Jurek Olszewski

Publications of Jurek Olszewski

• The comparison of the influence of various types of anaesthesia on perioperative bleeding control in endoscopic paranasal sinus surgery.

  Authors: Jarosław Miłoński, Hanna Zielińska-Bliźniewska, Rafał Sobański, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 03/2012; 66(2):122-125.

• 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.

• [Evaluation of tobacco smoking addiction and passive exposure to tobacco smoke in students of medicine].

  Authors: Hanna Zielińska-Bliźniewska, Justyna Młódzik, Jurek Olszewski

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 12/2011; 31(186):353-6.

  Active and passive tobacco smoking by students of medical universities show that medical studies cannot be an effective barrier against continuing or even commencing smoking. The aim of the study wasActive and passive tobacco smoking by students of medical universities show that medical studies cannot be an effective barrier against continuing or even commencing smoking. The aim of the study was an evaluation of tobacco smoking and passive exposure to environmental tobacco smoke in the Physiotherapy students of Faculty of Military Medicine Medical University of Lodz. There were 565 Physiotherapy students of between 1-5th year of studies, including 394 women and 171 men (mean age 22.41), who were covered by the questionnaire research. The author's form of the questionnaire consisted of closed questions about demographic data and data on active and passive smoking. Prior to completing the questionnaire each student signed an informed consent as well as had an opportunity to get familiar with the patient's information form and could ask additional questions. The results analysis of the questionnaire indicated that 21.42% of the studied subjects are active smokers whereas 78.58% - non-smokers. No statistically significant differences in tobacco smoking due to sex have been noticed. The highest percentage of smokers was found on the 2nd and 3rd year of studies. In the group of 444 non-smokers there were as many as 67.1% of passive smokers. Tobacco smoking rate among Physiotherapy students amounts to 21.42% and is lower than the rate observed in the Polish population. Among non-smoking physiotherapy students there are 67.1% who are exposed to secondhand tobacco smoke. The obtained result does not largely stray from the result for the adult Polish population.

• [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 analysis of mean arterial pressure and heart rate in patients treated with laryngological surgery within pre- and peri- and postoperative periods].

  Authors: Jarosław Miłoński, Joanna Urbaniak, Hanna Zielińska-Bliźniewska, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 09/2011; 65(5):357-62.

  This work aimed to analyse the mean arterial blood pressure (MBP) and heart rate (HR) in patients who underwent laryngological surgery within the preoperative, perioperative and postoperativeThis work aimed to analyse the mean arterial blood pressure (MBP) and heart rate (HR) in patients who underwent laryngological surgery within the preoperative, perioperative and postoperative periods. The study covered 502 patients, including 209 women and 293 men, aged 18-85, who were divided into 6 groups according to the type of surgery: I - FESS (Functional Endoscopic Sinus Surgery), II - septoplasty, III - endoscopic re-operation of the paranasal sinuses, IV - microlaryngoscopy, V - tonsillectomy, VI - middle ear surgery. Only the patients with BP below 140/90 mmHg and maximum class 2 in the ASA scale were qualified for the surgical procedure. On admission, the arterial blood pressure was measured and diagnostic investigations like FBC, blood grouping determination, coagulogram, ESR, CRP and imaging studies were performed in each patient. Every operation was conducted under TIVA. BT and HR were monitored during an operation as well as through the four following hours in a recovery room. The youngest group of patients with chronic palatine tonsillitis showed the lowest pressure values while the oldest studied group consisted of patients who were operated due to chronic otitis media and this group demonstrated the highest BP values. The patients with treated or untreated hypertension should be pharmacologically normalised by an anaesthesiologist. However, considerable lowering of BP can often be not possible, contrary to the patients with normal BP. The own experience indicates that perioperative lowering of BP, including hypotension, ought to be avoided in cardiology patients. The postoperative BP raise, usually accompanied by pain, was noticed in the own studies. Therefore, effective analgesic treatment should be implemented in a recovery room.

• [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 use of laryngostroboscopy in diagnostics and results evaluation of treatment of patients with organic lesions in the larynx].

