Introduction: Idiopathic facial nerve paresis still remains a challenge for laryngologists and neurologists. The etiology of idiopathic peripheral facial nerve paresis has not been explained so far. There is a group of patients that complain about coexisting hearing abnormalities. Aim: Analysis of audiological abnormalities in patients with idiopathic peripheral facial nerve paresis on the basis of pure tone audiometry and auditory brainstem responses. Material and methods: The retrospective analysis of 35 patients, aged under 40 years, with idiopathic peripheral facial nerve paresis hospitalised in Department of Otolaryngology of Warsaw Medical University – Poland (2004-2009). Control group consisted of age-matched, 23 healthy subjects. Each patient underwent audiometric evaluation that included pure tone audiometry and auditory brainstem responses. Statistical analysis was performed with Student’s t-test. Results: In the analysed group of 35 patients (17 male + 18 female), age ranged 13-40 years (mean 26.7 ± 7.1) signifi cantly prolonged latencies of wave III and V and III-V and I-V intervals in comparison with control group where observed (p<0.05). We found also that 48.6% patients with idiopathic peripheral facial nerve paresis had high-frequency hearing loss. Conclusions: The auditory brainstem responses in this study showed an association between retrocochlear pathology of the auditory system and idiopathic peripheral facial nerve paresis. Further investigations are necessary to estimate the etiopathology of these coexisting abnormalities.
Introduction: To assess an effect of cochleostomy on hearing threshold in guinea pigs. Material and methods: The authors performed animal experiments using fi ve 3-month-old guinea pigs. Before experiment hearing threshold were evaluated. Surgery involved access to the temporal bone by a post-auricular incision. After a wide opening of the bulla cochleostomy was created (10 000 turn/min, diamond bur of 0,8 mm diameter). Hearing threshold was identifi ed on the basis of presence of wave V in auditory brainstem responses (ABR) for click and frequency-specifi c stimulation. Also morphology and latency changes for wave V for this stimulation was assesed. Hearing status was evaluated before, just after and 1-, 2-, and 4-weeks after surgery. For surgical procedure and ABR examination all animals were anesthetized with an intramuscular injection of ketamine (50 mg/kg) mixed with xylazine (9 mg/kg) in the supplemental doses. After surgery the animal was treated by antibioticoterapy for 3 days – Enrofl oksacyna 0,3 ml subcutaneouly and analgesic – Tolfedine 0,05 mg in second day. Results: Four week observation of ABR morphology and hearing thresholds for click and frequency-specifi c stimulation of 100 dB SPL intensity showed only temporary changes confi rming that cochleostomy did not affect cochlear function. Conclusions: The correctly performed cochleostomy in guinea pigs did not affect persistently the cochlear function indicating that such an option of CI electrode insertion in patients is safe.
Ocriplasmin influence on posterior vitreous detachment (PVD) and vitreomacular traction (VMT) at patients treated in Ophthalmology and Ocular Oncology Clinic of University Hospital was evaluated. The paper presents results of the best corrected visual acuity (BCVA), images of swept source optic coherence tomography (OCT) and our experiences related with employment ocriplasmin at 4 patients. Patients were evaluated according to new classification of Vitreomacular Interface (VMI). Material and methods: Four patients (4 eyes with vitreomacular traction) were treated with 0,125 mg ocriplasmin (jetrea 0,5 mg/0,2 ml) intravitreal iniection. Duration of clinical signs of symptoms, the degree of disease severity (according to International Traction Study, IVTS, Group), presence of posterior vitreous detachment and resolution of vitreomacular traction and best corrected visual acuity (BCVA) improvement were evaluated. BCVA, ophthalmoscopy using Volk lens and swept source optical coherent tomography (OCT) were performed in all patients. Results: In 2 eyes (50%) total posterior vitreous detachment and vitreomacular traction was achieved. The BCVA improvement, withdrawn of symptoms, central scotomas and metamorphopsies were observed in patients. It has undergone decrease of vitreomacular traction after treatment at one patient 25%, central scotomas and metamorphopsies. We observe no changes at one patient after employed treatment (25%). The vitreous body detachment events (lasting 1 day vitreous floaters, photopsia, floaters) appeared in all treated patients. Subretinal fluid absorption and BCVA improvement were observed in effective treated patients during follow-up. No one patient had present treatment related complications. Conclusions: Enzymatic vitreolysis with ocriplasmin for vitreomacular traction is effective and safe treatment, which can be alternative management for both strategies: “watch and wait” or vitrectomy.
