Influence of aging on medial olivocochlear system function

BACKGROUND

There is still controversy regarding the influence of aging on medial olivocochlear (MOC) system function. The main objective of this study is to measure age-related changes of MOC system function in people with normal hearing thresholds.

METHOD

Bilateral assessment of the MOC effect for click-evoked otoacoustic emissions (CEOAEs; at 70±3 dB peak sound pressure level [pSPL], click at 50/second, 260 repeats, 2.5-20 millisecond window) and for distortion product otoacoustic emissions (DPOAEs; with [frequencies] f2/f1=1.22, [levels of primary tones] L1=65 dB SPL and L2=55 dB SPL; DP-grams for 2f1-f2 were collected for the f1 frequencies varying from 977 Hz to 5,164 kHz, with the resolution of four points per octave) was performed in a group of 146 (n=292 ears) healthy, right-handed subjects aged from 10-60 years with a bilateral hearing threshold from 0.25-4.0 kHz, not exceeding 20 dB hearing level; normal tympanograms; and a threshold of the contralateral stapedial reflex for broadband noise (BBN) of 75 dB SPL or higher. The MOC inhibition was assessed on the basis of changes in OAE level during BBN contralateral stimulation at 50 dB sensation level (mean, 65±3 dB SPL).

RESULTS

Comparative analysis of the MOC effect for CEOAE and DPOAE showed the weakest effect in the oldest age group (41-60 years) at almost all tested frequencies. Moreover, a weak, albeit significant, positive correlation between the level of OAE and the size of the MOC effect was documented.

CONCLUSION

On the basis of our study, we have found a decrease in the strength of the MOC system with increasing age in normally hearing subjects, as reflected by a decrease of the OAE suppression effects in older individuals and an increase of the number of CEOAE and DPOAE enhancements during contralateral acoustic stimulation in the elderly, especially in the high-frequency range.

The role of serotonergic 5-HT1A receptors in central cardiovascular regulation in haemorrhagic shock in rats

The bleeding and haemorrhage is strictly related with accidents and many medical procedures. In some conditions it leads to hypovolaemia and further to hypovolaemic shock. Under conditions of haemorrhagic shock, heart rate and blood pressure critically collapse. Reversing the sympathoinhibitory phase of hypovolaemia could be crucial for clinical management of injured patients after haemorrhage. Systemic administration of 5-HT1A agonists seams to produce resuscitating effects. The aim of this study was to investigate the participation of central serotonin and, in particular, 5-HT1A receptors in cardiovascular regulation in haemorrhagic shock in rats. Intracerebroventricular (i.c.v.) administration of serotonin (5-HT) increased the heart rate (HR), mean arterial pressure (MAP) and implicated that all haemorrhaged animals survived for the whole observation time (2 hours). Similar, although significantly more minor, effects were achieved after selective 5-HT1A activation. Moreover, the i.c.v. administration of selective 5-HT1A antagonist before i.c.v. 5-HT injection partially inhibited 5-HT induced changes. The results of the present work indicate that 5-HT plays an important role in the reversal of the haemorrhagic shock in rats. These effects are at least partially dependent on activation of 5-HT1A receptors.

Assessment of hearing organ activity in a group of neonates with central nervous system impairment

OBJECTIVE

Hypoxic-ischemic encephalopathy, primary subarachnoid hemorrhage in term newborns as well as periventricular leukomalacia and intraventricular hemorrhage in premature newborns are the major consequences of perinatal asphyxia. Intrauterine hypoxia and labor prolongation can also affect the hearing organ in newborns causing reversible or irreversible changes in the cochlea, brainstem or cortex. The aim of the study was to carry out the objective assessment of the cochlea and hearing pathway activity using CEOAEs and ABR; to find relationships between hearing status and parameters effecting on nervous system in neonates with central nervous system impairment occurring following perinatal asphyxia.

METHODS

To the investigation 36 newborns with hypoxic-ischemic encephalopathy, periventricular leukomalacia or intraventricular hemorrhage were included. The control group encompassed 32 health newborns matched as to the age. In all newborns otoscopic examination, CEOAEs after birth and CEOAEs with ABR 3 months later were performed. Perinatal anamnesis, general pediatric status, results of trans-fontanel ultrasonography and biochemical test results were taken into account in statistical analyses.

