Publications by authors named "Pavel Kominek"

54 Publications

Individualised Timing of Radio-Guided Parathyroidectomy Using Multi-Phase SPECT/CT Increases In Vivo Sensitivity and Accuracy and Reduces Operating Time: A Randomised Clinical Trial.

Diagnostics (Basel) 2021 Apr 9;11(4). Epub 2021 Apr 9.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic.

: Minimally invasive parathyroidectomy is the preferred treatment for primary hyperparathyroidism. Despite relatively accurate preoperative information, minimally invasive parathyroidectomy can be challenging, especially in the case of small and ectopic adenomas. Radio guidance aids in both in vivo identification and ex vivo confirmation of adenoma. In vivo accuracy is currently not satisfactory. The present study evaluated whether a beneficial effect (increased sensitivity, specificity, accuracy) is obtained with individualised timing of minimally invasive radio-guided parathyroidectomy (MIRGP) using preoperative multi-phase 99mTc-MIBI single photon emission computed tomography (SPECT)/computed tomography (CT). This randomised clinical trial was conducted from May 2016 to January 2020 in a tertiary referral hospital. Adult patients with primary hyperparathyroidism sent for 99mTc-MIBI SPECT/CT were included consecutively and randomly assigned to conventional (dual-phase) SPECT/CT and conventional MIRGP (group I) or multi-phase SPECT/CT and individualised MIRGP (group II). One hundred of 106 eligible patients were included, and 83 patients underwent complete intervention. A total of 47 patients in group I and 35 patients in group II were analysed. Group II had a shorter operating time ( = 0.003). The in vivo sensitivity and accuracy of radio guidance was 85.1% in group I and 100% in group II ( = 0.046), and 90.4% in group I and 100% in group II ( = 0.021), respectively. We found no difference in the in vivo specificity and ex vivo parameters between groups. Individualised timing increased the in vivo sensitivity and accuracy of radio guidance and reduced operating time, as some parathyroid adenomas rapidly wash out the radionuclide.
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http://dx.doi.org/10.3390/diagnostics11040677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070050PMC
April 2021

Author's reply to Letter to the Editor: "Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite".

Eur Arch Otorhinolaryngol 2021 Apr 3. Epub 2021 Apr 3.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 70800, Ostrava, Czech Republic.

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http://dx.doi.org/10.1007/s00405-021-06784-8DOI Listing
April 2021

Evolution of voice after transoral laser cordectomy for precancerous lesions and early glottic cancer.

Eur Arch Otorhinolaryngol 2021 Mar 18. Epub 2021 Mar 18.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52, Ostrava, Czech Republic.

Purpose: To evaluate voice quality evolution after a transoral laser cordectomy (TLC) for precancerous lesions and early glottic cancer.

Methods: This prospective study enrolled 18 patients scheduled for TLC for high-grade dysplasia, Tis, T1, and T2 glottic squamous cell cancers, from May 2017 to March 2020. Patients were grouped according to the extent of TLC: Group I (n = 11, 61.1%): unilateral subepithelial or subligamental cordectomy; Group II (n = 7, 38.9%): unilateral transmuscular, total, or extended cordectomy. Voice quality parameters, including dysphonia grade (G), roughness (R), breathiness (B), maximal phonation time (MPT), jitter, and shimmer, were evaluated before, and at 6 weeks and 6 months after the TLC.

Results: In Group I, the degree of G and R items remained without substantial improvement 6 weeks after surgery; however, improved above the pre-surgery level up to 6 months after surgery. The MPT, jitter, and shimmer did not change significantly at 6 weeks or 6 months post-TLC. In Group II, G, R, and B remained significantly impaired even 6 months post-surgery. Jitter, and shimmer worsened at 6 weeks, but reached preoperative levels at 6 months post-surgery. MPT was significantly worse at 6 weeks and remained deteriorated at 6 months post-surgery. All measured parameters were significantly worse in Group II than in Group I at 6 weeks and 6 months post-surgery. No patient required a phonosurgical procedure.

