Współczesna diagnostyka wczesnego raka głośni

Niniejszy artykuł stanowi przegląd piśmiennictwa i podsumowanie aktualnych wytycznych w diagnostyce zmian przerostowych fałdów głosowych podejrzanych o złośliwy charakter. Szczegółowo omówiono zarówno etap wstępnej diagnostyki, jak również stosowane metody pogłębionej diagnostyki śródoperacyjnej i propozycje wnikliwej oceny w trakcie badań kontrolnych po leczeniu

Modern diagnostics of early glottic cancer

This article is a review of literature and a summary of the current guidelines in the diagnosis of hypertrophic vocal folds lesions suspected of malignancy. It gives a detailed overview both of initial diagnosis, as well as the methods of in-depth intraoperative diagnostics and proposals for careful evaluation during post-treatment follow-up examinations

Difficulties in clinical staging of external ear canal carcinoma– a case report

Carcinoma of the external auditory canal (EAC) is known to be very rare with a rate of 1-6 per million people. It affects mostly people over the age of 50 regardless of gender. The most common type of carcinoma of EAC is squamous cell carcinoma (SCC). The aim of this paper is to present the case of a 56-year-old woman with carcinoma of EAC. She was admitted to otolaryngology clinic due to ear buzzing lasting for five months, periodic otorrhea and hearing deterioration in her right ear. In otoscopic examination a tumor in the right ear meatus was identified. It filled almost the entire canal. Biopsy confirmed the presence of squamous-cell cancer. Tumor advancement was diagnosed using computer tomography of the temporal bones, magnetic resonance imaging of the head and ultrasonography of the neck. Imaging examinations indicated T3 N0 stage. Doctors decided to perform lateral petrosectomy with elective neck dissection. During the operation, the results of histopathological examination of frozen specimens from marginal tissues revealed an invasion of the anterior wall of the ear canal, capsule of temporomandibular joint and parotid gland. The resection eventually included also parotid gland and temporo-mandibular joint with the caput of the mandible. After recuperation, the patient had complementary radiotherapy. The presented case shows that precise imaging is necessary before surgical treatment, but unfortunately the invasion of cancer may not be estimated properly. Based on literature, the best prognosis concerns wide resection with complementary radiotherapy, although the schedule of treatment is not determined

Laryngeal reinnervation in unilateral vocal fold paralysis- case report and literature review

Laryngeal reinnervation is the method of treatment in unilateral vocal fold paralysis. During the surgery an anastomosis between the main branch of ansa cervicalis and recurrent laryngeal nerve is formed. Regeneration of the nerve’s functional abilities is a long process, lasting from 4 to 6 months, up to a year. A 35 year-old male was admitted to the Department of Otolaryngology at Warsaw Medical University in order to undergo surgical removal of reoccurrence of Schwannoma in left cerebellopontine angle by translabyrinthine approach. Post-operative period was complicated with vagal nerve paralysis. The patient reported hoarseness, dysphagia and choking. Physical examination revealed left vocal fold immobilization in abducted position, saliva in piriform fossa and left-sided soft palate paralysis yet the patient was discharged home. 4 weeks after the surgery, the patient was admitted to the hospital again due to developing aspiration pneumonia. Augmentation of the left vocal fold with calcium hydroxyapatite was performed 2 months later. After this intervention temporary vocal improvement and choking frequency reduction was observed. Finally, the patient underwent laryngeal reinnervation with formation of ansa cervicalis main branch to recurrent laryngeal nerve anastomosis. Left vocal fold regained its functional abilities and the quality of the voice improved. Laryngovideostroboscopy performed 6 months later revealed mobilization of left vocal fold sufficient for proper glottis closure. The voice measures normalized and the swallowing improved. Conclusions This case report and analyzed data confirm that laryngeal reinnervation surgery in unilateral vocal fold paralysis helps achieve satisfactory effects in voice function and life quality

Review of recent treatment trends of laryngeal cancer in Poland: a population-based study

Objectives To investigate the utilisation of different treatment modalities for patients with laryngeal cancer (LC) during last decade in Poland.Setting Retrospective population-based study.Participants Patients with LC treated between January 2009 and December 2018.Primary and secondary outcome measures The contemporary utilisation of treatment modalities of LC: surgery with intent of radical resection (total or partial laryngectomy), radiotherapy (RT) and chemoradiotherapy (CRT).Results There was determined the overall number of 22 957 new diagnosis of LC from 2010 to 2018 and confirmed the steady decrease in the incidence rate of LC in the following years from 7.7 to 6.03. The mean age of patients with LC was raising by an average of 0.3832 of year per year. There was observed decrease in number of total laryngectomies (TLs) in subsequent years (from 1122 in 2009 to 776 in 2018). The number of procedures involving partial laryngeal resection was within stable ranges however the upward trend was observed separately for vocal cordectomy. There was established decreased involvement of surgery in LC treatment from 52.8% in 2009 to 24.3% in 2016 with the subsequent rise to 33.7% in 2018. The percentage of patients receiving RT increased from 23.8% in 2009 to 42.1% in 2013 with the next decrease to 25.7% in 2018. The utilisation of CRT in LC treatment was progressively increasing over analysed years from 23.4% in 2009 reaching 40.6% in 2018.Conclusions The presented data revealed an increase in total number of organs preserving treatment modality with CRT in subsequent years with decreasing number of TLs in Polish patients with LC

