Observations on hearing preservation in patients with hybrid-L electrode implanted at Poznan University of Medical Sciences in Poland

The objective of the paper is to evaluate the hearing preservation rate in patients with high frequency hearing loss, treated with Cochlear Nucleus Freedom Hybrid-L implant in the Otolaryngology Department, Poznan University of Medical Sciences in Poland. Study was designed as the retrospective analysis. Twenty-one patients were operated and implanted with Nucleus Freedom Hybrid-L implant. Pure tone thresholds were recorded prior to the surgery and at the time of speech processor switch-on. Patients were subdivided into two groups with respect to their PTA thresholds: group A—classic indications and group B—extended indications. Average PTA for three frequencies (250, 500, 1,000 Hz) were calculated for each patient pre- and postoperatively. In the group of 21 implanted patients in 17 cases we have observed preservation of hearing (12 patients from group A, 5 patients from group B) with a mean value of 13.1 dB. In 4 out of 21 patients deafness on the implanted ear was noted. Our results clearly indicate that with standard procedure hearing preservation can be obtained in majority of patients. Hearing preservation was not achieved in 19 %, but owing to design of the electrode of the Cochlear Nucleus Hybrid-L that enables to work as CI platform alone, in patients who lost their hearing after surgery re-implantations were not required. This proves that EAS is a safe and reliable method to help patients with specific type of hearing loss

The evaluation of a surgery and the short-term benefits of a new active bone conduction hearing implant - the Osia®

Introduction: Modern medicine offers a wide spectrum of different hearing devices, and bone conduction implants can be found among them. Objective: The presentation of the outcomes of the implantation of a new active bone conduction hearing implant --- the Osia®, and its comparison with the well-known passive transcutaneous system --- the Baha® Attract. Materials and methods: Eight adult patients with bilateral mixed hearing loss were randomly divided into two groups. Group 1 was implanted with the Osia®, and group 2 was implanted with the Baha® Attract. The details of the surgery were analyzed, along with the functional and audiological results. Results: In all the cases, the surgery was successful, and the healing uneventful. In both groups, it was observed that pure tone audiometry and speech audiometry in free field improved significantly after the implantation (mean gain in pure tone audiometry for the Osia group 42.8 dB SPL and for the Baha group 38.8 dB SPL). In the Osia group, the results after the surgery were much better than with the Baha® 5 Power processor on the Softband. The patients implanted with the Osia® evaluated the quality of their hearing as being superior to those implanted with the Baha® Attract. There was an evident improvement in the abbreviated profile of hearing aid benefit questionnaire and in the speech, spatial and qualities of hearing scale for both systems

Efficacy of surgical treatment in patients with post-traumatic facial nerve palsy

Introduction: The most common mechanism of post-traumatic facial nerve palsy are road accidents and falls. Treatment schemes as well as proper timing of surgery are still controversial. Aim: The aim of the study was the evaluation of the effects of surgical treatment in patients with post-traumatic facial nerve palsy. Treatment results were correlated with epidemiological factors, mechanism of injury, level of nerve damage, time of surgery and its extent. Material and methods: 9 patients with facial nerve palsy after head trauma were analyzed. In all patients complete paresis of the VII nerve occurred immediately after the injury. In 5 patients the nerve was damaged in the course of the longitudinal fracture of the temporal bone, in 3 as a result of its transverse fracture while in one woman there was no evident fracture line. In all cases, surgical treatment was performed between 4 days and 13 weeks after the trauma. In all cases transmastoid approach was used. Edema lesions of the nerve dominated in 6 patients, in two cases a bone fragment was noted along its course, in one person nerve was disrupted but primary reconstruction was not possible – the man was excluded from further analysis. The results of treatment were assessed by House-Brackmann (HB) scale 12 months after the procedure. Results: Very good (HBI) or good (HBII) recovery of facial nerve function was achieved in 2 and 4 out of 8 patients respectively. Surgical timing, the extent of surgery, patient’s age, mechanism of injury and level of nerve damage had no effect on the final outcome. Conclusions: The management of post-traumatic facial nerve palsy should be individual. The commonly accepted recommendation on surgical treatment is to undertake it in patients with immediate-onset and complete paralysis. Patients who, due to their severe general condition, cannot undergo early facial nerve decompression may benefit from delayed treatment for up to 3 months after the injury