Conclusion: After a TLC, voice quality evolution depended on the extent of surgery. It did not improve at 6 weeks post-surgery. Improvements in less extent cordectomies occurred between 6 weeks and 6 months post-surgery. Understanding voice development over time is important for counseling patients when considering phonosurgical procedures.
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http://dx.doi.org/10.1007/s00405-021-06751-3DOI Listing
March 2021

Effect of Balloon Eustachian Tuboplasty in Adults That Only Have Symptoms of Chronic Eustachian Tube Dysfunction, With a 1-Year Follow-Up: Prospective Clinical Trial.

Ear Nose Throat J 2020 Dec 10:145561320980199. Epub 2020 Dec 10.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.

Objectives: Balloon eustachian tuboplasty (BET) is a promising therapeutic option for eustachian tube (ET) dysfunction. However, data are lacking on the effect of BET in adults with symptoms of chronic ET dysfunction but without a contributing pathology. This study investigated the effect of BET in adult patients with only symptoms of chronic ET dysfunction.

Methods: This prospective clinical trial included adult patients with aerated physiological middle ears and symptoms of ET dysfunction for more than 6 months. Compliance with follow-up was 93.3%. We evaluated the effects of BET with tympanometry, assessment of the Valsalva or Toynbee maneuver with tympanometry verification, a Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and pure-tone audiometry. Data were recorded 1 day before surgery and 2, 6, and 12 months after BET. Therapy was considered successful when the patient exhibited a newly acquired ability to perform the Valsalva or Toynbee maneuver or when the ETDQ-7 score improved by 20% or more.

Results: We included 14 ears in the analysis. After 2, 6, and 12 months, therapy was successful, according to the ETDQ-7, in 11/14 (78.6%; 95% CI: 48.8-94.3), 13/14 (92.9%; 95% CI: 64.2-99.6), and 12/14 (85.7%; 95% CI: 56.2-97.5) ears, respectively. These results were statistically significant. The ETDQ-7 scores also significantly decreased at 2, 6, and 12 months after the BET, when any change was observed. All patients experienced improvement. Only 1 patient reported temporary deterioration after 2 months. Treatment was more frequently successful in patients without nasal polyps or pollinosis.

Conclusions: Adults with only symptoms of chronic ET dysfunction benefitted more and had longer lasting results from BET, compared to patients with pathologies caused by ET dysfunction. Balloon eustachian tuboplasty could be recommended for these patients.
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http://dx.doi.org/10.1177/0145561320980199DOI Listing
December 2020

Epstein-Barr virus may contribute to the pathogenesis of adult-onset recurrent respiratory papillomatosis: A preliminary study.

Clin Otolaryngol 2021 Mar 30;46(2):373-379. Epub 2020 Dec 30.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.

Objective: Human papillomavirus (HPV) causes adult-onset recurrent respiratory papillomatosis (AORRP), but AORPP prevalence is much lower than HPV prevalence. Thus, HPV infection is necessary, but not sufficient, to cause AORRP and other factors likely contribute to its pathogenesis. The present study aimed to investigate whether co-infection with herpetic viruses may contribute to the pathogenesis of AORRP.

Design: Prospective case-control study conducted from January 2018 to November 2019.

Settings: Tertiary referral centre.

Participants: Eighteen consecutive patients with AORRP and 18 adults with healthy laryngeal mucosa (control group) undergoing surgery.

Main Outcome Measures: Cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses 1 and 2, human herpesvirus 6, varicella zoster virus and HPV (including genotyping) were detected in biopsies of papilloma or healthy mucosa using real-time polymerase chain reaction and reverse line blot. Dysplasia and Ki67 levels were determined in papilloma specimens.