RESULTS

The mean amplitudes of CEOAEs in the first days of life were significantly reduced in investigation group comparing to control babies. 3months later the recorded responses significantly increased but did not reach values of control group. No differences were found between latencies of waves I and II. ABR latencies of waves III, IV, V and interpeak latencies I-III, III-V, I-V were delayed in investigation group when compared to control patients. Also morphology of ABR recordings in investigation group has slightly changed. Perinatal aspyxia leading to hypercapnia, low gestational age, prolonged artificial ventilation and meningitis were the main risk factors related to disturbances in ABR recordings.

CONCLUSIONS

The combined use of CEOAEs and ABR in neonates with central nervous system impairment involvement revealed the existence of abnormalities in cochlear micromechanics and retrocochlear auditory pathway. Etiology seems to be multifactoral.

Effect of tonsillectomy on the level of exhaled nitric oxide (NO) in patients with recurrent tonsillitis

BACKGROUND

Increased expression of inducible nitric oxide synthase in inflamed tonsils has been reported. Our preliminary observation was the first to demonstrate that increased exhaled NO level may occur in patients with tonsillitis.

OBJECTIVE

To extend the observation scope, the same group of patients was examined for NO exhaled after tonsillectomy.

MATERIALS AND METHODS

Exhaled oral NO level was measured with Niox Mino(®) analyzer, six-seven months after tonsillectomy in 27 non-atopic patients who suffered from recurrent tonsillitis and in 35 healthy non-atopic subjects.

RESULTS

After tonsillectomy, exhaled NO levels were significantly reduced as compared to the preoperative period values and did not differ significantly from those of the healthy subjects.

CONCLUSIONS

The results support a finding of the elevated exhaled NO consequent to NO production in chronically inflamed tonsils, but whether NO plays any role in the pathogenesis of tonsillitis or is merely a by-product of another process, needs to be determined.

Long-term results in patients after combined laser total arytenoidectomy with posterior cordectomy for bilateral vocal cord paralysis

The problem of ventilation efficiency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and efficacy of different surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF(25), FEF(50), FEF(75), PEF, MMEF(75/25), AREA(Ex), sR(T0T), R(T0T) were compared and analyzed. Also, the values of the inspiratory parameters FIV(1), FIF(50), PIF and the coefficients FEF(50)/FIF(50) and FIV(1)/FEV(1) were assessed. Moreover, subjective evaluation was performed based on a questionnaire. The statistical analysis reveals a significant decrease in FIV(1), FIF(50), PIF and FIV(1)/FEV(1). FEF(50)/FIF(50) and sR(T0T) (actual and predicted values) increased significantly after 5 years from the operation. However, the patients did not complain nor was this tendency reflected in their answers to the questionnaire. The probable reasons for such ventilation results are discussed. The role of phoniatric rehabilitation and the time elapsed is emphasized. In general, it can be concluded that laser arytenoidectomy with posterior cordectomy is a durable and effective procedure, although the objective assessment does not fully match the patient's subjective impression.

Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight

The relation between snoring and obstructive sleep apnea as well as hypothyroidism is the object of interest of many authors. The respiratory disturbances during sleep are often observed in patients suffering from hypothyroidism. The relation of snoring to overweight in those patients has not been taken into account. The aim of the study was to evaluate the relations between hypothyroidism and quantitative and qualitative respiratory disturbances during sleep. Additional aim was to establish the relations of sleep apnea syndrome, snoring, hypothyroidism and overweight. The subjects included 15 patients (11 females and 4 males) aged from 28 to 73 (mean 50.3) suffering from hypothyroidism. All of them underwent thyroid testing before and after the hormonal treatment. TSH and fT4 concentrations were determined. At the same time the sleep assessment (PolyMESAM) was performed twice. Data were obtained from sleep studies and questionnaires (Epworth sleepiness scale). After the thyroid hormones stabilization significant decrease of snoring severity was observed. On the contrary, the respiratory disturbance index (RDI), desaturation index (DI), the lowest saturation (LSAT) did not change significantly, however, the Epworth scale score showed significant improvement. The correlations showed the strong relation between loud snoring and TSH (r=0.73, p<0.01) and fT4 (r=-0.66, p<0.003) concentrations before the treatment. The analysis showed no correlation between body mass (BMI) and snoring. The hormonal stabilization in patients suffering from hypothyroidism causes improvement in snoring severity. Based on our investigation the relationship between hypothyroidism and severity of snoring and excessive daytime somnolence was confirmed. It indicates a possible connection between hypothyroidism and upper airway resistance syndrome.

