symptoms during exposure to the concentration of approximately 80 spores in 1 m3 of air, while patients sensitised to Cladosporium allergens, during exposure to the concentration of over 2800 spores in 1 m3 of air. The dominant symptom occurring in patients sensitized to fungal allergens was loss of nasal patency, and dyspnoea as well as recurring cough at higher concentrations.

CONCLUSIONS

Clinical symptoms of allergic disease were connected to the concentration and the kind of aeroallergen the subjects were exposed to.

[The existence vomeronasal organ in adult humans]

The influence of chemical substances (feromones) on human emotional and physical condition has fascinated psychologists, sexuologists and laryngologists since centurie. Literature conveys inconsistent information on vomeronasal organ (VNO) occurrence in humans. This organ is often called Jacobson's, and 2 symmetrical openings leading into it, located on both sides of septum, are called Ruyasch's ducts. The aim of the study was to analyze vomeronasal organ occurrence in humans in relation to age and sex. The study was conducted in a group of 634 patients, aged 18-80 years. All patients underwent routine ENT examination including rhinoscopy, nasal cavity examination with usage of 2.5x magnification lens (surgical glasses) and surgical microscope with 10x magnification. All persons had nasal cavities examined endoscopically. Every time presence of vomeronasal organ openings, along with localization, size and symmetry of these was noted. Subjects, who presented Jacobson's organ, were asked to fill a questionnaire concerning influence of smells on erotic sensations. Vomeronasal organ was fund in 312 persons, that is 49.21%. In 83.65% of cases vomeronasal organ opening size was smaller than 0.2 mm, what restricted its visibility to usage of magnifying lens, microscope, or endoscope. In 16.34% of cases only vomeronasal organ ducts openings were well visible in routine rhinoscopy without magnification. Vomeronasal organ was found more often in men than women. VNO was significantly more rare in patients with nasal septal deviation. In these cases, vomeronasal organ was usually found unilaterally, in all the cases on the concave side of deviated nasal septum.

[Laryngeal cancer risk factors]

Laryngeal cancer is the most common of head and neck cancers. Neoplasm used to develop basing on DNA mutation which leads to uncontrolled growth and cells' division. It is due to spontaneous mutations or influence of chemical, biological and physical factors. Laryngeal cancer generation is conditioned by many synergic factors. Some of them certainly participate in cancer genesis and this thesis is accepted by medical environment and other of them have been discussed giving different information. Definition of the risk factors role in laryngeal cancer etiology is very difficult especially regarding their contemporary occurrence in one person. Most common risk factors are environmental factors, gastroesophageal reflux, viral infections, diet, radiation, individual predisposition. Some of them, such as cigarette smoking and abuse alcohol are significantly oftener confirmed in patients with neoplasm diagnosis and others' role in developing of illness has been still researched. Thus the purpose of the study was to present so far achievements in laryngeal cancer etiology and to emphasize controversies relating to some factors' role in cancer genesis.

[Application of microsurgery in diagnosis and treatment of larynx diseases]

THE AIM OF THE STUDY

was analyzing cases of laryngeal diseases and their location that required treatment by surgical procedure as well as analyzing complications resulting from microsurgery of the larynx and their location during surgical procedures and treatment performed in the Otolaryngology Clinic at Military Institute of the Health Services Central Military Hospital in Warsaw (years 1994-2003).

MATERIAL AND METHODS

We analyzed 713 patients, of which 248 were women (34.8%) and 465 were men (65.2%) aged between 12 and 80 (the average age was 49.4 +/- 11.8), who were diagnosed as requiring microsurgery of the larynx using the Kleinsasser's set together with operating microscope and CO2 laser in selected cases.

RESULTS

The total of 713 microsurgical operations was performed in the larynx area. The largest group were the patients who were diagnosed as having polyps (33.0%), chronic laryngitis (19.6%) and an established diagnosis of laryngeal carcinoma. Complications were observed in 416 patients (58.3%).

CONCLUSIONS

Microsurgery of the larynx was the most often applied form of treatment of vocal fold polyps, chronic laryngitis and laryngeal carcinoma; pathological changes that require microsurgical treatment are mostly located in the epiglottis and the central part of the glottis whilst the major complications resulting from the microsurgery of the larynx are limited to superficial damage of the mucous membrane, mostly on the lips.