Results: EBV was present in 6 (33.3%) AORRP patients and no control patients (P = .019). Presence was not dependent on tobacco exposure (P = .413) or HPV genotype or concentration (P > .999). EBV presence was strongly related to increased cell proliferation (P = .005) and number of previous surgeries (P = .039), but not dysplasia (P > .999). Human herpesvirus 6 was found in 3 (16.7%) AORRP biopsies, with one false positive. No other herpetic virus was found.

Conclusions: Unlike other herpetic viruses, EBV seems to interact with HPV, enhancing cell proliferation and contributing to the pathogenesis and progression of AORRP. Further research is required to elucidate specific interactions and their role in the pathogenesis of AORRP.
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http://dx.doi.org/10.1111/coa.13681DOI Listing
March 2021

Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite.

Eur Arch Otorhinolaryngol 2021 Apr 23;278(4):1139-1144. Epub 2020 Nov 23.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 70800, Ostrava, Czech Republic.

Purpose: To evaluate 5-year voice outcomes of vocal fold augmentation (VFA) using autologous fat (AF) injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection.

Methods: Retrospective study of patients who underwent VFA between 2012 and 2015, with a 5-year follow-up. Patients with a glottic gap of ≤ 3 mm caused by unilateral vocal fold paralysis or vocal fold atrophy were included in the study. VFA was performed using AF injection via direct microlaryngoscopy in 17 patients, and using office-based CaHA injection in 19 patients. Subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection, and at 12 and 60 months post-VFA.

Results: Altogether 36 patients underwent VFA between 2012 and 2015, of whom 5 were excluded within 1 year post-VFA, and 2 were excluded between 1 and 5 years post-VFA. Of the remaining 29 patients, 3 (10.3%) underwent re-intervention at between 1 and 3 years post-VFA. Thus, the 5-year follow-up included 26 patients (72.2%; 11 males and 15 females). At 5 years after surgery, 73.1% of the patients were satisfied with their voice, with no significant between-group difference (P = 0.307). The mean improvement of VHI was 28.8 ± 17.82 in the autologous fat group versus 33 ± 26.24 in the CaHA group (P = 0.458). MPT improvement was also similar between the two groups: 6.2 ± 4.26 for the autologous fat group versus 6.3 ± 4.34 for the CaHA group (P = 0.667).

Conclusions: Both AF injection via direct microlaryngoscopy and office-based CaHA injection yielded good and comparable 5-year results.
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http://dx.doi.org/10.1007/s00405-020-06479-6DOI Listing
April 2021

Fibroepithelial Polyp of the External Auditory Canal in a 2-Year-Old Child.

Ear Nose Throat J 2020 Jul 20:145561320943343. Epub 2020 Jul 20.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Czech Republic.

Here, we report a unique case in which a fibroepithelial polyp was found in the cartilaginous part of the external auditory canal of a 2-year-old child. The polyp was successfully treated by excision using an endaural approach and healed without complications. This is the very first report of a fibroepithelial polyp in the external auditory canal in the pediatric population. Although fibroepithelial polyp is an extremely rare diagnosis, it should be considered in the differential diagnosis of a child's external auditory canal polyp.
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http://dx.doi.org/10.1177/0145561320943343DOI Listing
July 2020

Local Bevacizumab Treatment of Juvenile-Onset Respiratory Papillomatosis Might Induce Multiple Tracheal Pyogenic Granulomas.

Laryngoscope 2021 02 7;131(2):E518-E520. Epub 2020 Jul 7.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.

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http://dx.doi.org/10.1002/lary.28928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818179PMC
February 2021

Middle Ear Adenoma Imitating Late Postoperative Complication.

Ear Nose Throat J 2020 Jun 24:145561320935846. Epub 2020 Jun 24.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava-Poruba, Czech Republic.

Here, we present a rare case of middle ear adenoma in a 58-year-old female, which uniquely presented as an unstable open cavity after an endaural atticoantrotomy. Immunohistochemistry confirmed that the tumor produced endocrine and exocrine secretions. The tumor was radically surgically removed.
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http://dx.doi.org/10.1177/0145561320935846DOI Listing
June 2020

Temporal bone meningiomas: emphasizing radiologic signs to improve preoperative diagnosis.