PL
Cel: Celem badania była analiza wpływu okryplazminy na tylne przyleganie ciała szklistego (PVD, posterior vitreous detachment) i ustąpienie zespołu trakcji szklistkowo-plamkowej (VMT, vitreomacular traction syndrome) u pacjentów leczonych w Klinice Okulistyki i Onkologii Okulistycznej Szpitala Uniwersyteckiego w Krakowie. Materiał i metody: Leczeniu poddano 4 oczu 4 pacjentów z zespołem trakcji szklistkowo-plamkowej. Wszystkim pacjentom podano 0,125 mg okryplazminy (0,5 mg/0,2 ml) w postaci iniekcji do komory ciała szklistego. Oceniano czas trwania objawów klinicznych, stopień zaawansowania zmian według International Vitreomacular Traction Study (IVTS) Group, wystąpienie po ww. leczeniu odłączenia tylnego ciała szklistego, ustąpienie trakcji szklistkowo-plamkowej oraz poprawę ostrości wzroku z najlepszą korekcją (BCVA). U każdego pacjenta przed leczeniem i w okresie obserwacji wykonano następujące badania: ocenę ostrości wzroku z najlepszą korekcją, oftalmoskopię pośrednią z użyciem soczewki Volka oraz swept source optycznej koherentnej tomografii (ssOCT). W końcowym badaniu oceniano zmiany anatomiczne w siatkówce centralnej oraz BCVA, które porównywano z wynikami badania wyjściowego. Wyniki: W 2 spośród 4 przypadków (50%) zaobserwowano całkowite tylne odłączenie ciała szklistego z ustąpieniem trakcji szklistkowo-plamkowej. U tych pacjentów odnotowano największą poprawę ostrości wzroku, średnio o 3 rzędy, oraz ustąpienie objawów subiektywnych: mroczka centralnego i metemorfopsji. U 1 pacjentki trakcja szklistkowo-plamkowa uległa zmniejszeniu, ustąpił mroczek centralny i poprawiła się morfologia plamki oraz BCVA o 2 rzędy. U 1 pacjenta (25%) nie zaobserwowano żadnych zmian po ww. leczeniu. U wszystkich pacjentów, u których doszło do odłączenia ciała szklistego, towarzyszyły temu objawy: błyski i intensywne męty trwające 1 dzień. W okresie obserwacji u pacjentów, u których leczenie było skuteczne, stwierdzano obecność płynu podsiatkówkowego, ulegającego wchłonięciu wraz z poprawą BCVA. W żadnym przypadku nie stwierdzono powikłań związanych z leczeniem. Wnioski: Wyniki naszych badań dowodzą, że okryplazmina jest skutecznym i bezpiecznym lekiem stosowanym u pacjentów z zespołem trakcji szklistkowo-plamkowej oraz może być alternatywnym lekiem zarówno w strategii watch and wait, jak i w leczeniu operacyjnym metodą witrektomii.
Introduction: Certain problems in ear surgery are caused by temporal bone cholestetoma and chronic otitis media complicated by deafness, facial nerve dysfunction, vertigo or meningcephalocele. Lateral petrosectomy offers possibility of radical treatment and prevention of temporal bone destruction and following complications. Aim of study: It is an analysis of indications for lateral petrosectomy and it's results as a treatment of otitis media and temporal bone cholesteatoma. The possibility of synchronous cochlear implantation is noted. Material: Retrospective analysis of 62 patients after lateral petrosectomy, operated in the Department of Otolaryngology at the Medical University of Warsaw in 2001-2009. The group consisted of thirty one men and thirty one women. Results: Thirty two patients suffered from chronic granuloma or chronic choleateatoma otitis media or temporal bone cholesteatoma. Seventeen patients suffered from deafness prior surgery. Cochlear implantation was possible in fi ve patients: two of them after cranium fracture, two with deafness caused by chronic otitis media and one with deafness caused by osteoradionecrosis. Intraoperative CSF leak was observed of eight patients. In one case lateral perosectomy was used as a treatment of CSF leak after removal of cerebellopontine tumor. There was no evidence of CSF leak after surgery. Facial nerve dysfunction was observed in fi fteen cases. Conclusions: Lateral petrosectomy offers possibility of radical treatment in same patients with chronic otorrhea. The total removal of cholesteatoma prevents intracranial and intratemporal complications in case of chronic otitis media. Patients after lateral petrosectomy require systematic ENT and radiological (CT, NMR) examination.
Introduction: Certain problems in ear surgery are caused by temporal bone cholestetoma and chronic otitis media complicated by deafness, facial nerve dysfunction, vertigo or meningcephalocele. Lateral petrosectomy offers possibility of radical treatment and prevention of temporal bone destruction and following complications. Aim of study: It is an analysis of indications for lateral petrosectomy and it's results as a treatment of otitis media and temporal bone cholesteatoma. The possibility of synchronous cochlear implantation is noted. Material: Retrospective analysis of 62 patients after lateral petrosectomy, operated in the Department of Otolaryngology at the Medical University of Warsaw in 2001-2009. The group consisted of thirty one men and thirty one women. Results: Thirty two patients suffered from chronic granuloma or chronic choleateatoma otitis media or temporal bone cholesteatoma. Seventeen patients suffered from deafness prior surgery. Cochlear implantation was possible in fi ve patients: two of them after cranium fracture, two with deafness caused by chronic otitis media and one with deafness caused by osteoradionecrosis. Intraoperative CSF leak was observed of eight patients. In one case lateral perosectomy was used as a treatment of CSF leak after removal of cerebellopontine tumor. There was no evidence of CSF leak after surgery. Facial nerve dysfunction was observed in fi fteen cases. Conclusions: Lateral petrosectomy offers possibility of radical treatment in same patients with chronic otorrhea. The total removal of cholesteatoma prevents intracranial and intratemporal complications in case of chronic otitis media. Patients after lateral petrosectomy require systematic ENT and radiological (CT, NMR) examination.
Round window’s movability measurements with helping of LDV in evaluation of ossicular chain functioning. Aim of study: Quantitive evaluation of round window movability in normal conditions and after malleus stapes assembly reconstruction were aims of the study. Methods and materials: In the experiment there were taken 10 non-frozen temporal bones harvested within 48 hours.Temporal bones specimens were prepared like in closed technique with antromastoidectomy and large posterior tympanotomy. Hearing system before and after MSA reconstruction were evaluated by measurement of round window movement. Measurements were performed at four frequencies: 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. Results: In the normal ossicular chain the biggest movability were stated at frequency of 1 kHz. After reconstruction at all frequencies measurements were significantly worse. In reconstructed ears the highest movabilities were stated at frequencies 2000 Hz and 4000 Hz. Conclusions: Round window movability could be measured by Laser Doppler Vibrometry in posterior tympanotomy approach. Before reconstruction the biggest movability were evaluated at 1000 Hz and after MSA at 2000 Hz
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