Role of leptin, ghrelin, angiotensin II and orexins in 3T3 L1 preadipocyte cells proliferation and oxidative metabolism

There is now growing evidence that the reactive oxygen species have an influence on proliferation and antioxidative status of various cell types. The aim of the study was to investigate the effects of different concentrations of leptin, ghrelin, angiotensin II and orexins on proliferation, culture medium malondialdehyde (MDA) levels and antioxidative enzymes activities: superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) in 3T3 L1 preadipocytes cell culture. Cell proliferation was measured using [(3)H]tymidine incorporation. In 3T3-L1 cells leptin caused a significant reduction in proliferation (by 36%) compared to control. Ghrelin increased preadipocyte proliferation, and the effect was stronger in higher dose (by 39%), while proproliferatory effect of angiotensin II was stronger in lower doses (by 47%). All used doses of orexin A significantly increased 3T3 L1 cell proliferation (from 21% to 160%), while orexin B caused a marked reduction (from 35% to 70%) of this proliferation. The effects of both orexins were dose-dependent. Leptin and ghrelin increased activity of SOD, CAT, GSH-Px and decreased level of MDA. Angiotensin II treatment stimulated only SOD and CAT activities. Influence of orexins was different on various enzymes. Orexin A increased MDA levels, while orexin B caused a marked decrease in MDA levels. Our results strongly suggest the effects of appetite affecting hormones such as leptin and ghrelin on proliferation and antioxidative enzyme activities of preadipocyte cell lines. Orexin A was found to be the most efficient proliferative-signalling hormone, while orexin B revealed the most significant inhibitory effect on preadipocytes proliferation.

Huge retropharyngeal lipoma causing obstructive sleep apnea: a case report

Lipoma of the retropharyngeal space is a very rare benign tumor often causing unspecific clinical symptoms. The most common symptoms are dysphagia and/or respiratory disturbances. The clinical diagnosis may be difficult. The radiological imaging techniques (CT and MRI) can provide adequate information with regard to the composition and extension of the tumor, although final histological confirmation is essential. Surgery is the treatment of choice. We present a case of 40-year-old male patient complaining of obstructive sleep apnea symptoms (respiratory disturbances, excessive daytime somnolence, morning headache). The radiological examination (CT) showed a huge (11.7 x 7.2 cm) lipoma of the retropharyngeal space extending from the nasopharynx to the superior mediastinum. The tumor was removed via transcervical approach with complete amelioration of symptoms.

Intraoperative Monitoring of Cochlear Function Using Distortion Product Otoacoustic Emissions (DPOAEs) in Patients with Cerebellopontine Angle Tumors

HYPOTHESIS

Intraoperative monitoring by distortion-product otoacoustic emissions reflects the cochlear function changes in the real-time domain during removal of cerebellopontine angle tumors.

BACKGROUND

Cerebellopontine angle tumor surgery is associated with a significant risk of damaging internal auditory canal contents. Although monitoring facial nerve function intraoperatively has already been effectively developed, such efficacious monitoring of auditory function remains to be established. The aim of this study was to investigate the utility of distortion-product otoacoustic emissions for intraoperative monitoring of the cochlear function in humans during removal of cerebellopontine angle tumors.

METHODS

Continuous intraoperative monitoring of distortion-product otoacoustic emissions was performed in 20 of 62 patients undergoing surgical removal of cerebellopontine angle tumors. All of these 20 patients, who underwent the retrosigmoid approach, had distortion-product otoacoustic emissions present preoperatively. Depending on the amplitude and frequency band at which distortion-product otoacoustic emissions were present, monitoring was carried out at 2.0 to 6.0 kHz with primary stimulus tone amplitudes of 60 to 70 dB sound pressure level.

RESULTS

In patients operated on for cerebellopontine angle tumors, various patterns of distortion-product otoacoustic emission amplitude reductions and recoveries were observed. Distortion-product otoacoustic emissions recorded from the basal part of the cochlea (i.e., high frequencies) changed earlier and more profoundly than those from the middle and apical sections (i.e., lower frequencies). In some cases, cochlear function was affected irreversibly as reflected by loss of distortion-product otoacoustic emissions. Microcoagulation of small vessels, tumor debulking, and compression or stretch of the internal auditory canal contents were found to be procedures affecting distortion-product otoacoustic emissions. The status of distortion-product otoacoustic emissions at the conclusion of tumor dissection correlated with postoperative hearing levels.

CONCLUSION

Distortion-product otoacoustic emissions were used to monitor in the real-time domain auditory function during cerebellopontine angle tumor removal operations. The status of distortion-product otoacoustic emissions at the conclusion of the operations was related to postoperative hearing.