Eur Arch Otorhinolaryngol 2021 Jan 12;278(1):271-273. Epub 2020 Jun 12.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 00, Ostrava, Czech Republic.

Purpose: Temporal bone meningioma is an extremely rare disease. Lack of clinical attention due to its rarity might lead to delayed diagnosis. This short communication aims to emphasize radiologic signs of temporal bone meningiomas to improve preoperative diagnosis.

Methods: Radiological characteristics of temporal bone meningiomas are discussed.

Results: Temporal bone meningioma is characterized by diffuse "hairy" trabecular hyperostosis without the destruction of trabecular structures, bone thickening, and irregular surface margins of the temporal bone on computed tomography. The dural tail sign is a unique feature of temporal bone meningioma on magnetic resonance imaging.

Conclusion: Otolaryngologists certainly should be aware of characteristic radiologic signs of temporal bone meningiomas. Using modern computed tomography and magnetic resonance imaging protocols enables with a high degree of accuracy to distinguish temporal bone meningiomas from other more common entities in this location.
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http://dx.doi.org/10.1007/s00405-020-06110-8DOI Listing
January 2021

Metal particles in mucus and hypertrophic tissue of the inferior nasal turbinates from the human upper respiratory tract.

Environ Sci Pollut Res Int 2020 Aug 15;27(22):28146-28154. Epub 2020 May 15.

Center of Advanced Innovation Technologies, VŠB-Technical University of Ostrava, 17. listopadu 15/2172, Poruba, 708 33, Ostrava, Czech Republic.

Mucosal surfaces are the first mechanical barrier preventing the entry of foreign particles into the organism. The study addresses the detection and analysis of metal-based solid particles in cytological mucus samples from the surface of human hypertrophic tissue in the inferior nasal turbinates in patients diagnosed with chronic rhinitis. Solid particles were characterized by scanning electron microscopy and Raman microspectroscopy; all the biological samples were also subjected to vibration magnetometry. Since the upper airways are the first part of the respiratory tract, which is exposed to inhaled particles, it can be assumed that inhaled particles may be partially deposited in this region. Scanning electron microscopy revealed the presence of metal-based solid particles/clusters in the majority of the analysed cytological mucus samples and also in hypertrophic tissues; in all groups, the particles were of submicron size. Raman microspectroscopy detected the presence of particles/clusters based on amorphous carbon, graphite, calcium carbonate, anatase and barite only in the hypertrophic tissue. The obtained results show that the composition of some of the solid particles (i.e. Ba, Zn, Fe and Ti) detected in the mucus from the surface of the hypertrophic tissues resembled the particles found in the hypertrophic tissue itself. It can be assumed that after the capture of the inhaled particles by the mucus, they penetrate into the deeper layers of tissue.
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http://dx.doi.org/10.1007/s11356-020-09156-7DOI Listing
August 2020

Effect of voice therapy with or without transcutaneous electrical stimulation on recovery of injured macroscopically intact recurrent laryngeal nerve after thyroid surgery.

Eur Arch Otorhinolaryngol 2020 Mar 24;277(3):933-938. Epub 2020 Jan 24.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852, Ostrava, Czech Republic.

Purpose: Electrical stimulation-supported therapy is an often used modality. However, it still belongs to experimental methods in the human larynx. Data are lacking with which to evaluate the real effect in recurrent laryngeal nerve injury. The aim of this study was to investigate whether transcutaneous electrical stimulation added to voice therapy has a beneficial effect compared to voice therapy alone on vocal fold movement recovery in the case of an injured macroscopically intact recurrent laryngeal nerve.

Methods: Adults with unilateral vocal fold paralysis after thyroidectomy, in which the recurrent laryngeal nerve was left macroscopically intact, were included in this case-control study performed in tertiary referral hospital between September 2006 and June 2018. Among 175 eligible participants, 158 were included. Compliance with 6 months follow-up was 94.3%.