[Examination of the temperature stabilization process in the upper airways using a miniaturized electronic thermometer]

Diagnostic and treatment procedures in laryngology demand the knowledge on physiological processes taking place in nasal cavities in the course of breathing. It is of special importance in treatment with pharmacologic agents exerting an influence on nasal blood vessels and in nasal structures operations. The paper presents electronic thermometer which was specially designed for measurements in human higher airways. The system is set of flexible measurement head with miniature thermistor and microprocessor system connected to the personal computer fit out database application for collect and visualization measurement data. The device is safe for medical doctor and patient as well. With patient point of view, the measurements can be done easily and comfortably. The system allows recording dynamic changes of air temperature in upper airways and recalculates average inspired and expired air temperatures. The paper presents also initial results obtained in group of 15 healthy volunteers and 3 with tracheotomy It was made an estimation nasal ability to heating inspired air in particular places of nasal cavity and determined air temperature in nasal cavity outlet.

[Evaluation of polypectomy-related changes on olfactory function]

AIM

Aim of this study was to evaluate polypectomy-related changes of olfactory function in early postoperative period in comparison to the preoperative situation.

MATERIAL AND METHODS

Olfactory function was assessed in 25 patients of Military Medical Institute using Elsberg-Levy method. Measurements were performed preoperatively and 1 month after polypectomy.

RESULTS

Before the polypectomy measurements revealed higher odor thresholds in 18 patients. Postoperatively, decline of odor thresholds was observed in 14 hyposmic patients.

CONCLUSION

Present data indicates that olfactory function is related to nasal obstruction resulting from nasal polyposis. The study showed that polypectomy can increase olfactory function in patients with nasal polyps. Olfactometry can help to estimate nasal polyps during and after treatment even in early stage.

[Detection of Helicobacter pylori in nasal polyps specimens using urease test GUT plus]

In patients with nasal polyps the colonisation of nasal polyps tissues by Helicobacter pylori was investigated using urease test (GUT plus). In this prospective clinical trials we enrolled 61 subjects who had undergone endoscopic nasal polyps surgery and 30 subjects who had undergone septoplasty (control group) were questioned and biopsy specimens of the removed polyps or the mucosal part of inferior turbinate were tested by the urease test GUT plus. In result Helicobacter pylori was not found in the nasal polyps and mucosal part of inferior turbinate tissue of any of patients including the 43 of 61 patients with nasal polyps and 7 of 30 patients with septum deviation who had symptoms of gastroesophageal reflux. In our study using the urease test GUT plus we were not able to confirm presence of Helicobacter pylori in the nasal polyps tissue. However, further epidemiologic studies using different diagnostic methods would be necessary to confirm presence of Helicobacter pylori as potential underlying pathogenetic mechanism of nasal polyposis.

[Computerized image analysis in recognition and classification of aeroallergens]

In medical practice and research, it would be convenient to receive pollen identification and monitoring results in much shorter time than it comes from human identification. Image based analysis is one of the approaches to an automated identification scheme for pollens grain and pattern recognition on such images is widely used as a powerful tool.

PURPOSE OF THE STUDY

The goal of such attempt is to provide accurate, fast recognition and classification and counting of pollen grains by computer system for monitoring.

METHODS AND MATERIAL

The isolated pollen grain are objects extracted from microscopic image by CCD camera and PC computer under proper condition for further analysis.

RESULTS

The algorithms are based on the knowledge from feature vector analysis of estimated parameters calculated from grain characteristics including morphological features, surface features and other applicable estimated characteristics. Segmentation algorithms specially tailored to pollen object characteristics provide exact descriptions of pollen characteristics (border and internal features) already used by human expert. The specific characteristics and its measures are statistically estimated for each object. Some low level statistics for estimated local and global measures of the features establish feature space. Some special care should be paid on choosing these feature and on constructing the feature space to optimize the number of subspaces for higher recognition rates in low-level classification for type differentiation of pollens grain.

CONCLUSIONS

The results of estimated parameters of feature vector in low dimension space for some typical pollen types are presented as well as some effective and fast recognition results of performed experiments for different pollens. The findings show the evidence of using proper chosen estimators of tailored characteristics for good enough classification measures even for low dimensional classifiers for type differentiation of pollens grain.

[Examination of upper airway function using the dew point hygrometer with semiconductor detector]

The nasal mucosa with blood capillary network has a remarkable role in respiration process. The most important nose functions are heating and humidifying to optimal level of reaching throat and lungs air and partly absorption of humidity and temperature from expired air. Variations of humidifying and heating processes can invoke some upper airways disorders. The paper presents dew point hygrometer which was specially design for laryngological purposes. The hygrometer can measure dynamic changes of humidity in upper airways. The device is fully automated, easy to operate and can communicate with external personal computer. Database application allows saving patient data with archive examination results and can display them easily. During ongoing clinical tests, still increasing amount of data will allow precisely investigate correlations between humidifying process and some diseases. The main advantage of the device is a short response time on humidity changing. The number of readings (detections) can reach 5 readings per second (slightly depending on humidity level) which is much faster than in available on the market hygrometers with sorption sensors. The paper also presents some results obtained in group of healthy volunteers and one patient with tracheostomy The tests figured out actual humidity in certain parts of upper airways: nose, throat, trachea in breathing cycles under various surrounding conditions. The constructed hygrometer can be used for air humidity measurement in upper airways during some diseases and for evaluation of an influence of some drugs and environmental conditions changing on air upper ways mucosa.