  Authors: Wiesław Kluch, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 09/2009; 63(7):11-5.

  The aim of the work was to evaluate effects of the surgical treatment and postoperative rehabilitation of the patients with organic lesions of the larynx using laryngostroboscopy. A group of 110The aim of the work was to evaluate effects of the surgical treatment and postoperative rehabilitation of the patients with organic lesions of the larynx using laryngostroboscopy. A group of 110 patients of both sex was covered by the studies, aged 19-65, who underwent surgical treatment due to organic lesion in the larynx. The voice was assessed using the perceptive GRBAS scale and the laryngostroboscopic examination following and preceding the surgical treatment and foniatric rehabilitation (30 days after the operation). Direct microlaryngoscopic procedures were performed under local intratracheal anaesthesia, whereas the CO2 laser was used in the surgery in 18.2% cases and the other cases (81.8%) had the traditional technique applied. RESULTS OF THE STUDIES: In the studied material the following was found: chronic hypertrophic laryngitis in 46.4% of the patients, Reincke's laryngeal oedema in 29.1% of the patients, vocal cord polyp in 22.7% of the patients and laryngeal papilloma in 1.8% of the patients. The voice evaluation based on the GRBAS scale indicated that better voice improvement after the treatment and rehabilitation was found in the patients with Reincke's oedema and vocal fold polyp rather than in those with chronic laryngeal hypertrophy. The majority showed the degree of hoarseness, rough voice, blowing voice, weak and tight voice in the scale of either 0 or 1, contrary to the evaluation preceding the surgery. No better voice improvement was achieved in the GRBAS scale in the patients with laryngeal papilloma. On the grounds of the laryngostroboscopic examination it was found that the best voice improvement occurred after the surgical treatment and rehabilitation of the patients suffering from Reincke's oedema and vocal cord polyps. On the basis of the GRBAS scale and laryngostroboscopic examination of the patients after their surgical treatment and rehabilitation the best results in the voice quality were found in the patients with laryngeal polyps and Reincke's oedema whereas the worst results occurred in the patients with laryngeal papilloma.

• [Endoscopic treatment of patients with paranasal sinusitis and co-occurring anatomic disorders in nasal patency].

  Authors: Jarosław Miłoński, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 09/2009; 63(7):16-9.

  The aim of the study was to evaluate the frequency of co-occurrence of anatomic disorders within the nasal area in patients suffering from chronic paranasal sinusitis. Between 2006-2008 there wereThe aim of the study was to evaluate the frequency of co-occurrence of anatomic disorders within the nasal area in patients suffering from chronic paranasal sinusitis. Between 2006-2008 there were 446 endoscopic operations performed on patients with chronic paranasal sinusitis. Apart from paranasal sinuses surgeries, 172 patients underwent an additional operation on anatomic deviations within the nasal area. The study group included 98 women and 74 men. First, the nasal septoplasty was performed in a typical way according to the Cottle's principles with the use of endoscope, which was followed by functional endoscopic operations on paranasal sinuses. The middle concha bullosa operations were performed by opening the pneumatisized bony part and removing the lateral part. Among 446 patients who underwent endoscopic treatment due to chronic paranasal sinusitis substantial anatomic disorders were found in 38.6% of the cases qualifying the patients for further surgical procedures. Simultaneously, bilateral plasties of the middle concha bullosa were conducted in 25.1% of the cases whereas 10.3% of the patients underwent lateral operations on the middle concha bullosa. In the studied group the septoplasty was performed in 37.4% of the cases. Rarely unilaterally, with the use of endoscope, we removed spines or ledges from the nasal septum in 19.5% and 7.7% of the cases respectively. Moreover, 14 patients underwent operations on the nasal septum and middle concha bullosa at the same time. The co-occurrence of the spine in the nasal septum and middle concha bullosa was found in 6 operated patients. Bilateral middle concha bullosa and nasal septum ledge were operated three times. The anatomic causes of disorders in nasal patency were frequently found in the studied material. Thus, it proves their substantial part in patomechanism of paranasal sinusitis. Correcting anatomical anomalies ought to be performed simultenously with the operation within the paranasal sinuses. Endoscopically controlled limited septoplasty is a crucial element of complex surgical approach in the paranasal sinusitis.