Reinnerwacja krtani w jednostronnym porażeniu fałdu głosowego -opis przypadku i przegląd piśmiennictwa

Reinnerwacja krtani jest jedną z metod leczenia jednostronnego porażenia fałdu głosowego. Jedna z technik operacyjnych polega na wypreparowaniu nerwu krtaniowego wstecznego przy jego wejściu od krtani oraz zespoleniu go z gałęzią pętli szyjnej. Proces powrotu czynności nerwu krtaniowego wynosi średnio 4-6 miesięcy, ale może przedłużyć się nawet do roku. Autorzy przedstawiają opis przypadku pacjenta, u którego wystąpiło jednostronne porażenie fałdu głosowego na skutek uszkodzenia nerwu błędnego po reoperacji z dostępu przezbłędnikowego wznowy nerwiaka osłonkowego w kącie mostowo – móżdżkowym. Z powodu zaburzeń głosu oraz połykania, wykonano u chorego zabieg reinnerwacji krtani, który pozwolił uzyskać powrót ruchomości fałdu głosowego i trwałą poprawę głosu

Trudności w ocenie zaawansowania raka przewodu słuchowego zewnętrznego – opis przypadku

Nowotwory przewodu słuchowego zewnętrznego (PSZ) są niezwykle rzadkie, występują z częstotliwością 1–6 przypadków na 1 000 000 pacjentów. Zazwyczaj dotykają osoby w średnim wieku (50–60 lat), równie często kobiety, jak i mężczyzn. Najczęstszym typem histologicznym jest rak płaskonabłonkowy. Celem pracy jest omówienie przypadku raka PSZ u 56-letniej pacjentki leczonej w Klinice Otolaryngologii WUM. Pacjentka zgłosiła się z powodu trwającego od ponad 5 miesięcy szumu w prawym uchu, stopniowego pogorszenia słuchu i okresowego wycieku z prawego ucha. W badaniu otoskopowym uwidoczniono guz w PSZ całkowicie wypełniający jego światło. Wykonano biopsję tkanek guza. Rozpoznano raka płaskonabłonkowego. Następnie wykonano tomografię komputerową kości skroniowych, rezonans magnetyczny głowy i badanie ultrasonograficzne szyi. Na ich podstawie ustalono stopień zaawansowania guza na T3 N0. Zaplanowano zabieg petrosektomii bocznej z elektywną operacją węzłów chłonnych szyi. W czasie resekcji śródoperacyjne badania histopatologiczne potwierdziły naciekanie przez raka przedniej ściany PSZ, jamy bębenkowej, szczytu piramidy kości skroniowej, torebki stawu skroniowo-żuchwowego oraz ślinianki przyusznej. Poszerzono resekcję o staw żuchwowo-skroniowy wraz z głową żuchwy oraz śliniankę przyuszną. Przypadek pokazuje, że badania obrazowe są niezbędne przed planowanym leczeniem operacyjnym, ale rozległość nacieku raka często jest niedoszacowana. Dostępne w literaturze wyniki badań sugerują, że najlepsze rokowania mają chorzy poddani rozległej resekcji, uzupełnionej radioterapią, choć dokładny schemat leczenia nie został do tej pory w pełni ustalony

Analiza morfologii potencjałów słuchowych z pnia mózgu u pacjentów z samoistnym obwodowym porażeniem nerwu twarzowego

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

Reliability and validity of the Polish version of the Questionnaire of Olfactory Disorders

Abstract Background The comprehensive counseling of patients with olfactory dysfunctions requires accurate diagnosis. The recommendations include subjective assessment. The Questionnaire of Olfactory Disorders (QOD) is a disease‐specific questionnaire for the subjective evaluation of olfactory dysfunctions. Material The study included 54 patients with olfactory dysfunctions, who were recruited to the study group (SG). The other 47 patients without the history of olfactory dysfunction and nasal cavity pathology were voluntarily allocated to the control group (CG). The protocol of the study was introduced to each patient and included: olfactory testing with Sniffin' Stick test, fulfillment of the Polish version of World Health Organization Quality of Life brief questionnaire and completing of the Polish version of the QOD. All participants (101) were invited for refilling the QOD questionnaire after 2 weeks for the test–retest statistics. Results The Polish QOD statements were significantly correlated and met the requirement by having test–retest correlation larger than 0.7. We found that internal consistency of the test measured by Cronbach's alpha coefficient was very high. The mean scores of the QOD test in normosmic SG patients were compared with corresponding scores in normosmic CG patients using U Mann–Whitney test. The analysis revealed statistically significant differences on mean QOD scores for each domains except QOD‐S between both groups. Conclusions The Polish version of the QOD demonstrated high rate of the validity and the reliability. This instrument may be widely used in research projects and clinical practice concerning olfactory disorders in Polish patients. Level of Evidence NA