[Subjective and objective assessment of voice quality after surgical treatment of overgrowth changes in vocal folds]

OBJECTIVES

Complex estimation of results of treatment micro surgically of ill larynx with overgrowth changes of vocal folds and comparison of usefulness different methods of research phonation function of larynx, and also estimation of influence disturbances of voice on functional state, emotional and physical ill applying to Clinics.

MATERIAL AND METHOD

With researches embraced group 40 ill with hoarseness, of which reason one was organic changes of vocal folds under form of polyps, of vocal nodes, of cyst and of swellings Reincke, attended operational (microsurgery with method Kleinsasser). Voice priced twice before intervention surgical and 3 months after operation. In researches used with scale GRBAS, with estimation laryngostroboscopy of function of vocal folds, analysis acoustic created of voice and Polish version of Voice Handicap Index (VHI).

RESULTS

Values p = 0.001 for "G" and p = 0.002 for "B" testify about special usefulness these two values of scale GRBAS in estimation of efficiency used treatments. Value p = 0.0004 obtained in research VHI proves distinct statistical symptomatic between estimation one's own voice and his of influence on life ill before and after operation and about good result of treatment. Statistical analysis examined of acoustic parameters showed on indeed statistical symptomatic difference only in chance of variable RAP (p = 0.03). Greatly usefulness for estimations used treatments showed stroboscope research, where especially character close of glottis (p = 0.003) and changes of mucosal wave (p = 0.008) show distinct dependence statistical difference before and after operation.

CONCLUSIONS

In complex estimation of voice ill after operation overgrowth changes of vocal folds greatest usefulness showed research of laryngostroboscopy, Voice Handicap Index (VHI) and qualification of grade-G and breathiness-B in scale GRBAS. Thanks used to method VHI ill oneself priced efficiency effect treatments, and doctor knowing answers of patient on each questions canned properly to steer further treatment.

[Aspects of biological activity of T and NK lymphocytes in children with adenoid hypertrophy and concomitant otitis media with effusion]

The aim of this study was to inquire whether it has got an influence on the number and activity of peripheral blood T and NK cells.

MATERIAL AND METHODS

The examined group consisted of 51 children with adenoid hypertrophy. The first group consisted of 17 children with only one episode of otitis media with effusion (ome). The second group consisted of 14 children with more than 4 episodes of ome and the third group consisted of 20 children with adenoid hypertrophy without ome. Evaluation of percentage of CD4+, CD8+ and NK subsets with co-expression of CD69, HLA-DR molecules in peripheral blood was performed by flow cytometry method. In examined groups with ome the decrease of CD4 number was compensated by increase of the number of NK and CD19 cells. In these groups the increase of CD69 and HLA-DR expression on the examined subsets was observed. The results suggest that in recurrent otitis media with effusion may be one of the factors causing T lymphocytes deficiency. Obtained results might be one of the criteria of using adenoidectomy.

[Assessment of the correlation between taste and smell functioning]

There are few studies examining relationship between taste and smell. However their clinical unity is more often indicated. Smell perception abnormalities cause modification in taste of food intensity, disabling perception of taste as a consequence of taste's sniffing failure. Thus disturbances of these senses, which often commonly coexist could cause great discomfort in patients, however taste sense is estimated as less important comparing to smell sense. The aim of that study was to compare the taste perception in patients with normal smell function and patients with hyposmia and anosmia. There was analyzed correlation between the patients' subjective estimation of smell and taste senses and results of gustometry and olfactometry examinations.

MATERIAL AND METHOD

there were indicated three groups of patients based on smell examination with usage of Elsberga--Levy'ego olfactometr in Pruszewicz modification. The first group included patients with normosmia, the second--patients with hyposmia or anosmia related to every smell, the third--patients with hyposmia on few smells and normal smell feeling of others. The Bornstein's method gustometry modified by us was performed for all groups. Moreover patients presented their subjective estimation of smell and taste senses. All results were statistically analyzed, taking into consideration results with alpha < or = 0.05.

RESULTS

All (100%) patients with normosmia correctly identified sour, bitter and salty tastes, while only 53% of patients with hyposmia and anosmia got similar results. However 76.5% of patients from the second group subjectively estimated their sense of taste as a normal perception.

