Anatomical Anomalies of Carotid-Vertebral Arteries in Patients with Dizziness and Impaired Hearing

Currently, Doppler ultrasound examinations are of particular importance, including continuous wave Doppler and color-coded pulsed wave Doppler. Excellent images are obtained using contrast computed tomography angiography (CTA) and magnetic resonance angiography (MRA), which give greater understanding of blood flow in the cranial and intracranial vessels under normal conditions and in pathological situations caused by both anatomical anomalies and acquired abnormalities. Our previous studies, concerning the analysis of the frequency and types of anatomical anomalies of the cranial arteries, i.e. vertebral and carotid arteries, in patients with dizziness and impaired hearing, demonstrated that hypoplasia of the right vertebral artery was the most common anatomical anomaly occurring in 58.7% of cases, of which 51.7% were women and 6.9% men; hypoplasia of the left vertebral artery, occurring in 24.7% of the study group, of which 13.8% were women and 10.3% men; hypoplasia of the right internal carotid artery found in 3.4% of women and of the left internal carotid artery in 6.8% of cases, 3.4% in women and 3.4% in men; and hypoplasia of the right common carotid artery was reported in 3.4% of men, whereas critical stenosis of the left subclavian artery with subclavian steal syndrome was observed in 3.4% of women. Although tinnitus was the most frequent symptom occurring in those patients, in this study dizziness was most common in patients admitted to the Department for the diagnosis, possibly because they found it more disturbing

Diagnostic difficulties of a patient with sudden dizziness and suspected poisoning with household cleaning chemical: a case study

Based on a properly conducted medical evaluation and physical examination, it is possible to determine the type of dizziness such as systemic associated with the damage of peripheral vestibular system or non‑systemic associated with a central vestibular dysfunction. This is essential as it determines the order of consultations and determines specific indications for hospitalisation in the department of otolaryngology or neurology. The article presents a case of a patient admitted to the Clinic as planned to complete otoneurological and audiological diagnostics. On the grounds of comprehensive medical evaluation and available medical documentation it was concluded that acute ailments in the form of dizziness and balance disorders first appeared about a month beforehand during cleaning work. Meanwhile, the concerned family called the emergency medical team, who based on the symptoms and suspecting poisoning from household cleaning chemicals referred and transported her to the Nofer Institute of Occupational Medicine in Łódź.After performing an otorhinolaryngology physical examination and diagnostic tests, including laboratory, audiological, otoneurological and imaging tests, the following disorders were diagnosed: dizziness of mixed origin with decreased excitability of the middle ear labyrinth (affecting the left ear), moderate bilateral sensorineural hearing loss and unilateral tinnitus in the left ear.Na podstawie prawidłowo zebranego wywiadu i badania przedmiotowego można określić charakter zawrotów głowy jako układowe, związane z uszkodzeniem części obwodowej układu równowagi lub nieukładowe, związane z dysfunkcją części ośrodkowej układu przedsionkowego. Jest to istotne, gdyż ukierunkowuje kolejność konsultacji oraz determinuje określone wskazania do hospitalizacji w oddziale otolaryngologii lub neurologii.W artykule przedstawiono przypadek pacjentki przyjętej do kliniki w trybie planowym w celu uzupełnienia diagnostyki otoneurologicznej i audiologicznej. Z wywiadu oraz dostępnej dokumentacji medycznej wynikało, że ostre dolegliwości pod postacią zawrotów głowy i zaburzeń równowagi pojawiły się po raz pierwszy w życiu mniej więcej miesiąc wcześniej, w trakcie wykonywania prac porządkowych. Wówczas zaniepokojona rodzina wezwała zespół ratownictwa medycznego, który na podstawie zaistniałych objawów, podejrzewając zatrucie domowymi chemicznymi środkami czystości, skierował i przewiózł pacjentkę do Oddziału Toksykologii Instytutu Medycyny Pracy w Łodzi.Po wykonaniu badania przedmiotowego otorynolaryngologicznego oraz badań diagnostycznych, w tym laboratoryjnych, audiologicznych, otoneurologicznych oraz obrazowych, rozpoznano: zawroty głowy pochodzenia mieszanego ze skompensowanym zmniejszeniem pobudliwości lewego błędnika, obustronne odbiorcze uszkodzenie słuchu stopnia umiarkowanego, szumy uszne lewostronne

