Piotr Pietkiewicz

Publications of Piotr Pietkiewicz

• Electronystagmography versus videonystagmography in diagnosis of vertigo.

  Authors: Piotr Pietkiewicz, Renata Pepaś, Wiesław J Sułkowski, Hanna Zielińska-Bliźniewska, Jurek Olszewski

  International journal of occupational medicine and environmental health. 03/2012; 25(1):59-65.

  Vertigo is a very common symptom mainly caused by the lesion of vestibular system (peripheral or central) and often accompanied by some work-related diseases and occupational intoxications. The aimVertigo is a very common symptom mainly caused by the lesion of vestibular system (peripheral or central) and often accompanied by some work-related diseases and occupational intoxications. The aim of this study was to assess the value of electronystagmography (ENG) and videonystagmography (VNG) for diagnosing vertigo of various origin. The study included four groups, 25 subjects each, of patients suffering from vestibular disorders of peripheral, central and mixed origin versus healthy controls. All were examined by means of ENG and VNG, using the bithermal caloric test with 30°C and 44°C air irrigations of the ears. The findings (frequency of induced nystagmus FRQ, its slow phase velocity SPV, canal paresis CP, directional preponderance DP, vestibular excitability VE) were analysed and compared. In all patients with vertigo due to vestibular neuritis, barotrauma and kinetosis, significant CP, the important sign of peripheral site of vestibular lesion was identified both in ENG and VNG. None of the patients with central origin disorders showed CP in VNG; in the majority of cases DP was observed. However, in ENG we found CP in 5 patients with central origin disorders. There were no essential differences between ENG and VNG in measurements of FRQ and SPV except for higher values in VNG in controls and patients with mixed vertigo. The results suggest that the VNG should be recommended in preference as the valuable method to assess vertigo and to discriminate between the peripheral and the central vestibular lesions.

• [Analysis of histopathological evaluation of pathological lesions removed by endoscopic surgery of the nose and paranasal sinuses in the own material].

  Authors: Jarosław Miłoński, Hanna Zielińska-Bliźniewska, Piotr Pietkiewicz, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 11/2011; 65(6):447-50.

  The work aimed at evaluating results of histopathological examination of postoperative material in endoscopic paranasal sinus surgery in the own material. The analysis covered 3,896 results ofThe work aimed at evaluating results of histopathological examination of postoperative material in endoscopic paranasal sinus surgery in the own material. The analysis covered 3,896 results of histopathological examination of routine postoperative material from the Department of Clinical Pathomorphology and Cytopathology Military Medical Academy University Clinical Hospital in Lodz. The study was conducted in hematoxylin and eosin staining according to the principles of this method. The postoperative material included pathological lesions removed by endoscopic surgery of the nose and paranasal sinuses in patients who were treated at Department of Otolaryngology and Laryngological Oncology between 2006 and 2010. The treatment included 1,118 patients, 509 women at the age of 15–79 and 609 men aged 17–77. The material for histopathological examination was sent from merely 1,176 operations because 57 patients were operated twice and one patient was operated three times. Polyps within the nose and paranasal sinuses were confirmed by histopathological examination in 705 patients, including 289 women and 416 men. Hypertrophic changes were diagnosed in 404 patients, including 218 women and 186 men. Inverted papilloma was recognised in histopathological examination in 9 patients, including 2 women and 7 men. Hypertrophies were slightly more common in women than in men. Both in men and women unilateral hypertrophic changes within the ostiomeatal complex were predominant, 42.66% in women and 40.86% in men. Histopathological examination of postoperative material in patients under endoscopic treatment due to paranasal sinusitis is considerably important for complex evaluation of inflammation type and confirmation of indications for appropriate anti-inflammatory therapy.

• [The use of VHIT (videonystagmography head impulse test) in the diagnostics of semicircular canal injuries].

  Authors: Jurek Olszewski, Piotr Pietkiewicz, Jarosław Miłoński, Marzena Bielińska

  Otolaryngologia polska. The Polish otolaryngology. 06/2010; 64(7):32-5.