• [Tinnitus and depression].

  Authors: Hanna Zielińska-Bliźniewska, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 09/2009; 63(7):20-3.

  The aim of the study was to assess the frequency of depression and its intensity in patients with diagnosed tinnitus and their correlation with selected audiological parameters. 80 patients underwentThe aim of the study was to assess the frequency of depression and its intensity in patients with diagnosed tinnitus and their correlation with selected audiological parameters. 80 patients underwent the study, including 46 females (57.5%) and 34 males (42.5%) aged 20-84 suffering from tinnitus. The study methodology included: an interview, otorhinolaryngological examination, full audiological diagnostics and imaging test (CT or MR). Patients who qualified for the study completed a modified questionnaire according to the Beck Depression Inventory (BDI). THE STUDY RESULTS: The study found the depression level higher than the one in the general population and amounting to 45%, with 41.2% of the patients suffering from masked depression (a mean rating scale of 14-16), and 3.7% of the patients showing symptoms of moderate depression (27 points according to the rating scale). The own studies showed no statistically meaningful relation between intensification of depression in the studied patients and their age and sex as well as acoustic parameters such as frequency, tinnitus localization. However, a statistically variable relation was noted showing that the longer a patient suffered from tinnitus the more often depression occurred. The occurrence of depression among the studied patients with tinnitus is higher than in the Polish population. In the conducted studies dominated depression of mild intensity. It was affirmed that depression occurred more often in patients with tinnitus lasting longer than 5 years.

• [Results evaluation in cervical vertigo kinesitherapy--preliminary report].

  Authors: Marzena Bielińska, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 09/2009; 63(7):24-7.

  The work aimed at analyzing results of kinesitherapeutic procedures in patients with cervical vertigo as well as evaluating a mobility range of the cervical spine. The study was conducted on 23The work aimed at analyzing results of kinesitherapeutic procedures in patients with cervical vertigo as well as evaluating a mobility range of the cervical spine. The study was conducted on 23 people, including 17 women and 6 men suffering from cervical vertigo, at the age of 23-73 (the average age of 49.5). All the patients had an individually selected cycle of kinesitherapeutic exercises through the period of 2 months. The objective efficiency evaluation of the applied therapy was made on the grounds of the videonystagmographic examination (VNG). Additionally, the range of active mobility of the cervical spine was analyzed and the evaluation of vertigo according to Silvoniemi's criteria was performed. After a 2-month therapy 4 patients (17.4%) out of the examined material showed a total lack of vertigo, 15 patients (65.2%) demonstrated a meaningful decrease in the vertigo intensity, also in the frequency of their occurrence in 14 cases (60.8%). Only 3 patients did not show any decrease in vertigo whereas in 1 patient a slight increase in the intensity was indicated. On the basis of a subjective evaluation of the vertigo increase according to the 5-stage Silvoniemi's scale it was proved that a mean point assessment claimed by the patients at the beginning of the therapy amounts to 3.0 points whereas after the therapy it was as follows: 1.43 pt after 2 weeks, 1.17 pt after 1 month and 1.13 pt after 2 months of kinesitherapy. It is extremely difficult to fully eliminate the symptoms of cervical vertigo (in the studied material in 4 cases--17.3%) because the causes of their occurrence, which are connected with excessive tension and degeneration in the cervical spine, cannot usually be eradicated. Additionally, as a diagnostic means, the videonystagmographic examination (VNG) accompanied by the positioning tests and the cervical rotation test facilitates precise and objective monitoring of the progress in treatment and rehabilitation of vertigo.

• [Videolaryngostroboscopic examination of treatment effects in patients with chronic hyperthrophic larynges]

  Authors: Wiesław Kluch, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(6):680-5.