Sudden Dizziness of Peripheral Origin Caused by Head Injury. Case Presentation

Sudden dizziness attacks need to be diagnosed by multidisciplinary team of health professionals, including neurologist, otolaryngologist but also internist, cardiologist, and ophthalmologist. This is the case of a thirty‑two‑year‑old patient, who was admitted to the Otolaryngology Clinic through emergency department due to dizziness described as visualized spinning of the environment towards the right. In addition, he was suffering from nausea without vomiting at all. The ailments appeared for the first time in his life and it was in the night of hospital admission. During the medical evaluation, the patient confessed to get hit on his lower‑back of the cranium about a week ago, without losing consciousness. After performing an otorhinolaryngology physical examination and diagnostic tests, including laboratory, otoneurological and imaging tests (CT scan of the head) as well as neurological consultation, the following disorders were diagnosed: sudden dizziness of peripheral origin after a head injury and unilateral vestibular loss (affects left side). In this case, pharmacological treatment and habitual exercises were applied and recommended to continue for the next 3 months.Nagłe wystąpienie zawrotów głowy wymaga diagnostyki kilku specjalistów, w tym neurologa, otolaryngologa, a często też internisty, kardiologa czy okulisty. W artykule przedstawiono przypadek trzydziestodwuletniego pacjenta przyjętego do Kliniki Otolaryngologii w trybie pilnym z powodu zawrotów głowy o charakterze wirowania otoczenia w stronę prawą. Poza tym podawał nudności, bez wymiotów. Dolegliwości pojawiły się w godzinach nocnych w dniu przyjęcia do szpitala, po raz pierwszy w życiu. W wywiadzie podał uderzenie w głowę w okolicę potyliczną około tygodnia wcześniej, bez utraty przytomności. Po wykonaniu badania przedmiotowego otorynolaryngologicznego, badań diagnostycznych, w tym laboratoryjnych, otoneurologicznych i obrazowych (TK głowy) oraz konsultacji neurologicznej, rozpoznano nagłe zawroty głowy pochodzenia obwodowego po doznanym urazie głowy, a także deficyt narządu przedsionkowego lewego. Zastosowano leczenie farmakologiczne naczyniowe oraz ćwiczenia habituacyjne z zaleceniem ich kontynuowania przez trzy miesiące

The Voice Rehabilitation in Patients After Total Laryngectomy. What Has Changed?

