Articulation disorders and duration, severity and l-dopa dosage in idiopathic Parkinson's disease

Background Parkinson's disease (PD) is one of the most common diseases of the central nervous system (CNS). It is frequently heralded by speech disturbances, which are one of its first symptoms. Aim The aim of this paper is to share our own experience concerning the correlation between the severity of speech disorders and the PD duration, its severity and the intake of l-dopa. Material and methods The research included 93 patients with idiopathic PD, aged 26–86 years (mean age 65.1 years). Participants were examined neurologically according to the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr Scale. They were also assessed by Frenchay Dysarthria Assessment. Results Considerable and severe disorders were concurrent with impairments in the mobility of the tongue, lips, the jaw as well as the pitch and loudness of the voice. The strongest correlation but at a moderate level was found to exist between the severity of labial impairment, voice loudness and the length of the disease. There was also a positive correlation between lip movement while the motions were being diversified, lip arrangement while speaking and the intake of l-dopa. Conclusions As PD progresses a significant decline in vocal articulation can be observed, which is due to reduced mobility within the lips and the jaw. Exacerbation of articulation disorders resulting from progression of the disease does not materially influence the UPDRSS scores. l-dopa has been found to positively affect the mobility of the lips while the patient is speaking and their arrangement at rest

Selected structures of middle ear relevant to cochlear implantation on the basis of computer tomography

Background: The primary objective of this study was to analyze middle ear structures critical for cochlear implantation using computed tomography. Materials and methods: Patients who underwent cochlear implantation at the Department of Otolaryngology in Szczecin between 2015 and 2022 were eligible for the study. We analyzed computed tomography images of 57 ears in 52 patients. The following parameters were assessed: mastoid aeration, tegmen tympani height, sigmoid sinus position, posterior tympanotomy width, the distance between the facial nerve and chorda tympani, modified facial recess distance, and the prediction line described by other authors. Results: In 69% of patients, after the removal of the round window bony overhang, the round window membrane became fully visible. There were no statistically significant correlations found for parameters describing mastoid process anatomy or those rating the width of the posterior tympanotomy concerning round window access. The prediction lines, according to Kashio and Jwair, were found to be relevant. In cases where patients' access to the niche and membrane of the window was rated as good or very good during clinical evaluation, they were more likely to describe the window as being located posteriorly or medially in the radiological evaluation. Using a binary Jwair scale provided a better correlation with the clinical assessment. In cases where the windows were graded as posterior, the clinical assessment indicated better surgical access, especially to the RWM (Round Window Membrane). Conclusions: Evaluating middle ear anatomy on a computed tomography scan is useful for preparing for middle ear surgery but does not significantly affect the ability to access the round window. For such access, the position of the window in relation to the facial nerve is the most relevant factor, and measurements based on this relationship hold the highest clinical value

Small cell carcinoma with neuroendocrine differentiation of subglottic larynx- a case report

Small cell cancer (SCC) is a neuroendocrine neoplasm, which is most frequently found in the lungs. Extrapulmonary location of SCC is rare and may involve 2.5-5% of SCCs. We present a case of a 31-year-old male patient with an extremely uncommon subglottic SCC. The patient was qualified for a radical sequential chemoradiotherapy. After treatment, patient’s condition suggested complete remission. Recurrence was detected one year later, and the disease rapidly progressed, despite a second line chemotherapy. The patient died 29 months after initial diagnosis. This case aims to raise awareness on the aggressive laryngeal SCC and its good response to first line chemotherapy composed of cisplatin and etoposide, followed by radiotherapy

Ropień podokostnowy okolicy skroniowej - rzadkie powikłanie złośliwego zapalenia ucha zewnętrznego

Celem niniejszego badania było przedstawienie przypadku 59-letniego mężczyzny z zapaleniem ucha zewnętrznego powikłanego ropniem podokostnowym z destrukcją części łuskowej kości skroniowej. Mężczyzna lat 61, leczony od kilku dni z powodu zapalenia ucha zewnętrznego, został przyjęty do Kliniki Otolaryngologii Pomorskiego Uniwersytetu Medycznego z powodu nasilonych dolegliwości bólowych okolicy skroniowej po stronie lewej. Pacjent skarżył się na silny ból ucha, upośledzenie słuchu oraz gorączkę wynoszącą 38°C. Przez okres tygodnia chory był leczony ciprofloksacyną doustnie oraz miejscowo, ale objawy uległy nasileniu. W dniu przyjęcia do szpitala stwierdzono obrzęk i tkliwość okolicy skroniowej po stronie lewej, szczękościsk oraz masywny obrzęk skóry przewodu słuchowego zewnętrznego lewego, z pogrubieniem i przekrwieniem błony bębenkowej, bez cech perforacji. Audiometria tonalna wykazała niedosłuch przewodzeniowy z rezerwą ślimakową wynoszącą 50-60 dB. W tomografii komputerowej uwidoczniono ropień tkanek miękkich okolicy skroniowej, z destrukcją części łuskowej kości skroniowej wielkości 18x10 mm. Wykonano zabieg chirurgiczny - nacięcie ropnia z mastoidektomią. Podczas operacji stwierdzono uszkodzenie tylno-górnej ściany przewodu słuchowego zewnętrznego, która komunikowała się z jamą ropnia. Ubytek kości oraz oponę pokryto fragmentem chrząstki. W okresie pooperacyjnym uzyskano szybką poprawę stanu ogólnego i miejscowego. Wyniki badań bakteriologicznych były ujemne. Pacjent był diagnozowany w kierunku cukrzycy lub innego rodzaju niedoborów odporności, ale odchyleń nie stwierdzono. W kontrolnej audiometrii tonalnej uzyskano całkowite zamknięcie rezerwy ślimakowej. Pacjent został wypisany ze szpitala w stanie ogólnym i miejscowym dobrym. W toku obserwacji nie stwierdzono żadnych stanów zapalnych ucha

Subperiosteal abscess of the temporal area - rare complication of malignant external otitis

The aim of this study was to present a case study of 59 years old men with external otitis complicated by subperiostal abscess with destruction of squamosus part of temporal bone. 61 years old men was admitted to the Clinic of Otolaryngology PUM because of severe pain of temporal region on the left side and for few days he was treated for external otitis. The patient complained of severe ear pain, hearing loss and fever 38°C. For a week he was receiving ciprofloxacin orally and as ear drops but symptoms worsened. On the day of addmition edema and pain in temporal region on the left side, trismus and severe edema in left external ear were stated, tympanic membrane was red, thick and there was no perforation in it. Pure tone audiometry showed air bone gap 50-60dB. In computer tomography an abscess in soft tissue of temporal region was stated with destruction of the squamosus part of temporal bone 18x10mm. Surgery was performed – incision of abscess and mastoidectomy. During surgery the place of destruction in the postero – superior part of external auditory canal was identified and it communicated with abscess. The bony destruction and dura were covered with cartilage. In the postoperative period fast general and local recovery appeared. The bacteriological specimen was negative. The patient was diagnosed for diabetes or others immunological impairment but results were negative. In the control pure tone audiometry there was complete closure of air bone gap. The patient was discharged in good general and local condition. In the follow up there was no other ear infections