  INTRODUCTION: This work aimed at assessing effects of surgical treatment and post-operative rehabilitation of chronic hyper trophic laryngitis by videolaryngostroboscopy and the GRBAS scale. MATERIALINTRODUCTION: This work aimed at assessing effects of surgical treatment and post-operative rehabilitation of chronic hyper trophic laryngitis by videolaryngostroboscopy and the GRBAS scale. MATERIAL AND METHODS: The examinations were carrie on 50 patients of both sex, including 16 women (32.0%) and 34 men (68.0%) at the age of 19-66, surgically treated due t oedema hypertrophic lesions in the larynx. The voice was assessed by the perceptive GRBAS scale, a subjective voice self-assessment questionnaire, and through pre- and post-therapy videolaryngostroboscopic tests, which were also conducted afte phoniatric rehabilitation (30 days after the operation). Physical therapy (iontotherapy with hydrocortisone and 1% solutio of CaCl2) and respiratory and phonatory exercises were introduced in the rehabilitation. RESULTS: The GRBAS scale indicate that the patients with the Reincke's oedema and vocal fold polyp showed greater voice improvement after the therapy an rehabilitation than those with chronic hypertrophic laryngitis. Contrary to the assessment carried out before the surgica procedure, the hoarseness level, rough voice, breathing voice, weak voice and tense voice mainly ranged between 0 and scale. In stroboscopy a correct marginal shift and occlusion of the glottis were noticed in each case after eliminating lesion like Reincke's oedema and vocal fold polyp (merely in 6.0% we found a disorder in the marginal shift). In the above patient their voice formation was unrestrained, 69.0% and 75.0% respectively, mid-location of the voice was normal in 92.0% an 88.0%, normal phonation time in 85.0% and 94.0%, and accurate voice setting in 77.0% and 75.0%. In stroboscopy the wors results of the voice assessment were obtained in the laryngeal papilloma patient. CONCLUSIONS: The videolaryngostroboscop seems a perfect diagnostic method in larynx diseases, both in qualifying patients for a surgical treatment and monitorin effects of the treatment and post-operative rehabilitation.

• [Early hearing evaluation in patients treated by surgery due to chronic otitis]

  Authors: Jurek Olszewski, Wiesław Konopka, Marcin Repetowski

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(6):731-4.

  INTRODUCTION: The aim of the study was the comparison of hearing before and after ear surgery in patients with chronic otitis media according to Fowler and Sabine criteria. MATERIAL: The studyINTRODUCTION: The aim of the study was the comparison of hearing before and after ear surgery in patients with chronic otitis media according to Fowler and Sabine criteria. MATERIAL: The study comprised 42 patients (42 ears), aged 19-72 (26 females and 16 males). The patients were divided into three groups, considering the type of surgery; Group I--20 ears after myringoplasty, group II--14 ears after mastoidectomy with canal up and myringoplasty and group III--8 ears after the mastoidectomy with canal down. METHODS: Audiologic examination was performed together with the evaluation of hearing loss according to the criteria of Fowler and Sabine (CPT), before and 3 months after the ear surgery. The difference of 20% (CPT) was considered improvement or deterioration of the hearing. RESULTS: On the basis of the intraoperative examination, chronic otitis media with perforation was found in 18 patients, granulating otitis media in 16 patients and the chronic otitis with cholesteatoma in 8 patients. The myringoplasty was performed in 20 patients, the mastoidectomy with canal up and myringoplasty in 14 patients and the mastoidectomy with canal down in 8 patients. In 14 ears of group I (70%) hearing improvement was noticed, and in 6 (30%) remained unchanged. The mean hearing loss according to CPT in this group was 40.39% before ear surgery and 24.26% after. In group II in 6 ears (43%) hearing improvement was observed, whereas in 8 (57%) remained unchanged. The mean hearing loss according to CPT in this group was 71.40% before and 61.85% after surgical treatment. In group III, hearing improvement was noticed in 37% of ears and in 5 (63%) did not change after the ear operation. The mean hearing loss (CPT) in this group was 81.57% before treatment and 71.37% after. CONCLUSIONS: Considering early evaluation of hearing the best results were obtained in patients subjected to myringoplasty and conservative operations of the middle ear with canal up procedure.