Exclusively endoscopic approach for juvenile angiofibroma in an adult – a case report

Aim: To demonstrate clinical, radiological, and diagnostic pitfalls of juvenile angiofibroma (JA) in an adult.Study design: Retrospective analysis of a case report.Results: Juvenile angiofibroma in adults is a rare entity with only two cases reported in the literature, confirming thelow prevalence of the disease. We present a case of juvenile angiofibroma in an adult that preoperatively wassuspected to be a malignant disease. Effective treatment included surgical excision via an exclusively endoscopicapproach.Conclusions: Symptoms of JA in an adult may mimic a malignant process. However, in the case of unilateral epistaxis,rhinorrhea and nasal obstruction in an adult JA should be considered in the differential diagnosis

Analiza efektów leczenia chirurgicznego pourazowego porażenia nerwu twarzowego

Wstęp: Do pourazowych uszkodzeń nerwu VII najczęściej dochodzi podczas wypadków komunikacyjnych oraz upadków z wysokości. Wybór sposobu leczenia oraz czasu interwencji chirurgicznej wciąż budzi wśród klinicystów wiele kontrowersji. Cel: Celem pracy była analiza efektów leczenia chirurgicznego pacjentów z pourazowym uszkodzeniem nerwu twarzowego i ich zależności od: czynników epidemiologicznych, mechanizmu urazu, miejsca uszkodzenia nerwu, a także czasu podjęcia leczenia oraz rozległości zabiegu. Materiał i metody: Analizą objęto 9 pacjentów z porażeniem nerwu twarzowego po urazie czaszkowo-mózgowym. U wszystkich chorych pełne porażenie wystąpiło bezpośrednio po urazie. U 5 pacjentów do uszkodzenia nerwu doszło w przebiegu podłużnego złamania kości skroniowej, u 3 chorych na skutek jej złamania poprzecznego, u 1 chorej nie stwierdzono ewidentnej szczeliny złamania. We wszystkich przypadkach zastosowano leczenie operacyjne. Czas od urazu do podjęcia chirurgicznej interwencji wahał się od 4 dni do 13 tygodni. Wszystkich pacjentów operowano z dojścia przez wyrostek sutkowaty. U 6 chorych dominowały zmiany obrzękowe nerwu, w związku z czym wykonano jego dekompresję, u 2 pacjentów uwidoczniono częściowe zmiażdżenie nerwu przez odłam kostny, który usunięto, u jednej z osób stwierdzono przerwanie ciągłości nerwu; nie udało się go pierwotnie zrekonstruować, dlatego pacjenta wykluczono z dalszej analizy. Wyniki leczenia oceniano za pomocą skali House’a-Brackmanna (HB) po 12 miesiącach od zabiegu. Wyniki: Pełny powrót czynności nerwu twarzowego (HBI) uzyskano u dwóch pacjentów, satysfakcjonujący (HBII) u kolejnych czterech. Czas podjęcia leczenia oraz jego zakres, podobnie jak wiek chorego, mechanizm urazu oraz miejsce uszkodzenia nerwu pozostawały bez wpływu na ostateczny rezultat terapii. Wnioski: Postępowanie w przypadku pourazowego porażenia nerwu twarzowego powinno być ustalane w każdym przypadku indywidualnie. Powszechnie akceptowanym wskazaniem do leczenia zabiegowego jest uszkodzenie nerwu VII występujące bezpośrednio po urazie oraz jego całkowite porażenie. Pacjenci, u których ze względu na ciężki stan ogólny nie ma możliwości wczesnego przeprowadzenia zabiegu odbarczającego nerw twarzowy, mogą odnieść korzyść z odroczonego leczenia w okresie nawet do 3 miesięcy od urazu

