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2 Polish Journal of Otolaryngology

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Assessment and management of retraction pockets

100%

Alper C. M. , Olszewska E.

nr 1

1-21

This manuscript intends to review types, pathogenesis, associated risk factors, and potential methods of prevention and treatment of the retraction pockets in adults and children. The importance of retraction pockets (RP) lies in loss of original histological and anatomical structure which is associated with development of ossicular chain erosion, cholesteatoma formation and potentially life threatening complications of cholesteatoma. The trans-mucosal exchange each gas in the middle ear (ME) is towards equalizing its partial pressures with the partial pressure in the environment. MEs that have abnormalities in the volume and ventilation pathways in the epitympanic may be more susceptible to retraction pockets. Sustained pressure differences and/or inflammation leads to destruction of collagen fibers in the lamina propria. Inflammatory mediators and cytokines lead to release of collagenases result in viscoelastic properties of the lamina propria. The process of changes in the tympanic membrane structure may evolve to the cholesteatoma formation. There are many different staging systems that clinicians prioritize in their decision making in the management of RP. The authors discuss the management possibilities in different clinical situations: RP without and with ongoing or intermittent evidence of Eustachian Tube Dysfunction (ETD), presence of adenoid hypertrophy or re-growth of adenoids, presence or absence of effusion, invisible depth of RP without effusion. invisible depth of RP with effusion, ongoing RP after VT insertion, and finally suspicion of cholesteatoma in a deep RP with ME effusion. A decision algorithm regarding the management of TM retraction and retraction pockets is provided.

Histological evaluation of soft palate tissues in patients with sleep-disordered breathing

80%

Panek J. , Reszeć J. , Rogowski M. , Olszewska E.

2020

tom 74

nr 1

6-12

Introduction: Sleep is a physiological state essential for the proper functioning of the body. One of the reasons for its disturbance is obstructive sleep apnea syndrome (OSAS). Aim: The aim of this research is the histological evaluation of the soft palate in patients who suffered from various types of OSAS. Material and method: The study group consisted of patients with sleep-disordered breathing (SDB) in the form of primary snoring or OSAS. Patients with chronic tonsillitis, without a history of SDB, were included in the comparative group. Fragments of the mucous of the uvula (study group) and the palatoglossal pillar (comparative group) were obtained during surgery for histological evaluation. Using histological, histochemical and immunohistochemical methods, we assessed the inflammation and its severity (CD3, CD20, CD68), the structure of nerve fibers (S-100) and the size of blood vessels (CD34) in the examined tissue. Results: Patients with OSAS developed a local inflammatory process in the palatal tissues (stronger expression of CD3, CD20, CD68 in patients with OSAS). The severity of the immunohistochemical reaction with CD3 correlated with the stage of OSAS. A higher degree of fibrosis and a higher expression of CD34 and S-100 receptors were observed in patients with OSAS compared to snoring patients and patients from the comparative group. Conclusion: Most likely, snoring due to chronic tissue vibration leads to damage to the nerve fibers in the soft palate, which can intensify episodes of hypopneas during and increase the chance for sleep apneas.