  The aim of that work was to evaluate the usefulness of VHIT (Videonystagmography Head Impulse Test) in the diagnostics of injuries to the semicircular canals. The tests covered 58 patients agedThe aim of that work was to evaluate the usefulness of VHIT (Videonystagmography Head Impulse Test) in the diagnostics of injuries to the semicircular canals. The tests covered 58 patients aged 20-27, including 34 women and 24 men. Any deviations within the vestibular organs was excluded in the interview, otorhinolaryngological examination and full videonystagmographic test. The tests checked functions of the semicircular canals in the following way: in a sitting position and the head leaned forward at 30 degrees the patient was looking at a motionless point while quick movements to the left or right were performed to stimulate a particular lateral semicircular canal. When the vertical semicircular canals were tested the head was inclined laterally to the right side at 45 degrees. Then similar movements were performed forwards (stimulation of the left anterior semicircular canal) and backwards (stimulation of the right posterior semicircular canal). When the head was leaned laterally to the left at 45 degrees the right or left anterior semicircular canal was stimulated respectively. Functions of the canal were determined on the basis of gain (%). RESULTS OF THE TESTS: In 58 patients the gain value for particular semicircular canals was normal, and the mean values presented as follows: the lateral semicircular canal: 11.9% +/- 10.2, the anterior semicircular canal: 17.5% +/- 11.6 and the posterior semicircular canal: 19.2% +/- 13.5, whereas on the left side: 10.3% +/- 7.9, 18.1% +/- 11.1, 15.1% +/- 12.3 respectively. In one man the gain value for the right posterior semicircular canal was found significantly above the standard value--71%. VHIT showed much more sensitive than a full videonystagmographic test.

• [The rare case of lymphoma of the laryngeal vestibulum]

  Authors: Jurek Olszewski, Piotr Pietkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2007; 61(6):1014-6.

  Authors introduce case of the lymphocytoma of the laryngeal pocket at the patient hospitalized in the Clinic of the Otolaryngology and the Laryngological Oncology for the location of theAuthors introduce case of the lymphocytoma of the laryngeal pocket at the patient hospitalized in the Clinic of the Otolaryngology and the Laryngological Oncology for the location of the incommunicado button and large diagnostic difficulties under examination histopathologic.

• The association between positional vertebral and basilar artery flow lesion and prevalence of vertigo in patients with cervical spondylosis.

  Authors: Jurek Olszewski, Joanna Majak, Piotr Pietkiewicz, Cezary Luszcz, Marcin Repetowski

  Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 05/2006; 134(4):680-4.

  OBJECTIVE: The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes,OBJECTIVE: The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes, prevalence of vertigo, and decreased blood flow velocity through vertebral arteries (VA) after head rotation. STUDY DESIGN AND SETTING: A prospective, controlled study in academic neurotology was conducted. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained of positional vertigo lasting more than 6 months. Patients were examined by transcranial Doppler ultrasound with head rotations. RESULTS: We showed significant association between velocity flow in basilar artery after neck rotation and age, prevalence of vertigo, grade of radiological changes, and positional vertebral artery flow lesion. CONCLUSION: Spondylotic-induced VA compression may be the reason for decreased blood flow velocity in the basilar artery during head rotation, which may be of particular importance for older patients, especially complaining of vertigo. SIGNIFICANCE: Every patient with high-grade cervical spondylosis, especially complaining of vertigo, should be examined by using TCD (transcranial Doppler) with head rotations. In case of positional blood flow reduction during head rotation, further angiographic examination should be undertaken so as to plan suitable treatment. EBM rating: C-4.

• [Hearing evaluation in patients with vertigo]

  Authors: Wiesław Konopka, Marzena Mielczarek, Marek Michalski, Jurek Olszewski, Piotr Pietkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2006; 60(2):239-41.

  INTRODUCTION: Vertigo is one of the most frequent and disturbing sensations that the practicing otolaryngologist is called upon to treat. Vertigo is the illusory sensation of motion. True vertigo isINTRODUCTION: Vertigo is one of the most frequent and disturbing sensations that the practicing otolaryngologist is called upon to treat. Vertigo is the illusory sensation of motion. True vertigo is caused by pathology in the peripheral end organ, the vestibular nerve, and the pathways that connect them in the brainstem and rarely, in the cortex. AIM: The aim of this study was to evaluate hearing in people with vertigo according to the etiology of balance disorders. The study comprised 127 patients treated in our clinic between 1999 and 2004, 88 women and 39 men (254 ears) aged 24-90 years. The average age was 56. METHODS: Hearing tests (pure tone audiometry, speech audiometry, impedance audiometry, auditory brainstem responses, OAE) as well as vestibular function tests (electronystagmography, rotational chair tests, caloric tests) were performed. In order to evaluate the nature of vertigo radiological diagnostics (head and cervical computer tomography, vascular diagnostics using Doppler sonography) was performed. RESULTS: Audiometric testing showed impaired hearing in 71 of 127 subjects. Among 73 patients with vertigo of vascular origin caused by vertebrae-basilar insufficiency, bilateral cochlear lesion was noticed in 33 cases and unilateral in 9. In 8 patients with cervical ankylosing spondylitis 3 had cochlear hearing loss (1--unilateral, 2--bilateral). CONCLUSIONS: In our group of patients with vertigo in the most of cases the hearing loss was on cochlear origin.