CONCLUSIONS

Patients with smell disturbances significantly more often have abnormalities in taste perception than patients with normosmia and their subjective estimation of taste and smell senses is much more different than gustometry and olfactometry results.

[Techniques of intranasal drug use]

The aim of the study was to assess the incidence of changes in nasal mucosa in patients treated with long term intranasal corticosteroids and to determinate reasonability of intranasal drops administration in symptomatic treatment of nasal catarrh. The study included the total of 1962 patients. Within this group, 612 patients treated with intranasal corticosteroids underwent full laryngological examination to evaluate the status of nasal mucosa. In the group of 1350 users of web-based Allergologic Courier, who had used intranasal drops because of "runny nose" within last 3 months before the examination, a questionnaire survey was performed. The study results reflect poor knowledge the methods of nasal drops administration among patients, as well as low effectiveness of educational initiatives led by physicians and pharmacists. In 25 persons from 367 examined (6.81%) who used steroid spray locally, and who showed up in laryngological outpatient clinic, nasal mucosal damage was diagnosed for the first time. Mucosal damage was most frequently located in the right nasal septal mucosa--in 21 patients (5.72% of total patients) that was connected with improper nasal inhaler positioning and right hand movements directing it towards septum in the right nasal meatus. Among patients, who have remained under regular laryngological care in outpatient clinic (all of them are instructed of drug administration technique), only 5 persons (2.04%) out from 245 in the study group presented changes in nasal mucosa. No differences between changes occurrence on each side of nasal septum were found. Without proper training, only 8.52% from 1350 examined persons had been taking nasal drops in a proper manner to achieve its effectiveness.

[Computer-navigated surgery]

Computer-navigated surgery Computer-navigated surgery has become very popular in the recent years. It provides "the third dimension" to CT scans and endoscopic images. This technique enables the surgeon to reach given structures in the operation field using instruments and to visualise their location on CT scans acquired earlier by the computer and presented on the screen. Computer-navigated surgery facilitates the visualisation of instruments position in relation to anatomical structures in three projections. Because of the simultaneous presentation of the scans and the endoscopic picture on one screen, enormous comfort is granted to both the surgeon and the patient who can feel safe. The analysis of images reveals further information, which enhance the safety and lead to more effective procedures with diminished complications. The surgeon's assurance that the instruments are in the desired position, even in the anatomically complex structures, is the most impressive advantage of this technique. Computer-navigated surgery can be of great benefit in endoscopic surgery teaching programs. However, it cannot become a substitute of an adequate knowledge or replace proper education about anatomy of operated organs. The authors present the review of systems for computer-navigated surgery. They also describe their own experience based on endoscopic surgery of ethmoid and maxillary sinuses carried out with the use of computer navigation.

[Assessment of nasal obstruction treatment with the rhinomanometric examination]

The aim of the present study was to assess of nasal obstruction treatment by means of rhinomanometry at patients with deviation of the nasal septum and with rhinitis allergic or vasomotor. The research encompassed 171 patients with nasal obstruction, medicated in Department ENT, who were assigned to 6 different groups according to nasal obstruction reason: group I--42 patients with deviation of the nasal septum, group II--32 patients and group III--34 patients deviation of the nasal septum and with allergic rhinitis, group IV--33 patients and group V--30 patients with deviation of the nasal septum and vasomotor rhinitis and 30 healthy subject forming control group. In groups I, II and IV patients performed plastic surgery of nasal septum and group II and IV performed inferior nasal concha surgery. Laboratory norms for rhinomanometry were fixed on the basis of healthy control group results analysis. After the surgical treatment normal results in rhinomanometry were found: in group I 81%, in group II 53%, in group III 62%, in group IV 51% and in group V 63% patients.

[The usefulness of computer-aided navigation in endoscopic sinus and nasal surgery]

The usefulness of computer-aided navigation in endoscopic sinus and nasal surgery. Endoscopic surgeries of the sinuses are among the most difficult procedures in otolaryngology. The progress of endoscopic techniques led to reduction of invasiveness enabling the surgeon to perform precise procedures with minimal tissue traumatization. The systems for computer-aided endoscopic surgery combine preprocedural MRI or CT data with information regarding current location of the surgical tools. The aim of this study was to assess the usefulness of electromagnetic navigation system ENTrak 3500 in endoscopic nasal and sinus surgery. The study group consisted of 18 consecutive patients with maxillary or ethmoid sinusitis with concomitant nasal polyps, who were surgically treated in ENT Clinic Military Medical Institute in October 2003. In all patients the endoscopic nasal and sinus surgery with the use of computer-aided navigation was successful with complete removal of pathologic lesions within the cavities of the nose, maxillary and/or ethmoid sinuses.