Anna Bartochowska

Objectives: The aim of this study was to compare the surgical and postoperative clinical outcomes of punch-only and linear incision techniques for implantation of the Ponto^® bone conduction implant. Methods: Surgical and follow-up data were collected from 101 patients: 46 treated with Minimally Invasive Ponto^® Surgery (MIPS) and 55 with the linear incision technique (LT). The analysis focused on: (1) the surgical procedure, including operative time and intraoperative complications; (2) the healing process; and (3) long-term implant-site outcomes, including implant loss. Results: Median operative time was significantly shorter for MIPS than for LT (30 min vs. 40 min, p < 0.001). No major intraoperative complications were observed in either group. Adverse skin reactions were more frequent in the LT group than in the MIPS group (18.2% vs. 8.7%), but the difference was not statistically significant (p = 0.249). A single implant loss occurred in the LT group 18 months after surgery and was unrelated to failed osseointegration or the surgical technique, being caused by recurrent cholesteatoma. Conclusions: MIPS was associated with a significantly shorter operative time than the LT. Both MIPS and LT appear to be safe techniques. No statistically significant differences were detected between the groups with respect to adverse skin reactions or implant survival during the follow-up period.

We report a case of a 74-year-old patient with Arnold–Chiari syndrome (type 1) who, due to the bilateral profound hearing loss, was qualified for cochlear implantation. The difficult anatomy of the temporal bone necessitated special preparation for the procedure. The use of neuronavigation, in combination with facial nerve monitoring, enabled a safe surgical approach to the cochlea and ensured accurate placement of the implant.Cite this article as: Podlawska-Nowak P, Bartochowska A, Balcerowiak A, Gawęcki W. Cochlear implantation in patient with Arnold–Chiari malformation. J Int Adv Otol. 2025, 21(2), 1273, doi: 10.5152/iao.2025.231273.

Introduction: The COMQ-12 questionnaire is a tool to assess the quality of life in patients with chronic otitis media in many countries. The questionnaire consists of 12 questions: seven relating to the severity of symptoms, two regarding the impact of the disease on lifestyle and work, two concerning the impact on the need for healthcare, and one is a general question. Each question is rated on a scale from 0 to 5. Aim: To present the validation process and the final version of the Polish version of the COMQ-12 questionnaire. Material and methods: The Polish version of the COMQ-12 questionnaire was prepared based on an independent translation of the English version by three physicians (two otolaryngology specialists and one physician in the process of specialization in otolaryngology). The questionnaire was validated in a study including 60 participants: 30 patients with chronic otitis media and 30 volunteers without a history of middle ear diseases or hearing disorders. Each participant was asked to complete the COMQ-12 questionnaire twice at an interval of 4 weeks apart. The internal consistency, reliability, and construct validity of the questionnaire were analyzed using Cronbach's alpha and McDonald's omega coefficients, Spearman's rho correlation coefficient, and the Mann-Whitney test, respectively. Results: High internal consistency, reliability, and construct validity of the Polish version of the COMQ-12 questionnaire were shown in the course of statistical analysis. The overall internal consistency was 0.95 and 0.97 as assessed by Cronbach's alpha and McDonald's omega coefficients, respectively. Spearman's rho correlation coefficient was above 0.89 for each question. Statistically significant differences in the COMQ-12 total scores were obtained between patients with chronic otitis media and the control group. Conclusions: The Polish version of the COMQ-12 questionnaire can be a valuable clinical tool for the assessment of the quality of life in patients suffering from chronic otitis media.

Introduction: Bell’s palsy is still the diagnosis of exclusion. In most patients it does not progress, it is unilateral, and selflimiting. Additionally, the majority of patients recover spontaneously within 3 weeks. It is well known that all patients with irreversible facial nerve paresis (FNP) need further examinations to exclude the organic, infectious, metabolic, and autoimmunological causes of the palsy. The goal of the study was to assess the frequency of malignancies hidden under the diagnosis of “Bell’s palsy”. Aim: We aimed to create a diagnostic algorithm to avoid failures concerning patients whose only symptom of parotid gland cancer was irreversible FNP. Material and methods: We analyzed 253 consecutive patients with FNP treated in our department in the last 5 years. The subject of the study was “Bell’s palsy” cases. All patients with irreversible FNP were reassessed in 6–12 months. We underlined all shortcomings in the diagnostics of those in whom malignancies were found in MRI of the neck and presented the proposal for a diagnostic algorithm to avoid missing such an entity. Results: Bell’s palsy was observed in 157/253 patients (62.06%), in 36/157 (22.92%) it remained permanent. In 4/36 patients (11.11%) with irreversible FNP, which constituted 2.54% of all “Bell’s palsy” cases, parotid gland deep lobe mass was found in MRI. In one patient, infiltration of the skull base was diagnosed. Adenoid cystic carcinoma was confirmed in final histopathology in all cases. Conclusions: Our experience has shown that irreversible FNP can be a revelator of the malignant tumor located in the deep lobe of the parotid gland. Contrast-enhanced MRI covering intra- and extracranial segments of the facial nerve should be ordered in all cases of FNP without recovery after 4 months. Repeated imaging should be considered in undiagnosed cases. The main point of our study is to underline that the assessment of the deep lobe of the parotid gland with MRI should be included in the standard diagnostic protocol in all irreversible “Bell’s palsy” cases.