• [The value of impedance audiometry in the hearing loss diagnosis]

  Authors: Sylwia Kowalska, Wiesław Konopka, Renata Słomińska, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(6):764-8.

  INTRODUCTION: The aim of this work was to assess the value of impedance audiometry in the differential diagnostics of hearing disorders, especially in patients suffering from tinnitus. MATERIAL ANDINTRODUCTION: The aim of this work was to assess the value of impedance audiometry in the differential diagnostics of hearing disorders, especially in patients suffering from tinnitus. MATERIAL AND METHODS: The analysis dealt with results of the audiological tests in 198 patients (116 female and 82 male), hospitalised in 2007 due to their hearing deterioration, tinnitus or sudden deafness. The conducted audiological tests covered threshold and suprathreshold pure tone audiometry, speech audiometry, BERA and impedance audiometry. RESULTS OF THE STUDIES: Women (58.5%) and people over 50 years old (58.6%) constituted the majority of the patients. In 166 (83.8%) patients the conducted tests via impedance audiometry did not prove any deviations from the normal condition, the lesions referred to both ears in 32 (16.9%) patients and one ear in 17 (8.5%) patients. An incorrect tympanogram was found in 23 people, including type As in 11, type Ad in 2, type B in 4 and type C in 6 subjects. Low values of acoustic receptivity of the middle ear were noted in 20 ears, whereas high values in 11 ears. In 3 ears we found low values of the gradient (below 0.3), high values--in 11 ears. The middle ear pressure between -170 and -350 daPa was noticed in 20 ears, and positive values, above +50 daPa up to +75 daPa, in 3 ears. Disorders in the stapedial reflex registration were observed in 38 (19.1%) patients. The assessment of the conducted subjective and objective audiological examinations allowed to recognise bilateral perceptive hearing injuries in 139 patients, including 49 (25.9%) of cochlear origin with OWG, in further 70 patients the hearing loss referred to higher frequencies and was rather slight. CONCLUSIONS: The own experiences indicated that the impedance audiometry constitutes the integral part of contemporary audiological diagnostics and still remains an objective method facilitating quick, non-invasive evaluation of the functions of particular elements in the middle ear.

• [Evaluation results of treatment polyps of nose and paranasales sinuses by endoscopic method]

  Authors: Jurek Olszewski, Jarosław Miłoński

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(4):400-2.

  INTRODUCTION: This work aimed at the analysis of results of the treatment of nasal and paranasal sinus polyps by the endoscopic method. MATERIAL AND METHODS: The tests were conducted on 142 patients,INTRODUCTION: This work aimed at the analysis of results of the treatment of nasal and paranasal sinus polyps by the endoscopic method. MATERIAL AND METHODS: The tests were conducted on 142 patients, including 75 women and 67 men at the age of 17-68, who underwent the endoscopic surgical treatment due to nasal polyps and paranasal sinus polyps between 2006-2007. In all the patients we conducted functional surgical procedures of the nose and paranasal sinuses by the endoscopic method. In the post-operative treatment we applied the nasal steroid therapy and guided antibiotic therapy. The efficiency of the treatment was assessed 6 months after the procedure. RESULTS: All in all, we conducted 278 polipectomies (163 repolipectomies) of the nose, 278 ethmoidectomies (56 reethmoidectomies), 188 ostium-ductal complex operations, 43 maxillary sinus operations, 21 sphenoid sinus operations and 64 surgical dilatations of the sphenoid sinus ostinum, 49 surgical dilations of the frontal sinuses. In 7 cases the nasal septum operation was conducted simultaneously. Six months following the operation, the endoscopic test showed a correct patency in the ostinum of the paranasal sinuses, sphenoid and frontal sinuses, and no inflammatory traits like reddening, swelling of the nasal mucosa or any pathological secretion. Four times we noticed reddening and swelling of the nasal mucosa, and the mucopurpulent secretion accompanying correct patency of the ostinum in the paranasal sinuses. The control examination carried out 6 months after the surgical treatment showed, according to the patients, the appropriate nasal patency in 93.7%, sensation of the blood flowing down the throat in 20.4%, mucorrhoea in 2.8%, smell impairment in 17.6% and headache in 2.8%. CONCLUSIONS: In the majority of the cases we conducted nasal and paranasal sinus re-operations after the prior traditional procedures, which are still used in many institutions not equipped with endoscopic surgery appliances.