Preventing internal auditory artery vasospasm using topical papaverine: an animal study

BACKGROUND

Internal auditory artery (IAA) spasm is thought to be one of the causes of postoperative sensory hearing loss after attempted hearing preservation removal of an acoustic neuroma. The use of topical papaverine, a nonspecific vasodilator, to prevent vascular insufficiency to the inner ear and to improve hearing outcomes has been suggested but not proven.

MATERIALS AND METHODS

Vasospasm was mechanically induced by compressing the IAA in the control ears of six rabbits after application of topical saline. The subsequent reduction of cochlear blood flow (CBF) was measured using a laser-Doppler (LD) flow-monitoring technique. Functional loss of cochlear activity was verified with distortion product otoacoustic emissions (DPOAE). The contralateral experimental ears were treated with the topical application of papaverine directly to the IAA and cochleovestibular nerve complex. CBF and DPOAE were compared between the control and papaverine treated ears for 3-minute and 5-minute IAA compressions.

RESULTS

Every control ear demonstrated some degree of postcompression IAA vasospasm (i.e., reduced CBF) and reduction of DPOAE. Nearly complete recovery of CBF and DPOAE to baseline was observed in all of the papaverine treated ears.

CONCLUSIONS

An animal model of IAA vasospasm was described. Mechanically induced vasospasm of the IAA was prevented by the topical application of papaverine. These findings have clinical implications for surgical procedures involving the internal auditory canal/cerebellopontine angle such as acoustic neuroma removal.

Role of mannitol in reducing postischemic changes in distortion-product otoacoustic emissions (DPOAEs): a rabbit model

OBJECTIVES

The aim of this study was to observe the effects of mannitol, administered topically at the round window (RW), on cochlear blood flow (CBF) and distortion-product otoacoustic emission (DPOAE) after repeated episodes of cochlear ischemia.

METHODS

Ten young rabbits were used for this study. Reversible ischemic episodes within the cochlea were induced by directly compressing the internal auditory artery (IAA). CBF was measured using a laser-Doppler (LD) probe positioned at the RW niche. DPOAEs were measured at 4, 8, and 12 kHz geometric mean frequency (GMF) using 60 dB sound pressure level (SPL) primary tone stimuli. In five test ears, mannitol was administered topically at the RW for 30 minutes before the IAA compressions. In five control ears, the IAA compressions were undertaken without application of RW medication. Each ear underwent three 5 minute IAA compressions with a 60 minute rest period between compressions.

RESULTS

In the control animals, it was observed that a progressive reduction in DPOAE level followed each successive IAA compression at all three test frequencies. The reduction in DPOAE amplitudes was consistently greater at the higher test frequencies. In the test rabbits, the RW administration of mannitol resulted in significantly less reduction in DPOAE level measures after repeated IAA compressions. For example, 30 minutes after reperfusion at 12 kHz GMF, DPOAE levels in the control ears were reduced by 1.5, 6.0, and 16 dB, compared with 1.5, 4.0, and 6.0 dB in the mannitol test ears.

CONCLUSIONS

Mannitol appears to exert a protective effect on cochlear function after periods of ischemia. The RW appears to be an efficacious route for topical administration of mannitol into the inner ear.

The influence of laser arytenoidectomy on ventilation parameters in patients with bilateral vocal cord paralysis

Bilateral vocal cord paralysis is a symptom that may lead to serious breathing problems. The treatment of patients with vocal cord paralysis presents a challenge to otolaryngologists. Many techniques have been developed in an attempt to improve the patient's airway insufficiency. The aim of the study was to evaluate the efficacy of the laser total unilateral arytenoidectomy with posterior cordectomy in patients with bilateral vocal cord paralysis. Thrity-six patients (33 females, 3 male) aged between 24 and 76 (mean 52) were treated by laser arytenoidectomy. The flow-volume loop and pletysmography were performed in all patients before and after the operation. Additionally, a group of 15 patients with unilateral vocal cord paralysis was introduced and analyzed as a special control. Based on the relative increase of the parameters after the surgery, the most useful of them were selected for the evaluation. Also, the character of the laryngeal obstruction was defined. Changes in the flow-volume loop before and after surgery were compared by planned comparison in univariate analysis ANOVA/MANOVA with an isolated control group. As the parameters AREA(EX), FEF50, FEF75, PEF and MMEF(75/25) increased most effectively, they appeared to be the most useful in the evaluation. FIV1/FEF1, FEF50/FIF50 and FEV1/FEV(0,5) allowed the definition of the obstruction as an extrathoracic dynamically variable quantity. The resistances measured during pletysmography diminished significantly after surgery. The introduction of the special control group with unilateral vocal cord paralysis showed that despite the significant improvement after surgery, the patients who had been operated on still had a laryngeal obstruction worse than that of patients from the control group. The laser arytenoidectomy is shown to be a useful and efficacious procedure for bilateral vocal cord paralysis.