The most unpleasant consequence of laryngectomy is the inability to communicate with a sonorous voice. One way to overcome these depressing feelings is to focus on the most important problem at the moment: learning replacement speech. The mechanism of creating the esophageal voice is as follows: the role of the vibration generator is taken over by the upper part of the esophagus, the so‑called mouth of the esophagus, forming a pseudoglossus, and the esophagus is the reservoir of air. The air expelled from the esophagus with an antiperistaltic movement vibrates the pseudo‑loudspeaker, creating a basic sound, which is then appropriately modulated in slightly altered resonance and articulation cavities. It is advisable to start the introductory exercises for learning voice and substitute speech before the surgery. The actual rehabilitation begins after the wound has healed, preferably during hospitalisation. The first exercises should be conducted by a doctor to prevent developing abnormal habits that make it difficult to master the substitute speech. The quality of esophageal speech and the speed of mastering it depends not only on the persistence and regularity of the practitioner. The effectiveness of rehabilitation is delayed by high tension of the esophageal mouth sphincter, the extent of surgery, radiotherapy, hearing loss, poor dental condition, and coexisting diseases. Voice prosthesis implantation is one of the two currently considered equivalent methods of voice rehabilitation in patients after complete removal of the larynx due to cancer. It is a method of surgical voice rehabilitation. The pioneer of this method in Poland was a well‑known and recognised otolaryngologist, prof. Erwin Mozolewski, who first applied voice rehabilitation using a voice prosthesis in Szczecin in 1972. The method of surgical rehabilitation of speech in patients after laryngectomy consists in creating a tracheo‑esophageal fistula and implanting a simple, unidirectional air valve, the so‑called voice prosthesis. This allows the patient, when closing the tracheostomy with a finger, to direct the exhaled air from the lungs to the esophagus and the lower pharynx to produce a substitute basic tone in the same place as in the case of esophageal speech (in the so‑called pharyngeal segment).Najbardziej przykrą konsekwencją operacji usunięcia krtani jest niemożność porozumiewania się dźwięcznym głosem. Sposobem na pokonanie przygnębiających uczuć jest skoncentrowanie się na najważniejszym w danej chwili problemie: uczeniu mowy zastępczej. Mechanizm tworzenia głosu przełykowego jest następujący: rolę generatora drgań przejmuje górny odcinek przełyku, tzw. usta przełyku, tworzące pseudogłośnię, a zbiornikiem powietrza jest przełyk. Powietrze usuwane z przełyku ruchem antyperystaltycznym wprowadza w drgania pseudogłośnię, tworząc dźwięk podstawowy, który następnie jest odpowiednio modulowany w nieznacznie zmienionych jamach rezonacyjnych i artykulacyjnych. Ćwiczenia wprowadzające do uczenia się głosu i mowy zastępczej korzystnie jest zacząć jeszcze przed operacją. Właściwą rehabilitację rozpoczyna się po wygojeniu rany, najlepiej jeszcze podczas pobytu w szpitalu. Pierwsze ćwiczenia powinny być prowadzone przez lekarza, by nie powstawały nieprawidłowe nawyki, utrudniające opanowanie mowy zastępczej. Jakość mowy przełykowej oraz szybkość jej opanowania zależą nie tylko od wytrwałości i systematyczności ćwiczącego. Skuteczność rehabilitacji opóźniają: wysokie napięcie zwieracza ust przełyku, rozległość zabiegu operacyjnego, radioterapia, ubytek słuchu, zły stan uzębienia, choroby współistniejące. Implantacja protez głosowych stanowi jeden z dwóch, obecnie uznanych za równoważne sposobów rehabilitacji głosu u pacjentów po całkowitym usunięciu krtani z powodu raka. Jest metodą chirurgicznej rehabilitacji głosu. Pionierem tej metody w Polsce był znany i uznany otolaryngolog – prof. Erwin Mozolewski, który w 1972 roku w Szczecinie jako pierwszy zastosował rehabilitację głosu przy użyciu protezy głosowej. Metoda chirurgicznej rehabilitacji mowy u chorych po usunięciu krtani polega na wytworzeniu przetoki tchawiczo‑przełykowej i wszczepieniu prostej, jednokierunkowej zastawki powietrznej – tzw. protezy głosowej. Pozwala to, przy zamknięciu otworu tracheostomy palcem, kierować powietrze wydechowe z płuc do przełyku i gardła dolnego w celu wytworzenia zastępczego tonu podstawowego w tym samym miejscu co w przypadku mowy przełykowej (w tzw. segmencie gardłowo‑przełykowym)

The quality of substitute speech with laryngectomees patients with or without the implanted voice prosthesis type Provox II