• [Distortion product otoacoustic emissions before and after one year exposure to impulse noise]

  Authors: Wiesław Konopka, Jurek Olszewski, Piotr Pietkiewicz, Marzena Mielczarek

  Otolaryngologia polska. The Polish otolaryngology. 02/2006; 60(2):243-7.

  INTRODUCTION: Firearms are a common source of impulse noise that may be very harmful to the auditory organ. Impulse noise from weapons and explosions continually produces hearing damage amongINTRODUCTION: Firearms are a common source of impulse noise that may be very harmful to the auditory organ. Impulse noise from weapons and explosions continually produces hearing damage among military personnel. The discovery of otoacoustic emission (OAE) has given a new possibility of early diagnosis of noise induced hearing loss. The transiently evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) are non-invasive, objective and frequency specific audiometric tests for evaluating outer hair cell function. The aim of the study was to asses the effects of exposure to impulse noise on DPOAE after one year of the obligatory military service. MATERIAL AND METHODS: The study comprised 92 (184 ears) soldiers, subjected to impulse noise during military service. The examine group was divided according total noise exposure. The control group consisted of secondary school students not exposed to noise. DPOAE was recorded before and after one year of military service. RESULTS: After military service significant deterioration of DPOAE level was observed at frequencies of 1, 3, and 4 kHz on the right ear and 2, 5 and 6 kHz left one. CONCLUSIONS: 1. Reduction of DPOAE amplitude connected all frequencies. 2. We did not notice significant differences between groups connected total noise exposure.

• [Kinesitherapy treatment for patients with cervical vertigo (preliminary report)]

  Authors: Marcin Repetowski, Jurek Olszewski, Joanna Majak, Piotr Pietkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):396-7.

  The aim of the study was to assess the effectiveness of kinesitherapy in cervical vertigo treatment. Thirty two patients with cervical vertigo, aged 20 to 75, were examined. The patients performedThe aim of the study was to assess the effectiveness of kinesitherapy in cervical vertigo treatment. Thirty two patients with cervical vertigo, aged 20 to 75, were examined. The patients performed kinesitherapy exercises three times a day for four weeks. The effects of therapy were assessed by everyday task self-control cards and ENG examinations. In the present study, objective improvement was noticed in 18,7% patients. Subjective improvement assessed by the patients everyday task self-control cards reached 62.5%. Kinesitherapy seems to be the good method of treating neck-related vertigo, but it should be confirmed in further study on the large group of patients.

• [Sarcoidosis limited to the lymph nodes of the neck]

  Authors: Jarosław Miłoński, Jurek Olszewski, Wiesław Konopka, Piotr Pietkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):438-9.

  A case of isolated neck sarcoidosis is presented. Isolated sarcoidosis confined to the neck lymph node is rare. Sarcoidosis is a systematic disease usually involving pulmonary findings.A case of isolated neck sarcoidosis is presented. Isolated sarcoidosis confined to the neck lymph node is rare. Sarcoidosis is a systematic disease usually involving pulmonary findings. Extrapulmonary involvement including the liver, eyes, lymph nodes, central nervous system, muscles and bones is common. This report documents a very rare case of isolated sarcoidosis of the neck, which is very rare diagnosed by otolaryngologists.

• [Impulse noise influence on hearing]

  Authors: Wiesław Konopka, Jurek Olszewski, Piotr Pietkiewicz, Marzena Mielczarek

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):296-7.

  Impulse noise from weapons and explosions produces hearing damage among military service. The discovery of otoacoustic emissions (OAE) has given a new possibility of early diagnosis of noise inducedImpulse noise from weapons and explosions produces hearing damage among military service. The discovery of otoacoustic emissions (OAE) has given a new possibility of early diagnosis of noise induced hearing loss. The aim of the study was to assess the effects of exposure to impulse noise on TEOAE, SNR and PTA. MATERIAL AND METHODS: the study comprised 92 (184 ears, aged 18.5-20 years) soldiers, subjected to impulse noise during one year of military service. The soldiers were divided in to three groups according exposure to noise. Group I the highest exposure 2222, 9 kPa2/s, group II--611, 8 kPa2/s and group III--103-109 kPa2/s. The control group consisted of 60 (120 ears) secondary school students. Hearing evaluation was performed before and after one year of military service, using extended pure tone audiometry, tympanometry, TEOAE and SNR. RESULTS: after military service significant deterioration of hearing was observed on average 1-2 dB for 0.125-3 kHz and 4-6 dB for 4-12 kHz for all examined soldiers without differences between groups. TEOAE reductions were registered predominantly at frequencies of 3 and 4 kHz, for both ears and SNR mean values reduction for the frequencies of 2, 3 and 4 kHz. CONCLUSIONS: TEOAE especially in cases where clinical audiometry is less sensitive can monitor small changes in the cochlea. There were no differences between groups and ears.