Aim: Liquid biopsy (LB) is a method that detects circulating tumor cells or circulating tumor DNA or RNA in the body fluids of patients with cancer. Despite the developments in LB, it is still not used in clinical practice in head and neck cancers (HNC). The aim of our study was to analyze the epidemiological data of HNC patients and controls who were enrolled in an LB study based on circulating free DNA (cfDNA) detection. Material and methods: A group of 152 patients diagnosed with HNC (128 men and 24 women) and 56 healthy volunteers (48 men and 8 women) were enrolled into the study. Peripheral blood samples were collected before treatment from HNC patients and controls. Plasma was isolated and cfDNA concentration was assessed in the range of 35-10,380 bp. Results: The comparison of cfDNA concentration by gender between the HNC patients and the control group, and by comorbidities in the control group, showed no significant differences (p values: 0.13-0.69, 0.15-0.50 and 0.13-0.80, respectively). Conclusions: Patients' gender and general status were found to have no effect on cfDNA concentration. Further analysis is necessary to define other correlations and the possible application of LB in HNC diagnosis, follow-up, and treatment.

OBJECTIVE: The aim of the study was to present the indications for facial nerve decompression in malignant external otitis, to analyze the results of such treatment, and to describe own experience in that field. METHODS: A search in the PubMed and Google Scholar databases for English language articles published between 1968 and May 2022 was performed. We focused on papers describing patients with malignant external otitis and facial nerve palsy treated by decompression. Moreover, retrospective analysis of 24 consecutive patients with malignant external otitis hospitalized in our department in the past 10 years was performed. RESULTS: In the literature, 48 cases with malignant external otitis and facial nerve paresis treated by decompression were identified. In total, 41 patients recovered (85.42%), 4 died (1 due to exacerbation of the disease, 2 for pneumonia, and 1 for heart failure), and in 3 cases the final outcome was not presented. In most cases (24; 50%), facial nerve function did not improve after decompression, in 8 patients (16.67%) partial recovery was observed, in 11 cases (22.92%) full improvement was observed, and data were not given for 5 patients. In only one case, the spread of infection and deterioration of local and general patient states were noted. In our material, we identified 13 patients with malignant external otitis and facial nerve palsy. Two of them were treated surgically, of which only one had facial nerve decompression. Partial improvement of facial nerve function was observed after 6 months of rehabilitation. CONCLUSION: The management of malignant external otitis is still difficult and not well defined. Facial nerve decompression seems justified in selected cases of malignant external otitis not responding to conservative treatment. Cite this article as: Marszał J, Wierzbicka M, Bartochowska A. Is facial nerve decompression justified in malignant external otitis? Literature review and own experience. J Int Adv Otol. 2023;19(3):191-198.

Purpose of review: The current review is to present the current knowledge regarding epidemiology, diagnostics, and management of malignant adnexal neoplasms (MANs). Recent findings: Immunotherapy and gene-related therapies are still being developed as the methods of salvage treatment in advanced and disseminated cases: CACNA1S, ATP2A1, RYR1, and MYLK3, as well as p53 or the JAK/STAT pathways, may be therapeutic targets; the efficiency of talimogene laherparepvec and nivolumab is assessed. Summary: MANs are rare tumors, but due to the aging of population their incidence is increasing. Their clinical presentation is unspecific, which makes the diagnosis challenging. Histopathological assessment is difficult even for experienced pathologists. Mohs micrographic surgery or wide local excision are recommended to treat primary lesions. Adjuvant radiotherapy may be beneficial in case of insufficient or positive surgical margins, in nodal metastases, in selected types of MANs like sebaceous, trichilemmal, and pilomatrix carcinomas, and as the induction treatment in large tumors located in medically fragile or cosmetically important regions. The role of chemotherapy is not well defined; however, it is recommended in distant metastases. Immunotherapy can improve the prognosis in advanced stage of the disease.