Introduction. The quality of substitute speech with laryngectomees patients with or without the implanted voice prosthesis type Provox II on the bases of two clinical cases was compared. Material and methods. The evaluation of voice was compared on the bases of two patients treated in Otolaryngological and Laryngological Oncology Clinic. The patients K.P. aged 46 (medical history number 2778/2008) who, on March 12, 2008 underwent total laryngectomy with the Rethie method including the removal of left thyroid lobe due to thyroid and larynx cancer. The patients D.K. ages 44 (medical history number 13705/2010) who on November 4, 2010 underwent total laryngectomy with the Rethie method including selective lymphe node operation of Region II on the right side with the implanting of the voice prosthesis type Provox II due to larynx cancer. Each patients was instructed on tracheostomy care and systematic performing of the fallowing exercises: diaphragmatic‑ribbed tract breathing loosening masseter muscle system and esophageal sphincter, the use of lauder reflection in the process of voice production, the method of obtaining loud reflection lengthening of the time of phonation and eliminating breath sounds. The evaluation of the quality of substitutive speech was performed after three months. Results. On the basis of the conversation with the patients, it turned out that the patient with the implanted voice prosthesis had better quality of substitutive speech and better communication possibility. Conclusions. The learned substitutive speech with the interoperatively implanted the voice prosthesis type P. II turned out to be the best way of communication.Udostępnienie publikacji Wydawnictwa Uniwersytetu Łódzkiego finansowane w ramach projektu „Doskonałość naukowa kluczem do doskonałości kształcenia”. Projekt realizowany jest ze środków Europejskiego Funduszu Społecznego w ramach Programu Operacyjnego Wiedza Edukacja Rozwój; nr umowy: POWER.03.05.00-00-Z092/17-00

Delayed perforation of posterior pharyngeal wall caused by dislodged bioresorbable interbody cage. Case report

A 48-year-old man was admitted for the management of congenital anomalies: Arnold–Chiari type I malformation combined with odontoid upward migration. He also had degenerative stenosis of the spinal canal by spurs at C2/C3 and C3/C4 levels. Osseous deformities caused ischaemic changes of the brainstem as well as spinal cord compression. Authors used the Biocage – interbody cage covered by bioresorbable layer to fill the surgically created gap after removal of the right part of C3 vertebral body. Twenty-seven months after implantation, the implant was extruded through posterior pharyngeal wall. Authors describe this unusual case and discuss possible causes of Biocage extrusion

Paradoxical vocal fold movements as a functional cause of laryngeal dyspnoea and hoarseness

Paradoxical vocal fold movements is a complex and heterogenic syndrome. It is a functional disorder manifesting itself as a pathological adduction of vocal folds in the inspiratory and/ or expiratory phase, resulting in airway obstruction and dyspnoea. This pathology may appear as an extreme form of psychosomatization involving otolaryngological organs, leading to dyspnoea and stridor. The paper presents the case of a young woman who was admitted to hospital due to dyspnoea, stridor and hoarseness. The paper presents the clinical picture, diagnostics and therapeutic procedures which were used.Paradoksalne ruchy fałdów głosowych (ang. paradoxical vocal fold movements – PVFM) to kompleksowy, heterogenny zespół objawów o zróżnicowanej etiologii i manifestacji klinicznej. Jest to zaburzenie czynnościowe, które oznacza patologiczne przywiedzenie fałdów głosowych w fazie wdechowej i/lub wydechowej, co skutkuje obturacją dróg oddechowych i dusznością. Jednostka ta może być klinicznie skrajną postacią psychosomatyzacji, w zakresie laryngologicznym prowadzącą do objawów zwężenia głośni. W artykule zaprezentowano przypadek młodej kobiety, która zgłosiła się do szpitala z powodu duszności ze stridorem oraz chrypki. Przedstawiono obraz kliniczny, diagnostykę i postępowanie terapeutyczne

Genetic polymorphisms in DNA base excision repair gene XRCC1 and the risk of squamous cell carcinoma of the head and neck