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

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

Comparison of the efficacy and tolerability of amoxycillin/clavulanic acid 875 mg b.i.d. with cefuroxime 500 mg b.i.d. in the treatment of chronic and acute exacerbation of chronic sinusitis in adults

The efficacy and safety of amoxycillin/clavulanic acid (AMX/CA) (875/125 mg b.i.d. for 14 days) were compared with that of cefuroxime axetil (500 mg b.i.d. for 14 days) in a multicenter, open, parallel-group, randomized clinical trial in 206 adults with chronic or acute exacerbation of chronic sinusitis. Clinical response was similar, with 95% of AMX/CA-, and 88% of cefuroxime-treated, clinically evaluable patients cured (95% confidence interval; -0.6% to +15%). In bacteriologically evaluable patients, cure rates, defined as eradication of the original pathogen with or without re-colonization with non-pathogenic flora, were also similar, with 65% of AMX/CA- and 68% of cefuroxime-treated patients cured (95% confidence interval; -18% to +15%). However, clinical relapse was significantly higher in the cefuroxime group: 7% (7/89) of clinically evaluable patients, compared with 0% (0/98) in the AMX/CA (p=0.0049) group. A similar incidence of possible or definite adverse events related to the study drug was reported for both treatments (AMX/CA 4.4%, cefuroxime 4.3%), the most frequent being diarrhea. Four adverse events were recorded as serious or life-threatening with only one considered related to the study drug (urticaria, cefuroxime). AMX/CA 875/125 mg b.i.d. for 14 days is as effective and well tolerated as cefuroxime axetil 500 mg b.i.d. for 14 days in the treatment of chronic, or acute exacerbation of chronic sinusitis, but is associated with a significantly lower clinical relapse rate.

Influence of contralateral stimulation by two-tone complexes, narrow-band and broad-band noise signals on the 2f1-f2 distortion product otoacoustic emission levels in humans

In order to test the frequency specificity of the efferent suppressive effect on otoacoustic emissions, changes in the 2f1-f2 distortion product otoacoustic emission (DPOAE) levels induced by contralateral stimuli of different spectra were measured in 10 normally hearing adults. Three types of contralateral stimuli were used: (i) a set of 6 pairs of pure tones with the same frequencies as used for DPOAE stimulation; (ii) 6 narrow-band noise signals with cut-off frequencies equal to the frequencies of the primary tones used for DPOAE stimulation; and (iii) broad-band noise with a bandwidth of 840-6,000 Hz. A small suppressive effect was observed mainly in the mid-frequency region. Broad-band noise was more effective at suppressing DPOAEs than narrow-band noises and two-tone complexes. Occasionally, small enhancements in DPOAE amplitudes were observed. Based on the results of this study, it is concluded that DPOAE changes induced by contralateral stimuli are not frequency-specific, and are too small to have routine clinical value.

Recurrent laryngeal nerve palsy after thyroid cancer surgery: a laryngological and surgical problem

Recurrent laryngeal nerve paralysis is one of the most frequent complications after thyroid surgery due to goiter and cancers. A higher probability of this complication occurs after secondary procedure of the thyroid and in malignant cases. The symptoms may differ and depend on many factors. Generally, patients need careful ENT and surgical care including diagnosis and treatment. Four hundred and sixty-six patients who underwent thyroid operation due to cancer were analyzed. The group was composed of 227 papillary carcinoma, 87 follicular carcinoma, 51 medullary carcinoma, and 101 anaplastic carcinoma. Two hundred and fifty-three total thyroidectomies, 82 lobectomies and subtotal second lobe operations, 91 subtotal thyroidectomies, and 40 biopsies (wedge resections) were performed. In all 426 total and subtotal thyroidectomies an attempt to identify the recurrent laryngeal nerves was carried out. For 360 patients (77%) the surgical procedure was primary and for 106 patients (23%) the operation was secondary. Preoperative and postoperative laryngoscopic examinations were performed in all patients. Every patient with palsy underwent special laryngological procedures if needed (tracheotomy, phoniatric rehabilitation, conservative treatment and surgery in lack of improvement). The rate of postoperative vocal cord paralysis was 4.7%. The permanent palsy rate was 3.5%. In 1.2% recovery was observed. Of the 4.7% palsy rate, 3.2% concerned unilateral palsy and 1.5% bilateral pathology. Using the chi2 test, no significant differences between the rate of unilateral and bilateral paralysis and between temporary and permanent paralysis were found. On the basis of our material and results, identification the recurrent laryngeal nerves should be mandatory at surgery, thereby avoiding paralysis. Special laryngological procedures and surgical care from the beginning of paralysis are necessary for patients with vocal cord palsy. It allows to diagnose and treat patients with quite good results.

