Wyniki wyszukiwania - Biblioteka Nauki

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Wady wrodzone ucha wewnętrznego – klasyfikacja, przegląd, problemy kliniczne

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Haber K. , Konopka W. , Amernik K. , Mierzwiński J.

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tom 9(3)

1-11

PL

Wprowadzenie: U części pacjentów z głębokim niedosłuchem odbiorczym stwierdzane są wady ucha wewnętrznego. Początkowo uważano je za przeciwskazanie do wszczepienia implantu ślimakowego. Jednakże wraz z rozwojem chirurgii i technologii implantów ślimakowych możliwe stało się leczenie również tej grupy pacjentów. Wszczepienie implantu w przypadku wad ucha wewnętrznego może jednak wiązać się z wieloma trudnościami chirurgicznymi i możliwymi komplikacjami. Cel: Celem pracy jest przedstawienie: (1) współczesnej klasyfikacji wad ucha wewnętrznego, (2) problemów chirurgicznych i klinicznych związanych z poszczególnymi wadami, a także (3) przypadków wad ucha wewnętrznego stwierdzonych w ośrodkach autorów. Materiał i metody: Ze 111 dzieci kwalifikowanych do wszczepienia implantu ślimakowego w trzech ośrodkach klinicznych wyłoniono grupę pacjentów, u których stwierdzono wady ucha wewnętrznego. Przeanalizowano: badania obrazowe pacjentów wykonane przed założeniem implantu, badania słuchu, protokoły operacyjne ze wszczepienia implantu ślimakowego, wyniki pomiarów śródoperacyjnych oraz śródoperacyjne badania obrazowe. Omówiono klasyfikację wad ucha wewnętrznego uznawaną obecnie za wiodącą. Wyniki: U 19/111 (17%) dzieci stwierdzono duże wady ucha wewnętrznego w 35 uszach. U 13/19 (68%) pacjentów wada była obustronna i symetryczna, u 6/19 (32%) pacjentów zaobserwowano inne wady w uchu prawym i lewym lub wadę jednostronną. Stwierdzono wszystkie z głównych wad wyróżnionych w klasyfikacji, poza resztkową otocystą. Najczęstsze z nich to: hipoplazja ślimaka, niepełny podział ślimaka i poszerzony wodociąg przedsionka. Dyskusja: Duże wady wrodzone ucha wewnętrznego są istotnym problemem diagnostycznym i klinicznym u dzieci kwalifikowanych do wszczepienia implantu ślimakowego. Mogą one uniemożliwiać bądź znacząco utrudniać wszczepienie implantu ślimakowego i opiekę pooperacyjną. Duże wady stwierdzane są w badaniach obrazowych nawet u od 20 do 30% pacjentów z głębokim niedosłuchem.

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Inner ear malformations – overview, current classifications, challenges in management

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Haber K. , Konopka W. , Amernik K. , Mierzwiński J.

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tom 9(3)

1-11

EN

Introduction: Some patients with profound sensorineural hearing loss have inner ear malformations. Initially, those were believed to be a contradiction to cochlear implantation. However, with the advance of cochlear implant surgery and technology, it has become possible to treat this group of patients. However, cochlear implantation in the case of inner ear malformations can be associated with numerous surgical difficulties and possible complications. Purpose: The paper aims to present: (1) modern classification of inner ear malformations, (2) surgical and clinical challenges related to all types of malformations, and (3) cases of inner ear malformations identified in the authors’ centers. Material and methods: Of 111 children enrolled for cochlear implantation in three clinical centers, a group of patients with malformations of the inner ear was selected. We analyzed: preoperative imaging studies of patients performed prior to cochlear implantation, hearing tests, surgical protocols of cochlear implantation, results of intraoperative measurements and intraoperative imaging studies. We discuss what is currently believed to be the leading classification of inner ear malformations. Results: In 19/111 (17%) children, we diagnosed severe inner ear malformations in 35 ears. In 13/19 (68%) patients the malfor mations were bilateral and symmetrical, while 6/19 (32%) patients had different malformations in the right and left ear or one-sided malformation. All inner ear malformations described in the classification were found, except for rudimentary oto cyst. The most common are: cochlear hypoplasia, incomplete partition, and enlarged vestibular aqueduct. Discussion: Severe inner ear malformations are a major diagnostic and clinical challenge in children qualified for cochlear implantation. They can preclude or considerably complicate cochlear implantation and postoperative care. Inner ear malformations are found in imaging studies even in 20 to 30% of patients with profound hearing loss.

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Subperiosteal abscess of the temporal area - rare complication of malignant external otitis

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Amernik K. , Paradowska-Opałka B. , Kawczyński M. , Jaworowska E.

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tom 5(4)

45-49

EN

The aim of this study was to present a case study of 59 years old men with external otitis complicated by subperiostal abscess with destruction of squamosus part of temporal bone. 61 years old men was admitted to the Clinic of Otolaryngology PUM because of severe pain of temporal region on the left side and for few days he was treated for external otitis. The patient complained of severe ear pain, hearing loss and fever 38°C. For a week he was receiving ciprofloxacin orally and as ear drops but symptoms worsened. On the day of addmition edema and pain in temporal region on the left side, trismus and severe edema in left external ear were stated, tympanic membrane was red, thick and there was no perforation in it. Pure tone audiometry showed air bone gap 50-60dB. In computer tomography an abscess in soft tissue of temporal region was stated with destruction of the squamosus part of temporal bone 18x10mm. Surgery was performed – incision of abscess and mastoidectomy. During surgery the place of destruction in the postero – superior part of external auditory canal was identified and it communicated with abscess. The bony destruction and dura were covered with cartilage. In the postoperative period fast general and local recovery appeared. The bacteriological specimen was negative. The patient was diagnosed for diabetes or others immunological impairment but results were negative. In the control pure tone audiometry there was complete closure of air bone gap. The patient was discharged in good general and local condition. In the follow up there was no other ear infections.

4

The use of petrosectomy in cochlear implant surgery

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Amernik K. , Niemczyk K. , Twardowska R. , Jaworowska E.

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tom 9(2)

1-6

EN

Introduction: The treatment and rehabilitation of hypoacusis with the use of cochlear implants is a safe and reliable method suitable for both children and adults. In people affected by chronic otitis media cholesteatomatosa or such who have previously undergone open repair of the ear, we use a special surgical technique known as lateral/subtotal petrosectomy. Material and methods: The study group consisted of patients with profound bilateral sensorineural hearing loss, in which otitis media with and without cholesteatoma has been diagnosed or after open repair of the middle ear. A retrospective analysis of patient data, as well as radiological and audiological results, was conducted. Results: In the Clinic of Otolaryngology and Laryngological Oncology of the Pomeranian Medical University in the years 2008–2018 we performed 90 cochlear implant surgeries, including a petrosectomy in 1 child with cholesteatoma (5 years) and in 2 adults after open repair (62 and 73 years). In all cases the procedure was done in a single stage. Healing proceeded correctly in all patients undergoing petrosectomy. The observation period ranges from 26 to 32 months, computed tomography examinations revealed no indirect characteristics of recurrent cholesteatoma. The patients remain under constant ENT supervision. The child has risk factors for autism and mental retardation, he displays good auditory responses and speech understanding; he has not developed active speech. As regarding free field pure tone audiometry, in adults hearing in the cochlear implant remains at 35 and 40 dB, and speech understanding at 80%. Discussion: Patients with chronic otitis media can be treated efficiently and safely with a cochlear implant using lateral petrosectomy. Lateral/subtotal petrosectomy is the access of choice when deep sensorimotor hearing loss coexists with chronic inflammation in the middle ear.