• [Analysis of select diagnostic examination results and their connection with cervical vertigo diagnosis]

  Authors: Jurek Olszewski, Joanna Majak, Piotr Pietkiewicz, Marcin Repetowski

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):393-5.

  Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not established. The aim of present study was to asses diagnostic value of classical radiologic,Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not established. The aim of present study was to asses diagnostic value of classical radiologic, electronystagmographic (ENG) and transcranial doppler ultrasonographic (TCD) examinations in cervical vertigo diagnostic process. Forty patients with vertigo lasting more than 6 months with radiological evidence of cervical spondylosis participated in the study. All patients had ENG and TCD with neck rotation test. Cervical vertigo was diagnosed in patients with positive neck rotation test in: TCD examination (15% decrease of vertebral artery flow) and/or ENG examination (cervical nystagmus). We diagnosed cervical vertigo in 65% of patients. Multivariate model of logistic regression analysis showed that the best statistical predictors of cervical vertigo were: asymmetry of vertebral artery flow in TCD (OR: 92.2; 95% CI: 6,2-1381) and presence of osteophytes and discopathy in radiological examination (OR: 64.1; 95% CI: 1,3-1107). The transcranial doppler ultrasonographic examinations seems to be useful for diagnosing cervical vertigo.

• [Phlegmon neck and face as a complication peritonsillar abscess--case report]

  Authors: Krzysztof Kuśmierczyk, Jurek Olszewski, Wiesław Konopka, Piotr Pietkiewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 10/2005; 19(111):450-1.

  The authors describe a 46-year-old male patient. Inflammatory state of tonsils and peritonsillar abscess caused a serious complication which came to parapharyngeal phlegmon and superficial softThe authors describe a 46-year-old male patient. Inflammatory state of tonsils and peritonsillar abscess caused a serious complication which came to parapharyngeal phlegmon and superficial soft tissue phlegmon face and neck. A wide application of antibiotic gives a rare complication, but mortality reaches a few percent. A basic method is a surgical treatment--a wide cut of tissues in many places, to drainage interfascia space and compound aim intravenous antibiotic therapy.

• [Middle ear schwannoma--case report]

  Authors: Jurek Olszewski, Wiesław Konopka, Andrzej Radek, Krzysztof Zieliński, Piotr Pietkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2005; 59(6):907-10.

  Schwannoma is one of the common benign middle ear space tumors. The tumors may present with facial nerve paresis or palsy, otologic symptoms and/or parotid mass middle ear schwannomas may originateSchwannoma is one of the common benign middle ear space tumors. The tumors may present with facial nerve paresis or palsy, otologic symptoms and/or parotid mass middle ear schwannomas may originate from the nerves of the tympanic caviti or by extensions from outside the middle ear space. Schwannomas of the facial nerve can occur along any segment, but they frequently involve the geniculate ganglion and extend proximally or distally from there. MRI and CT imaging characteristics are similar to those of vestibular schwannomas. We present the clinical and radiologic features of a middle-space schwannoma originating from facial nerve. The patient underwent middle ear exploration and mastoidectomy. The tumor was of facial nerve origin and was separated from middle ear. The pathologic diagnosis was schwannoma.

• [Analysis of vascular vertigo due to cervical spondylosis and vertebro-basilar insufficiency based on sex and age in clinical materials]

  Authors: Piotr Zalewski, Wiesław Konopka, Piotr Pietkiewicz

  Otolaryngologia polska. The Polish otolaryngology. 02/2004; 58(1):97-100.

  According to examination of 97 patients with vascular vertigo the dependence on vertigo to vertebral spondylosis and insufficiency vertebro-basilar artery was showed. Vertebral degeneration wasAccording to examination of 97 patients with vascular vertigo the dependence on vertigo to vertebral spondylosis and insufficiency vertebro-basilar artery was showed. Vertebral degeneration was noticed in 70.1%, basilar artery insufficiency in 42.3% of the patients. In 75.6% of the patients there was noticed both of above symptoms. Rotary test showed labyrinth asymmetry in 41.2% and in caloric test 50.5% of the patients.