• [The analysis of the bacterial and fungal flora in maxillary sinuses in patients operated due to FESS method]

  Authors: Jurek Olszewski, Jarosław Miłoński

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(4):458-61.

  INTRODUCTION: The aim of this work was to analyse the bacterial and fungal flora in maxillary sinuses in patients operated due to the FESS method. MATERIAL AND METHODS: Studies were conducted on 110INTRODUCTION: The aim of this work was to analyse the bacterial and fungal flora in maxillary sinuses in patients operated due to the FESS method. MATERIAL AND METHODS: Studies were conducted on 110 patients, including 47 women aged 17-78 and 63 men aged 17-66, who underwent endoscopic surgical procedures due to chronic polypoid maxillary sinusitis between 2006 and 2007. 214 cultures were prepared altogether. During the endoscopic operation on paranasal sinuses, a cannula was introduced along the natural entrance and material for the culture and antibiogram was removed by suction. RESULTS: In the studied material of 214 cultures, 72 (33.6%) cultures obtained positive results, including 2 cases with bacterial and fungal floras present simultaneously (Aspergillus fumigatus and Aspergillus niger) in 38 operated patients. In 25 (34.5%) cultures we noted the presence of Staphylococcus epidermidis, which was sensitive to the following antibiotics: Cotrimoxazole, Rifampicin, Vankomycin, Teicoplanin and Levofloxacin. Staphylococcus epidermidis was isolated in 22 (31.0%) cultures, showing 100% sensitivity to similar antibiotics like the previous one. Another bacteria (Escherichia coli) was cultured in 10 cultures (13.8%), in 70% of the cases every second bacteria was Staphylococcus epidermidis with 100% sensitivity mainly to cephalosporins and aminoglycosides. In 3 cultures (4.17%) we found Klebsiella pneumoniae, with 100% sensitivity to cephalosporins and aminoglycosides and 100% resistance to penicillins. In three cases Pseudomonas fluorescens and Proteus mirabilis (4.17% each) were cultured with their sensitivity and resistance similar to those of Klebsiella pneumoniae. Two cases (2.8% each) in the cultures were noted: Citrobacter freundii, Streptococcus oralis and Hafnia alvei, which were 100% sensitive to some cephalosporins and aminoglycosides whereas their resistance to penicillins and Cefuroxime was as high as 100%. CONCLUSION: In the operated patients suffering from chronic polypoid maxillary sinuses we found 33.6% of positive results in the bacterial flora. This indicates that the changes were accompanied by an acute inflammatory condition, thus surgical procedures had to be followed by a guided antibiotic. The cultured bacteria demonstrated sensitivity to some cephalosporins and aminoglycosides and resistance to penicillins, which proves the abuse of penicillins in the treatment of acute inflammatory states of upper airways.

• [Electrical stimulation as an alternative method of tinnitus treatment]

  Authors: Wiesław Konopka, Marzena Mielczarek, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 02/2008; 62(5):601-5.