<p>Abstract</p> <p>Background</p> <p>The genes of base excision repair (BER) pathway have been extensively studied in the association with various human cancers. We performed a case-control study to test the association between two common single nucleotide polymorphisms (SNPs) of <it>XRCC1 </it>gene with human head and neck squamous cell carcinoma (HNSCC).</p> <p>Methods</p> <p>The genotype analysis of Arg194Trp and Arg399Gln gene polymorphisms for 92 HNSCC patients and 124 controls of cancer free subjects, in Polish population were performed using the PCR-based restriction fragment length polymorphism (PCR-RFLP) with endonuclease <it>Msp</it>I.</p> <p>Results</p> <p>No altered risk has been found individually for these SNPs, however haplotypes analysis showed high association with head and neck cancer. The highest frequency, according to wild-type of Arg194Arg and Arg399Arg genotypes, was identified for Arg194Trp-Arg399Arg haplotype (OR, 2.96; 95% CI, 1.01–8.80).</p> <p>Conclusion</p> <p>Finally, we identified the combined Arg194Trp-Arg399Arg genotype of base excision repair gene <it>XRCC1 </it>that was associated with HNSCC and may have an impact on identification of a high-risk cancer population.</p

Effectiveness of bimodal auditory and electrical stimulation in patients with tinnitus: A feasibility study

Background: Tinnitus is a common symptom, affecting about 10–15% of the adult population. When input from the somatosensory system can influence and/or elicit tinnitus, this type of subjective tinnitus is called somatosensory tinnitus. Recently, a new type of bimodal neurostimulation treatment has shown promising results for a specific subgroup within the somatosensory tinnitus population. It is, however, not clear if this bimodal stimulation is also effective in patients with other types of subjective tinnitus. Aim: The aim of this study was to evaluate the feasibility and efficacy of non-invasive bimodal auditory-somatosensory stimulation in reducing tinnitus severity among a general population of people with subjective tinnitus. Methods: Chronic subjective tinnitus patients were recruited from the ENT department of the Antwerp University Hospital. Somatosensory stimulation was delivered by Transcutaneous Electrical Nerve Stimulation (TENS), and it was combined with auditory stimulation via headphones. The therapy comprised six sessions of thirty minutes twice a week for a period of 3 consecutive weeks. Follow up measurements were scheduled 9–12 weeks after the last treatment session. The change of the Tinnitus Functional Index (TFI) score, a questionnaire evaluating tinnitus burden and effects on the quality of life, was the primary outcome measure. Results: Twenty-nine patients were enrolled in the study. A linear mixed-effects model was used to analyze the efficacy of bimodal treatment. The results of this analysis showed a statistically significant decrease (by 6, 9 points) in average TFI score at the follow up visit when compared to baseline. The ability to modulate tinnitus did not have an influence on the treatment results. Conclusion: Our study showed that bimodal stimulation is a feasible and safe method of tinnitus treatment. The method might be an effective treatment for some participants with tinnitus, especially those who have accompanying neck/temporomandibular problems, although, the evidence from this trial is quite weak. Additional research is needed toward establishing the optimal treatment protocol, as well as selecting the most appropriate inclusion criteria

Antioxidative assessment of new trans-palladium (II) complexes in head and neck cancer

Background: Head and neck neoplasms stand for 6% of all malignant neoplasms worldwide. Chemotherapy has limited use due to the biological properties of the tumor (in the majority of cases moderately and poorly differentiated squamous cell carcinoma). The fundamental molecule used in treatment is cisplatin and its derivates, that can be associated with fluorouracil. The new chemotherapeutic agents are not in common use during the treatment of head and neck malignancies. However, the use of low molecular weight complexes Pd (II) carries the potential of being more effective in therapy. Material and Methods: Fifty-one patients, 30 men and 21 women (aged 52.9 ± 12.1 years) with head and neck cancer were included in the study. Fifty-one healthy subjects, 31 men and 20 women, (aged 54.1 ± 14.7 years) years formed the control group. Antioxidant enzymes, superoxide dismutase, and catalase activities in erythrocytes were examined. Results: An increased level of antioxidant enzymes was seen in the blood samples from patients with head and neck cancer after incubation with Pd (II) complex. In the group we obtained a statistically significant result p = <0.001. Discussion: That project may contribute to the development of new, more efficient head and neck cancer treatment strategies. In our opinion, the results can be used in the future to develop a valuable prognostic marker of the disease. This is important because the initial phase of cancer is asymptomatic. The search for factors involved in pathogenesis translates into economic benefits and makes therapy more effectiveness through the reduction of treatment expenses