The hearing system in newborns from the Upper Silesia. Assessment of TEOAE depending on selected parameters of delivery disorders

Transient evoked otoacoustic emission (TEOAE) is an accepted test for screening of the cochlea function in newborns. In this study 300 newborns was tested using TEOAE, as well as analysing such parameters as birth weight, Apgar scale, bilirubinaemia. The study indicated the tendency of TEOAE to decrease in newborns with low birth weight and low Apgar scores. Hyperbilirubinaemia seems to have an influence on cochlea function monitored by TEOAE, especially if there were simultaneously low Apgar scores. A similar tendency, although slightly stronger, was observed in the preterm newborn group. TEOAE seems to be a good method of recording the negative influence on the cochlea activity such factors as low birth weight and asphyxia. Hyperbilirubinaemia with asphyxia acts upon the cochlea similarly. All these tendencies were observed more strongly in the preterm newborn group. It is concluded that TEOAE analysis demonstrated its utility as a screening test assessing the hearing state in newborns, additionally the associations of cochlea activity was found with a few parameters of delivery disorders.

Assessment of the medial olivocochlear efferent system in children. pure tone 1.0 kHz and 2.0 kHz suppressive effects on transient evoked otoacoustic emission

The role of medial efferent system in regulating outer hair cell function has been studied by many investigators. Usually narrow band noise or white noise as contralateral stimulation (CS) suppressors have been used and changes in OAE amplitudes estimated. Thirty children aged 6-15 years (mean 12.5 +/- 4.7), without any changes in tonal and impedance audiometry and with negative history regarding otiatric diseases were examined. Transient evoked otoacoustic emissions (TEOAE) were recorded using ILO 92 Otodynamics Analyser. CS was performed using 1.0 kHz and 2.0 kHz continuous pure tones of 30 dB SL or 50 dB SL. Effects of CS on TEOAE evoked by click of 80, 70 and 60 dB SPL were investigated. TEOAE analysis included assessment of TEOAE amplitude of half octave frequency bandwidth (HOFBW-1.0; HOFBW-1.5; HOFBW-2.0; HOFBW-3.0 and HOFBW-4.0 kHz) and 0.8 kHz frequency bandwidth (0.8-FBW) amplitudes centred at 1.0; 2.0; 3.0; 4.0 and 5.0 kHz. TEOAE amplitude recorded for stimuli 80, 70 and 60 dB SPL without CS decreased: mean values respectively 6.1 +/- 4.2; 5.4 +/- 4.5 and 3.3 dB SPL +/- 4.3. CS effect on TEOAE was observed for all CS options, however, larger suppressive effect was recorded on TEOAE elicited by 70 dB SPL stimulus using 1 kHz/50 dB SL tone as a suppressor and on TEOAE elicited by 60 dB SPL stimulus using 2 kHz/50 dB SL tone as a suppressor. HOFBW and 0.8-FBW analyses showed the association between the frequency/intensity of the suppressors and decreasing of amplitudes of adequate frequency bands. It is concluded that the described method of investigating of the medial olivocochlear efferent system seems to be sensitive and confirms frequency-dependent suppressive effect on OAE.

Contralateral suppression of TEOAE in diabetic children. Effects of 1.0 kHz and 2.0 kHz pure tone stimulation--preliminary study