  INTRODUCTION: The aim of the study was to evaluate the influence of the selective electrical stimulation of the hearing organ on tinnitus in people with sensorineural hearing loss. MATERIAL ANDINTRODUCTION: The aim of the study was to evaluate the influence of the selective electrical stimulation of the hearing organ on tinnitus in people with sensorineural hearing loss. MATERIAL AND METHODS: The study comprised 248 tinnitus patients treated by using electrical stimulation. The material was divided into two groups, regarding the method of stimulation. In group I--168 people, transtympanal electrical stimulation of the promontory was applied, whereas in group II--80 people, hydrotransmissive technique was used. ENT examination, audiological and radiological diagnostics, as well as the evaluation of the audiometric parameters of tinnitus was performed. The patients were asked to fill in the questionnaire concerning tinnitus. In 80 patients hydrotransmissive electrical stimulation was conducted using the own prototype device, in 168 patients--transtympanal stimulation, after local anaesthesia with Xylocain gel. RESULTS: On the whole, in group of 248 patients, subjective improvement (decrease in the severity of tinnitus) was noticed in 130 people (52.4%), comprising 32 cases (13%) of total relief. In 93 patients (37.5%) tinnitus remained unchanged, and in 25 (10.1%) the deterioration was observed. The comparison of the results of two electrical stimulation methods, showed the superiority of hydrotransmissive one (improvement in 58.75% of patients), however, the number of cases of total relief was greater in the case of transtympanal method (15.5%). Considering subjective evaluation, as well as audiometric (the intensity and the frequency parameters, MML) the hydrotransmissive method appeared to be more effective (improvement in 53.75%) comparing to transtympanal stimulation (improvement in 44.6%). CONCLUSIONS: On the basis of studies conducted in the Clinic and the long history of the electrical stimulation administration in tinnitus treatment, it can be stated that this method may by applied in cases, in which other therapeutical methods failed.

• [Central vertigo of posterior cranial fossa tumors origin].

  Authors: Wiesław Konopka, Jurek Olszewski

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(3):291-4.

  Many pathologies of the posterior fossa can induce vertigo or dizziness. Usually they are due to benign or malignant tumors. The aim of our study was to present the cases of the patients with centralMany pathologies of the posterior fossa can induce vertigo or dizziness. Usually they are due to benign or malignant tumors. The aim of our study was to present the cases of the patients with central vertigo attended to the Otorhinolaryngology emergency department of the University Hospital. The authors present three cases of the posterior cranial fossa tumors. All of the patients underwent a battery of audiovestibular tests. Each patient presented with positional vertigo, and electronystagmography revealed positional nystagmus indicative of a central lesion. In these cases positional vertigo was the first and only presenting symptom of central nervous system disease. The findings in these cases emphasize the need of looking for positional nystagmus in patients with suspected posterior fossa lesions as well as radiological diagnosis by using CT or MRI.

• [Tinnitus diagnosis and treatment on the basis of our experiences].

  Authors: Jurek Olszewski, Sylwia Kowalska, Krzysztof Kuśmierczyk

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(1):76-81.

  The aim of the study was to analise tinnitus diagnosis and treatment on the basis of our experiences. 137 patients hospitalizated in Otolaryngology and Laryngological Oncology Clinic because ofThe aim of the study was to analise tinnitus diagnosis and treatment on the basis of our experiences. 137 patients hospitalizated in Otolaryngology and Laryngological Oncology Clinic because of tinnitus (88 women - 64% and 49 men - 35,8%) were included to the study. The diagnostic procedures were unified that enabled put forward correct diagnosis. After history and otoscopy, detailed audiologic diagnostic procedures (pure tone audiometry, suprathreshold audiometry, speech audiometry, acoustic immittance measures, auditory brainstem responses) were taken. Electronystagmography and videonystagmography, tinnitus loudness match, head and neck radiologic examinations supplemented diagnostic procedures. Alternative tinnitus treatment options were applied. Study confirmed that tinnitus is the most frequent in patients above 50 years old (67,8% of participants). Tinnitus frequently coexist with bilateral sensorineural hearing impairment (69,1% of participants). 40,1% from asalysed group of patients complained of tinnitus of medium frequencies and 30,6% of patients complained of high frequency tinnitus. 42,3% of participants suffered from vertigo. The risk of tinnitus increases in patients above 55 years old that suffer from metabolic conditions and cervical spondylosis. Tinnitus frequently coexist with bilateral sensorineural hearing impairment and are bilateral or they are noticeable in better hearing ear. The most beneficial to tinnitus is causal and symptomatic treatment with several methods application.