Introduction: In 2017, the European Academy of Otology and Neurotology (EAONO) published a consensus statement in cooperation with the Japan Otological Society (JOS) that unified the definition, classification and staging of the middle ear cholesteatoma. It was intended to help determine the severity of the disease, difficulty of complete removal, and to make it easier to compare surgical outcomes between different centers. The classification defines 5 regions within the middle ear (the so-called STAM system): S – difficult access sites (S1 – protympanum/anterior epitympanum/supratubal recess, and S2 – sinus tympani), T – tympanic cavity, A – attic, and M – mastoid process. This consensus also distinguishes 4 stages of cholesteatoma (STAGE I–IV) depending on the local extent of the cholesteatoma or the presence of extracranial or intracranial complications. Aim: The aim of this study was to analyze patients with chronic otitis media with cholesteatoma, to assess the treatment outcomes, and to correlate it with the stage of the disease according to the EAONO/JOS classification. Material and methods: We conducted a retrospective analysis of the medical records of patients undergoing the first surgery for chronic otitis media with cholesteatoma between 2015 and 2020. The study group consisted of 204 patients aged 6–82, including 113 males and 91 females. Results: The analysis showed a statistically significant relationship between the disease stage and erosion of the malleus (p = 0.00342), the incus (p = 0.0001) and the stapes suprastructure (p = 0.00193). The highest cholesteatoma recurrence rate was observed following its removal accessed through the external ear canal alone. It was less common after a closed tympano-plasty (canal wall up, CWU) and even less frequent after open tympanoplasty (canal wall down, CWD). Very good results were also found in patients after surgery with mastoid process obliteration (bony obliteration tympanoplasty, BOT). In contrast, no correlation between the cholesteatoma recurrence rate and the stage of the disease was observed in the studied group (p = 0.53430). The statistical analysis showed that, as the disease progressed through stages I–III, the preoperative hearing loss for air conduction (p = 0.0025) and for bone conduction (p = 0.0042), as well as the air-bone gap (p = 0.0201) were signi-ficantly higher. Also, the analysis of the postoperative hearing results showed that all the values were higher in advanced stages of the disease, and the differences were statistically significant (p = 0.0156 for air conduction, p = 0.0069 for bone conduction, respectively). Conclusions: Our study showed that the classification by EAONO/JOS helps objectively determine the stage of the disease, which in turn correlates with the degree of bone destruction and with hearing results. It also provides an opportunity to com-pare treatment outcomes with other researchers. However, this system does not predict the risk of cholesteatoma recurrence based only on its location and staging. The operative technique which was used seems to be the key factor.

Purpose: The aim of this study was to present a series of 6 patients with facial nerve palsy and masked mastoiditis which constituted as revelators of localized granulomatosis with polyangiitis (GPA) and to evaluate the utility of the ACR/EULAR 2017 provisional classification criteria for GPA in such cases.Methods: Study group included 58 patients with GPA. Cases with facial nerve palsy and masked mastoiditis were thoroughly analyzed.Results: The mean age of patients was 37 years. All manifested unilateral facial nerve palsy and hearing loss, while only 2 reported aural complaints suggesting inflammatory cause of the disease. All cases were qualified for surgical intervention. Intraoperative findings were similar: granulation tissue in tympanic cavity and/or pneumatic spaces of the mastoid process. Only 50% of histopathological results suggested vasculitis. In all cases, elevated levels of antineutrophil cytoplasmic antibodies (ANCA) against peroxidase 3 (PR3-ANCA) were determined. Two patients presented rapid progression of the disease and died within 1 week and 2 months, respectively. Four other patients manifested gradual improvement of hearing and facial nerve function after treatment.Conclusion: GPA should be included into differential diagnosis in all cases of persistent facial nerve palsy especially when otological symptoms coexist. Even localized GPA could be very aggressive, revelating generalized form of the disease. Rapid systemic treatment of GPA can protect hearing and facial nerve from permanent severe dysfunction. The ACR/EULAR 2017 provisional classification criteria for GPA seem to be valuable tool in diagnosing ENT patients with localized otological form of the disease.

Purpose: The aim of the study was to assess hearing, surgical and clinical results of the treatment in patients with cholesteatomatous labyrinthine fistula (LF) focusing on the different techniques and materials used in the management. Methods: Study group included 465 patients. Cases with LFs discovered or confirmed during surgical procedure were thoroughly analyzed. Results: LFs were noted in 11.4% of all cases. Thirty-eight patients, with all follow-up data available, were included into the further analysis. Most LFs were located in the lateral semicircular canal (87%). LFs were assessed as small in 2 cases, as medium in 24 patients while 12 were described as large. Based on Dornhoffer and Milewski classification, 50% of LFs were classified as IIa, 24% as IIb, 6 LFs were very deep (type III), while 4—superficial (type I). The size and type of LF did not influence postsurgical complaints (p = 0.1070, p = 0.3187, respectively). Vertigo was less frequent in LFs treated by “sandwich technique”, especially those with opened endosteum. In 30 (79%) patients, hearing improved or did not change after surgery. Hearing outcomes were significantly better in the ears operated by means of CWU technique (p = 0.0339), in LFs with intact membranous labyrinth (p = 0.0139) and when “sandwich technique” was performed (p = 0.0159). Postsurgical bone conduction thresholds levels were significantly better in LFs covered by “sandwich method” (p = 0.0440). Conclusion: “Sandwich technique” (temporal fascia–bone pate–temporal fascia) enables preservation of hearing as well as antivertiginous effect in patients with cholesteatomatous labyrinthine fistula.