The medial efferent system and its regulating outer hair cell function have not been previously studied in diabetic children. In this study, the group comprised 32 diabetic children, aged 6.0-16.0 years, with diabetes lasting 2.0-9.0 years, with normal tonal and impedance audiometry. A control group consisted of 30 healthy children with similar age and sex distribution. Contralateral stimulation (CS) was performed using 1.0 and 2.0 kHz pure tones on the level of 30 and 50 dB SL. Effects of CS on transient evoked otoacoustic emissions (TEOAE) elicited by click of a level equal to 70 and 60 dB SPL were investigated. Analysis included assessment of TEOAE amplitude and 0.8 kHz frequency bandwidth (0.8-FBW) amplitudes (signal/noise) centred at 1.0; 2.0; 3.0; 4.0; 5.0 kHz. TEOAE-RA recorded for stimulus 80, 70 and 60 dB SPL without CS were decreasing: average values respectively 7.3, 4.7 and 3.9 dB SPL. In the group of diabetic children TEOAE amplitudes, recorded for different click levels without CS, were similar to these recorded in healthy children. It suggested that normal function of the cochlea was preserved, mostly outer hair cells. However, the obtained effects of CS, in comparison with healthy children, were weaker and not so regular. Statistical analysis revealed that the reduction of TEOAE amplitudes for adequate 0.8-FBW in the control group was significantly higher, for both 1.0 kHz and 2.0 kHz CPTs of 30 dB SL and 50dB SL, in comparison with diabetic children. It is concluded that the suppressive effect on OAE in diabetic children is rather weak and seems to be associated with pathological changes in medial olivo-cochlear myelinated fibres.

Latencies of the 2f1-f2 distortion product otoacoustic emissions measured using a phase-gradient method in young people, in the elderly and in people exposed to noise

Distortion product otoacoustic emissions (DPOAE) are generally accepted as a good tool for investigating the micromechanics of the cochlea. The 2f1-f2 DPOAE latencies provide significant data regarding travelling waves. In this study the 2f1-f2 DPOAE latencies were measured using a phase-gradient method, with a swept-f2 procedure, for three groups: Group I comprised 60 healthy young people, aged 17-32 years; Group II comprised elderly patients, aged 56-72 years, with presbyacusis; and Group III consisted of 74 miners, aged 19-35 years, who had been exposed to noise for 2-15 years. Measurements were performed for frequencies between 1.0 and 6.0 kHz. In all groups the latencies were fitted using a non-linear regression model. The aim of the study was to compare the latency and amplitude of 2f1-f2 DPOAE in different inner ear pathologies. The highest DPOAE amplitudes were recorded in Group I and in miners with 2-4 years noise exposure (Group IIIa), and the latencies showed a similar pattern. The lowest DPOAE amplitudes were recorded in the elderly and in miners with 8-15 years noise exposure (Group IIIc), but in contrast the longest latencies were measured in miners and the shortest in the elderly. The latency analysis significantly reinforces opinions on the micromechanics of the cochlea, mostly in terms of the cochlear functioning as a filter and amplifier and with regard to the elasticity of the basilar membrane.

Photodynamic therapy of premalignant lesions and local recurrence of laryngeal and hypopharyngeal cancers

The main advantage of photodynamic therapy (PDT) in laryngology seems to be its non-invasiveness and the possibility of using it despite previous application of conventional methods. In the study, we gave PDT to two separate groups of patients, i.e. five patients with advanced tumour (four of them with local recurrence (squamous cell carcinoma) after surgery and radiotherapy and one with a primary hypopharyngeal tumour) and five patients with leucoplakia. In the first group delta-aminolaevulinic acid (ALA) was administered orally (dose 3 g), while in the second, an ointment containing 10% ALA was applied locally. In both groups prior to irradiation, the tissue level of protoporphyrin IX was verified using an adapted Xillix Life instrument. All treated lesions were irradiated with an argon-pumped dye laser (dose range 100-250 J/cm2, wavelength 635 nm). In the first group, partial response was obtained. In these advanced cases, diminution of cancerous ulcerations was observed. In the leucoplakia group, complete response was achieved in four out of five treated patients. On the basis of our preliminary results, PDT may be useful in eradicating premalignant lesions of the oral cavity and in the palliation of advanced lesions of the oropharynx and larynx.

Immunohistochemical analysis of lymphocytic infiltration in the tumor microenvironment in patients operated on for laryngeal cancer