Interventions: medicament therapy and voice therapy (group 1) vs. medicament therapy and voice therapy and transcutaneous electrical stimulation (group 2).

Main Outcome: vocal fold movement.

Results: A total of 149 patients were included in the analysis (group 1, 89 patients; group 2, 60 patients). The groups were homogenous. In groups 1 and 2, 64% and 60% of vocal folds, respectively, were improved after 6 months (P = 0.617). No difference was found between patients who improved and patients who did not improve.

Conclusions: Adding transcutaneous electrical stimulation to voice therapy provided no beneficial effect on the recovery of vocal fold movement. Therefore, its indications should be re-evaluated; it is questionable whether stimulation should be routinely recommended.
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http://dx.doi.org/10.1007/s00405-020-05806-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031404PMC
March 2020

Updating the nationwide methodology for hearing screening of newborns in the Czech Republic.

Cas Lek Cesk 2019 ;158(6):221-224

Screening programs examining neonatal hearing serve to detect hearing defects, as a prerequisite for hearing rehabilitation, communication skills, and the enhancement of speech development. There are two methods through which neonatal hearing screening is carried out - the transiently evoked otoacoustic emissions (TEOAE) or the automatic BERA (AABR, automated auditory brainstem response). Positive screening means the discovery of a hearing defect (permanent hearing loss), and negative screening (normal TEOAE or the AABR results) means the absence of a hearing defect. The procedural aim is to update and adjust the neonatal hearing screening, which is determined by the Bulletin of the Ministry of Health of the Czech Republic No. 7/2012. Neonatal screening is performed at three levels: at neonatological site, at the ENT (phoniatric) rescreening site and at the ENT regional centre. The activities at each level are accurately and concretely identified including the issue of billing the performance to health insurance companies and informed consent to personal data protection (GDPR). The correct functioning of screening for hearing loss is based on the simple organization of the screening, patient examination comfort, medical recovery from it, and its economic viability. The schedule for neonatal hearing screening and rehabilitation recommends the following steps: 1. screening of a newborns hearing on the second or third day after delivery by a neonatological nurse using otoacoustic emissions, alternatively AABR for newborns at risk; 2. hearing rescreening in the third to sixth week of child`s age at the ENT rescreening site; 3. completion of hearing impairment diagnostics within three to sixth months of age at the ENT regional centre. The failure to follow the procedure above is a threat to the hearing and speech development of the child with severe permanent hearing impairment. The collaboration of ENT doctors with neonatologists and paediatricians allows for creating conditions under which the functional nationwide hearing screening of newborns can be established throughout the Czech Republic.
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January 2020

Balloon Eustachian Tuboplasty Combined With Tympanocentesis Is not Superior to Balloon Eustachian Tuboplasty in Chronic Otitis Media With Effusion-A Randomized Clinical Trial.

Otol Neurotol 2020 03;41(3):339-344

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava.

Objective: Balloon Eustachian tuboplasty (BET) appears to be a promising therapeutic option for Eustachian tube dysfunction. However, data are lacking on its effect in adults with chronic otitis media with effusion (COME) and whether it should be combined with tympanocentesis. The aim of our study was to determine if there is a beneficial effect of BET combined with tympanocentesis compared with BET only and provide data on the effect of BET in adults with COME.

Study Design: Randomized clinical trial.

Setting: Tertiary referral hospital.

Participants: Adults with COME lasting more than 6 months after tympanostomy tube exclusion. Among 40 eligible ears, 30 were randomized to treatment.

Intervention: BET (group 1) versus BET with concurrent tympanocentesis (group 2).

Main Outcome Measures: Tympanometry, Valsalva or Toynbee maneuver with tympanometry verification, Eustachian Tube Dysfunction Questionnaire, and pure-tone audiometry.