• [Rhabdomyosarcoma embryonale of the middle ear at 55-year-old women]

  Authors: Piotr Zalewski, Piotr Pietkiewicz, Jacek Schmidt, Bogusław Olborski, Dariusz Młoczkowski

  Otolaryngologia polska. The Polish otolaryngology. 02/2004; 58(6):1165-8.

  The study presents extremely rare of the middle ear rhabdomyosarcoma embryonale at 55-year women. Authors showed untypical clinical process and own suspect of neoplasm illness. In difficult cases ofThe study presents extremely rare of the middle ear rhabdomyosarcoma embryonale at 55-year women. Authors showed untypical clinical process and own suspect of neoplasm illness. In difficult cases of the middle ear chronic granulomatosis, classical HE histological method maybe not enough and should be extended as an immunohistochemical examination.

• Evaluation of Transient and Distortion Product Otoacoustic Emissions before and after shooting practice.

  Authors: Wieslaw Konopka, Piotr Zalewski, Piotr Pietkiewicz

  Noise & health. 02/2001; 3(10):29-37.

  Firearms are a common source of impulse noise that may potentially damage a hearing organ. It is not easy to predict soldiers' personal susceptibility to noise exposure. The purpose of this study wasFirearms are a common source of impulse noise that may potentially damage a hearing organ. It is not easy to predict soldiers' personal susceptibility to noise exposure. The purpose of this study was to evaluate of the transient evoked otoacoustic emission (TEOAE) and distortion-product otoacoustic emission (DPOAE) before and after shooting and compare it with conventional pure tone audiometry. Standard pure tone audiometry, tympanometry, TEOAE and DPOAE measurements were recorded before and 10-15 minutes after shooting. Ten male soldiers (20 ears) were exposed to impulse noise from automatic gunfire (15 single rounds of live ammunition). They did not use any earplugs. The reduction in amplitude of the TEOAE after shooting was 3.1 and 5.1 as SPL for 3 and 4 kHz respectively for the right ear and 4.3 dB SPL for 1 kHz and 0.6 dB SPL at 2 kHz for the left ear. The greatest reduction in DPOAE occurred at frequencies of 1.0 kHz (3.8dB SPL) and 3.0 kHz (2.9 dB SPL) for the left ear. There were no differences in the audiometric thresholds before and after shooting. Emissions appear to be more sensitive for monitoring early cochlear changes after shooting, than pure tone audiometry.

• [Endoscopic operations of the nose and paranasal sinuses in the own material].

  Authors: Jarosław Miłoński, Piotr Pietkiewicz, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 65(1):14-9.

  The aim of the study was to evaluate the results and 4-year own experience in the endoscopic treatment of the nose and paranasal sinuses. In the Clinic of Otolaryngology and Laryngological OncologyThe aim of the study was to evaluate the results and 4-year own experience in the endoscopic treatment of the nose and paranasal sinuses. In the Clinic of Otolaryngology and Laryngological Oncology of the Medical University of Lodz between 2006 and 2009 there were 603 endoscopic operations performed on patients with chronic paranasal sinusitis, including 287 females aged 17-80 and 316 males aged 18-87. The patients were qualified for the operation on the basis of an interview, objective otorhinolaryngological examination, frontal and transverse computerized tomography of the nose and paranasal sinuses, laboratory tests (blood cell count, sedimentation tests, urine tests, electrolytes tests). Moreover, allergological diagnostics (skin prick tests, intranasal provocation tests), a histopathological examination of the removed lesions and a culture of biological material from the paranasal sinuses were done. The 0 degree and 30 degrees endoscopes of Storz GMBH and Wolf and the video rotation microtome (debrider). Possible reasons for paranasal sinusitis were: viral infection (34.8%), anatomical disorders (28.5%), irritating factors like tobacco smoke (17.9%), allergy (13.4%), tumours (3.2%) and gastroesophageal reflux (2.1%). Finally, the following endoscopic operations were conducted: revision surgery of the maxillary sinuses in 680 cases (56.4%), ethmoidectomy in 586 cases (48.6%), polypectomy in 273 cases (22.6%), re-polypectomy in 232 cases (19.2%), sphenoid sinus revision in 229 cases (19.0%), frontal sinus revision in 80 cases (6.6%) and re-ethmoidectomy in 77 cases (6.4%). The average stay in the Clinic lasted 3.2 days. Advantages of the complex surgical treatment are found in both post-operative and pharmacological procedures. The FESS surgery should be only a minimally invasive technique, which subsequently could guarantee an effective treatment, slight post-operative complications, a short hospitalization period and a quick return of the patient to work, as it is proved by the own study.