Otosurgery with the High-Definition Three-Dimensional (3D) Exoscope: Advantages and Disadvantages

Background: The aim of the study was to describe our initial experience with the high-definition three-dimensional (3D) exoscope for middle ear surgery versus the operating microscope. Methods: The study included 60 randomly chosen patients diagnosed with otosclerosis (n = 30) or chronic otitis media (n = 30) with a clinical indication for surgery. The primary measurement was the subjective estimation of quality of the visibility of the operating field provided by the 3D exoscope—VITOM-3D (Karl Storz, Tuttlingen, Germany) in comparison to the operating microscope. Results: All procedures, except for two (3.3%) converted to the microscope, were successfully completed using a 3D exoscope. In both stapedotomy and tympanoplasty, the exoscope was superior to the microscope during more superficial portions of the procedures. By contrast, in deeper areas of the middle ear, the exoscope provided significantly worse visibility, but usually not suboptimal. Both intraoperative bleeding and the narrow surgical field substantially reduced the visibility with the 3D exoscope in comparison to the microscope. Conclusions: Overall, our study shows that the 3D exoscope offers excellent, highly magnified, and well-illuminated high-definition images of the surgical field. However, our experience revealed several important limitations of this system, including decreased depth perception in deep areas of the tympanic cavity and reduced visibility in a difficult surgical field, with subsequent need to switch to an operating microscope in select cases

Przewlekłe zapalenie ucha środkowego maskujące rozwój nowotworu – opis przypadku

The authors would like to present a rare case of the middle ear cancer which has been developed in postoperative cave in 67 years old patient operated for cholesteatoma 50 years earlier. The patient was admitted to the ENT Department of Poznań University of Medical Sciences because of the ear suppuration and headache occurring for 3 months. CT and MR images suggested granulation tissue filling the postoperative spaces with bone destruction, infiltration of the dura and temporal lobe abscess formation. Intraoperative findings allowed excluding the preliminary diagnosis of intracranial complication in the course of chronic otitis media, revealing the tissue masses resembling neoplastic infiltration. The histopathology examination confirmed the final diagnosis of squamous cell cancer. The patient was directed to radiotherapy. The authors report a case of middle ear squamous cell carcinoma and discuss its diagnostic aspect

Bliznowaty zanik odcinka szyjnego tchawicy w następstwie przedłużonej intubacji

Tracheal intubation is presently one of the basic medical procedures. It is connected with many different complications. One of them is tracheal stenosis, which occurs in 6–21 percent of patients after intubation of the trachea. In contrast to this high frequency of tracheal stenosis we didn’t find any publications about complete atrophy of a big part of trachea after prolongated intubation and we describe a first case of such complication. The reasons and the possibilities of treatment in such situation are discussed

Current indications for cochlear implantation in adults and children

Introduction: Surgical treatment of deafness by cochlear implants is used for more than 40 years, and during this period permanently, gradual and significant expansion of indications for this surgery has been observed. Material and methods: In our Department in the years 1994-2018 1480 cochlear implantations were performed, both in adults (647) and in children (883). In this study current indications and the rules for eligibility of patients based on 25 years of experience are presented. Results: Indications for cochlear implantation in adults are: 1) bilateral postlingual deafness, 2) bilateral sensorineural hearing loss - in pure tone audiometry > 70 dB HL (average 500-4000 Hz) and in speech audiometry in hearing aids understanding 80dB HL confirmed by hearing tests, after about 6 months of rehabilitation with the use of hearing aids. Discussion: Although cochlear implantation is used for more than 40 years, the indications for this treatment underlies constant modifications. They concern the age of eligible patients, implantation in patients with partially preserved hearing, as well as treatment for patients with difficult anatomical conditions. In many countries, bilateral implantations are commonly performed, and more and more centers recommend this treatment in the case of unilateral deafness or asymmetric hearing loss, especially with the accompanying tinnitus in the deaf ear