Results: A total of 25 patients (14 ears in group 1 and 15 ears in group 2) were included in the analysis. No significant difference in the effect of treatment was found between the groups. When patients were evaluated as one group, after 2, 6, and 12 months, improvement was found in tympanometry in 55, 48, and 48%; in the ability to perform maneuvers in 55, 41, and 41%; in audiometry in 69, 62, and 59%; and in questionnaire scores in 76, 72, and 69%, respectively.

Conclusions: There was no beneficial outcome of tympanocentesis performed concurrently with BET and therefore it should not be routinely recommended. The success of therapy appears to be reduced compared with other pathologies caused by Eustachian tube dysfunction.
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http://dx.doi.org/10.1097/MAO.0000000000002518DOI Listing
March 2020

Laryngopharyngeal Reflux Is a Potential Risk Factor for Juvenile-Onset Recurrent Respiratory Papillomatosis.

Biomed Res Int 2019 10;2019:1463896. Epub 2019 Feb 10.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 70852 Ostrava, Czech Republic.

Introduction: Human papillomavirus (HPV) causes juvenile-onset recurrent respiratory papillomatosis (JORRP). Although HPV is common in children, the prevalence of JORRP is low. It is likely that other factors contribute to the pathogenesis of JORRP, during either activation or reactivation of a latent HPV infection. There is evidence that laryngopharyngeal reflux (LPR) might be such a risk factor for adult-onset recurrent respiratory papillomatosis. This study investigated if LPR might also be a risk factor for JORRP.

Materials And Methods: Children with JORRP of the larynx that required microlaryngoscopy at a tertiary referral hospital were included in this prospective case-series study from November 2015 to November 2017. Using immunohistochemistry, HPV infection and pepsin associated with LPR were diagnosed from laryngeal biopsies.

Results: Eleven children (aged 4-14 years) were analyzed. No patient had a history of immunodeficiency or tobacco smoke exposure. All patients underwent at least three previous surgeries due to JORRP and had been vaccinated against HPV in the past. Five children were treated using antivirotics and immunomodulators. The only known maternal risk factor was that three mothers were primiparous. All 11 samples were infected with HPV (type 6 or 11). Pathologic LPR was diagnosed in 5/11 children (45.5%).

Conclusion: LPR may be a risk factor for JORRP, contributing to its development by activating or reactivating a latent HPV infection. Results are in accordance with those from our previous study in adults.
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http://dx.doi.org/10.1155/2019/1463896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387692PMC
July 2019

Endoscopic Transcaruncular Medial Orbitotomy as an Alternative Approach to Anterior Ethmoidal Artery Coagulation.

J Craniofac Surg 2019 May/Jun;30(3):911-913

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava.

Background: The authors present a series of 5 patients with anterior epistaxis in which a transcaruncular endoscopic approach was used for the anterior ethmoidal artery coagulation (AEA).

Methods: Six AEA coagulations (5 unilateral, 1 bilateral) using the transcaruncular endoscopic approach were performed in 5 patients with anterior epistaxis resistant to conservative measures. An incision was made between the plica semilunaris of conjunctiva and the lacrimal caruncle. Using a rigid endoscope, tissues were dissected lateral to the lacrimal sac, to the posterior lacrimal crest. The periorbit was incised and pulled aside. Hereafter, the technique was the same as that involving a frontoethmoidal incision. After bipolar coagulation of the AEA, the conjunctiva was sutured.

Results: Bleeding was resolved in all patients. One patient experienced early postoperative temporary diplopia.

Conclusions: The transcaruncular endoscopic approach is a promising technique with no outer scarring. It is convenient in patients with difficult orientation in the nasal cavity, relatively safe, and faster than the transnasal endoscopic approach.
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http://dx.doi.org/10.1097/SCS.0000000000005207DOI Listing
July 2019

Combined transcranial magnetic stimulation in the treatment of chronic tinnitus.

Ann Clin Transl Neurol 2018 Jul 8;5(7):857-864. Epub 2018 Jun 8.

Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Ostrava 17. listopadu 1790 Ostrava 70852 Czech Republic.

Objective: Repetitive transcranial magnetic stimulation (rTMS) is currently being tested for suppressing the symptoms of subjective chronic primary tinnitus, although its effect is controversial. The aim of this randomized double-blinded controlled trial was to determine the effect of rTMS with unique settings for tinnitus treatment.

Methods: Fifty-three adult patients suffering from chronic subjective unilateral or bilateral nonpulsatile primary tinnitus for at least 6 months were randomly assigned to rTMS (group 1, = 20), sham stimulation (group 2, = 12), or medicament therapy only (group 3, = 21). The dorsolateral prefrontal cortex (frequency 25 Hz, 300 pulses, and 80% resting motor threshold [RMT]) on the left side and primary auditory cortex (1 Hz, 1000 pulses, 110% RMT) were stimulated on both sides in patients in group 1 for 5 consecutive days. The Tinnitus Reaction Questionnaire (TRQ), Tinnitus Handicap Questionnaire (THQ), Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), pure-tone audiometry with Fowler scoring of hearing loss, and tinnitus analysis were used to evaluate tinnitus in all patients. Data were recorded the day the patient was included in the study and at 1- and 6-month follow-up.

Results: The study groups were homogenous. No significant effect of rTMS was found at 1 or 6 months based on the BDI, THQ, and TRQ scores or tinnitus masking. There was a significant but clinically irrelevant effect on the THI score after 1 and 6 months.

Interpretation: No significant effect of bilateral low-frequency rTMS of the primary auditory cortex and high-frequency stimulation of the left dorsolateral prefrontal cortex was demonstrated.
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http://dx.doi.org/10.1002/acn3.587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043768PMC
July 2018

Comparison of narrow band imaging and the Storz Professional Image Enhancement System for detection of laryngeal and hypopharyngeal pathologies.

Eur Arch Otorhinolaryngol 2018 Jul 30;275(7):1819-1825. Epub 2018 Apr 30.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic.

Objective: The aim of this study was to compare narrow band imaging (NBI) endoscopy and Storz Professional Image Enhancement System (SPIES) in observing epithelial and/or subepithelial microvascular irregularities and pathologies.

Methods: A total of 73 patients with laryngeal or hypopharyngeal lesions were investigated using high-definition NBI endoscopy preoperatively in local anesthesia and using SPIES system intraoperatively in general anesthesia from August 2016 to October 2017. Superficial vascular structures were classified preoperatively (NBI) and intraoperatively (SPIES) according to descriptive guidelines of vascular changes by Arens. All lesions were endoscopically evaluated and divided according to the histological examination into four groups (A-benign lesions, B-recurrent respiratory papillomatosis, C-low-grade dysplasia, D-high-grade dysplasia, carcinoma in situ or invasive squamous cell carcinoma), and results were compared with NBI and SPIES optical biopsy.

Results: Benign lesions (polyps, cysts, chronic inflammation, hyperkeratosis) were histologically confirmed in 26/73 (35.6%) cases and identified by NBI in 20/26 lesions (76.9%) and in 20/26 cases (76.9%) by SPIES, respectively. Recurrent respiratory papillomatosis was confirmed in 16/73 (21.9%) and detected in 15/16 cases (93.8%) by NBI and in 16/16 cases (100.0%) by SPIES. Low-grade dysplasia (mild and moderate dysplasia) was histologically detected in 7/73 patients (9.6%) and accurately identified by NBI in 6/7 (85.7%) and by SPIES in 6/7 (85.7%) cases, respectively. Histopathological features of severe dysplasia, carcinoma in situ or invasive squamous cell carcinoma were detected in 24/73 (32.9%) patients. According to the NBI endoscopy the suspected vascular neoangiogenesis was recognized in 19/24 cases (79.2%) and in 18/24 cases (75.0%) using SPIES endoscopy. Sensitivity and specificity of NBI endoscopy and SPIES system in correct prediction of histological diagnosis of already detected lesions were 83.0 and 98.0% and 86.0 and 96.0%, respectively. Results of NBI/SPIES endoscopy and histopathological features of laryngeal and hypopharyngeal lesions were compared and the level of agreement was 81.43%, kappa index κ = 0.7428 (95% CI 0.682-0.832) (p < 0.001) by NBI endoscopy and 81.16%, kappa index κ = 0.7379 (95% CI 0.638-0.880) (p < 0.001) by SPIES endoscopy, respectively. The agreement was confirmed as substantial and strong. Level of agreement of both endoscopic methods was 92.54%, kappa index κ = 0.8965 (95% CI 0.877-0.954) (p < 0.001), agreement was confirmed as almost perfect. Between NBI and SPIES endoscopic imaging methods is no significant differentiation.