The aim of this study was to evaluate semiquantitative and qualitative analysis of lymphocytic infiltrations in a neoplasm microenvironment in patients with laryngeal cancers and the correlation analysis between the intensitivity degree and composition of lymphocytic infiltration in foreseeing a survival time and probability of the appearance of lymph node metastases. Postoperative specimens from 43 patients (Upper Silesia region) operated on for laryngeal cancer in the 2nd ENT Department, Silesian Medical University in Zabrze between 1985 and 1995 all had unfavorable courses due to tumor recurrences. The patients' ages ranged from 39 to 79 years (mean 57 years). Tissue specimens were subjected to routine processing. The degree of pathological changes was ascertained and immunohistochemical preparations of laryngeal tissue were prepared according to generally accepted methods. The following primary monoclonal antibodies were used: CD 3, CD 20, CD 43, CD 45 RO, CD 56. The distribution analysis of the intensity of the phenotype CD 43 evaluated the lymphocytic infiltration in relation to differentiation of the whole study group. The intensity of CD 43 cell infiltration increased in the group of patients with lymph node metastases. In patients with stage IV disease, a relationship was found between survival time and intensity of cell infiltrations with CD 43 and CD 45 RO lymphocytes. The influence of these two lymphocyte phenotypes in the patient subgroups - one after total laryngectomy with confirmed lymph node metastases and the other group without lymph node metastases - showed their prognostic value. Our analysis of lymphocytic infiltration, mostly of CD 43 cells, in the neoplasm microenvironment indicated a prognostic value for determining a shorter survival time and the possibility of lymph node metastases in patients with recurrences of cancer.

Clinical application of proliferating cell nuclear antigen, oncoprotein p53 and tumor front grading analysis in patients operated on for laryngeal cancer

The authors assessed proliferating cell nuclear antigen (PCNA), p-53 oncoprotein and morphologic tumor front grading (TFG) in patients with advanced squamous cell carcinoma (SCC), of the larynx and a poor prognosis and tried to find a correlation with tumor stage, the Broders grading system, local and neck lymph node metastases, as well as nodal and local recurrences. In addition, utility of the parameters investigated was evaluated in developing a prognostic factor model, using uni- and multivariate Cox regression analysis. Included in this study were 54 patients (mean age 57 years +/- 8.6). PCNA-positive staining was found in all but one patient with advanced disease, while p-53 stained positively in only 24 subjects (44.4%). The PCNA index ranged from 4.6 to 59.0% (mean, 23.4 +/- 11. 0) and the p-53 index varied from 4.0 to 42.0% (mean, 17.2 +/- 8.6). The TFG score ranged from 9 to 23 points (mean, 15.1 +/- 3.2). PCNA, p-53 and TFG were found to be the markers that provided significant additional information about the biological behavior of tumor cells. The high variability of the results (PCNA, p-53) and high percentage of negatively stained cells (p-53) reduced their application in clinical use. PCNA correlated with tumor grade, G (r = 0.38; P < 0. 01), but negatively with nodal (N) disease(r = -0.37; P < 0.01). The mean values of PCNA and p-53 index were higher in the subgroup with local recurrences. Our present attempt to develop a useful prognostic factor model failed.

Squamous cell carcinoma antigen levels in patients with different stages of laryngeal cancer

An attempt was undertaken to evaluate the usefulness of squamous cell carcinoma antigen (SCC Ag) in different stages of squamous cell carcinoma of the larynx. Antigen levels were determined in blood serum before treatment in 25 patients with laryngeal cancer treated at the II ENT Department, Silesian Medical School in Zabrze. Ages were 39-65 years (mean, 56.6 years). Fifteen healthy volunteers of similar ages served as controls. SCC Ag was estimated by an enzyme-immunological method using the Abbot set. Increasing levels of SCC Ag were found in 14 patients (65%). The mean SCC Ag level before treatment in the tumor group was 2.93 +/- 0.23 ng/ml and 0.79 +/- 0.19 ng/ml in the control group (standard, 1.5 ng/ml). Mean SCC Ag levels depending on the clinical stage of disease were: stage I, 1.52 ng/ml; stage II, 2.16 ng/ml; stage III, 3.03 ng/ml; stage IV, 4.57 ng/ml. Differences in all groups were statistically significant when compared to the healthy controls (P < 0.05).

Evaluation of upper airway obstruction after partial laryngectomies by radiological method and flow-volume loop analysis

Anatomical and functional estimations of the upper airways in patients after partial laryngectomies (cordectomy, hemilaryngectomy, enlarged hemilaryngectomy) carried out due to cancer are discussed in this paper. The post-operative lumen of the larynx and the trachea were estimated by radiological examination. The coefficient larynx/trachea (L/T) was proposed to describe fixed obstruction. At the same time, all patients underwent spirometric examinations. Inspiratory and expiratory parameters of the flow-volume loop were evaluated. In 39 patients the L/T coefficient was lower than in a group of patients with chronic bronchitis (p < 0.05). Also inspiratory and some expiratory parameters of the flow-volume loop decreased in contrast to the group with chronic bronchitis. All results showed the usefulness of radiological and spirometric methods in detecting upper airway obstructions and confirmed their fixed character. The influence of the area of operation on the degree of upper airway obstruction was emphasized.