• [Clinical analysis in patients with cervical vertigo in ENT].

  Authors: Jurek Olszewski, Marcin Repetowski

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(3):283-7.

  The aim of this work was a clinical analysis of patients suffering from vertigoes of neck origin, conducted within the own study. The study covered a group of 120 patients, including 76 females andThe aim of this work was a clinical analysis of patients suffering from vertigoes of neck origin, conducted within the own study. The study covered a group of 120 patients, including 76 females and 44 males, aged 20-85, who were diagnosed and treated due to vertigoes of neck origin in the Clinic of Otolaryngology and Laryngological Oncology the Medical University of Łódź between 2005-2006. Criteria for all the patients treated for vertigoes of neck origin include: an interview, subject otolaryngological treatment, complete audiological tests, laboratory tests, computerized tomography of the head or classical and functional x-ray of the cervical spine, blood flow in vertebral arteries and the basilar artery due to the Doppler method (using Transport-TCD apparatus, 2 Mhz head through the great foramen and using the torsion of the neck test). The electronystagmographic examination (ENG) covered registration of: position nystagmus detected in five classical positions according to Nylen, neck nystagmus in the torsion of the neck test. All the patients suffering form vertigoes of neck origin were treated with physical therapy and kinesitherapeutic exercises. The major part of the studied material of the patients with vertigoes of neck origin constituted: office workers (56.76%), aged 41-60 (59.16%), smoking (50.83%), suffering from hypercholesterolemia (35.29%), with abnormal x-ray of the cervical spine (93.37%) and injuries in this segment (13.33%), using non-steroid anti-inflammatory (69.17%) and vascular (52.59%) drugs, thus not young people with some additional pathological history. On the grounds of the obtained results it is claimed that the registration of the neck nystagmus in the torsion of the neck test as well as the position nystagmus examination according to Rose were most useful in this study, which facilitated reliable diagnostics of the vertigoes of the neck origin and monitoring of their intensity after applied treatment.

• [The rare case of the multiple primary planoepithelial laryngeal cancer and clarocellular renal cancer].

  Authors: Jurek Olszewski, Marek Sosnowski, Krzysztof Zieliński, Krzysztof Kuśmierczyk, Renata Słomińska

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(3):330-4.

  The authors present a rare case of the primary multiple planoepithelial laryngeal cancer and clarocellular renal cancer in a patient operated in the Clinic. The patient, called EJ., was admitted toThe authors present a rare case of the primary multiple planoepithelial laryngeal cancer and clarocellular renal cancer in a patient operated in the Clinic. The patient, called EJ., was admitted to the Clinic of Otolaryngology and Laryngological Oncology due to hoarse voice he had been suffering for 6 months. On the interview with the patient, otolaryngological and videolaryngostroboscopic examinations we diagnosed hypertrophic changes in the whole length of the right vocal fold with the fold mobility preserved. The hypertrophic changes in the right vocal fold were removed by Kleinsasser direct microlaryngoscopy. However, the histopathological examination showed carcinoma planoepitheliale keratodes infiltrans mucosae laryngis G-2. In the further treatment the patient was qualified to the dexter chordectomy by the CO2 laser. The histopathological examination confirmed the total removal of the changes within the healthy cells. After about one year from the completed laryngological treatment the patient visited the urological outpatient clinic due to pain ailments in the right lumbar part. The urographic examination and CT of the abdominal cavity showed a tumour (8 x 9 cm), in the right kidney. The patient was admitted to the 1st Clinic of Urology the Chair of Urology and qualified to the dexter nephrectomy. Following the operation the histopathological examination indicated carcinoma clarocellulare partim cysticum renis dextri. Class, Fuhrman 20, pT2 Nx Mx. The hyperplasia limited to the renal parenchyma. Cut-off lines of the ureter and vessels without neoplastic infiltration. The patient remains under constant catamnesis at the urological and laryngological outpatient clinic, no symptoms of the neoplasm relapse.