Conclusion: Both methods, NBI endoscopy and SPIES system, are comparable in detection and analysis of superficial neoangiogenesis, typical for benign lesion and for precancerous or cancerous changes in larynx and hypopharynx.
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http://dx.doi.org/10.1007/s00405-018-4987-3DOI Listing
July 2018

Comparison of Impedance and Pepsin Detection in the Laryngeal Mucosa to Determine Impedance Values that Indicate Pathological Laryngopharyngeal Reflux.

Clin Transl Gastroenterol 2017 Oct 26;8(10):e123. Epub 2017 Oct 26.

Department of Otorhinolaryngology, University Hospital Ostrava, Ostrava, Czech Republic.

Objective: Recently, a 24-h impedance was used to detect laryngopharyngeal reflux (LPR). However, not every case of LPR is pathological. Thus, pathological pharyngeal impedance values need to be clearly established to diagnose pathological LPR. The aim of our study was to establish pathological 24-h pharyngoesophageal impedance/pH values for the diagnosis of LPR.

Methods: The study was conducted in a tertiary care setting. A total of 30 patients who were referred to microlaryngoscopy for a laryngeal pathology that might be caused by LPR were included in this prospective study. All patients were off proton-pump inhibitor therapy. The 24-h pharyngoesophageal impedance-pH monitoring was performed 1 day before surgery. A biopsy of laryngeal tissue was obtained during microlaryngoscopy and was analyzed by immunohistochemistry to detect pepsin. The patients were divided into two groups: pepsin negative and pepsin positive (which indicated pathological LPR). The results of 24-h multichannel intraluminal impedance-dual-channel pH monitoring were compared between the groups. The number of LPR episodes in the pepsin-positive group was analyzed to establish a cutoff value for pathological LPR.

Results: There were 18 participants in the pepsin-negative group and 12 in the pepsin-positive group. The median total pharyngeal refluxes detected were two (0-5) in the pepsin-negative group and 14 (6-39) in the pepsin-positive group (P<0.001), although the groups were otherwise homogeneous. There was a statistically significant difference in the number of all types of refluxes between groups. Six or more pharyngeal refluxes were the cutoff for the presence of pepsin in the laryngeal mucosa and, thereby, for the diagnosis of relevant/pathological LPR.

Conclusion: Six or more pharyngeal reflux episodes registered during the 24-h impedance/pH monitoring seem to be the cutoff for diagnosing pathological LPR. Therefore, it is possible to suggest establishing this value as the pathological impedance value indicating pathological LPR. These results must be interpreted with caution due to the small sample size.
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http://dx.doi.org/10.1038/ctg.2017.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666120PMC
October 2017

[Newborn hearing screening - importance, current state in the Czech Republic].

Cas Lek Cesk Summer 2017;156(4):173-177

The importance of early detection of hearing impairment in newborns and children and the early rehabilitation of hearing disorder with hearing aid or cochlear implant was demonstrated in a number of papers. As a result, newborn hearing screening was introduced in many countries around the world. The incidence of congenital hearing impairment has been underestimated for a long time, empirically determined incidence was 1:1000 neonates. Thanks to newborn hearing screening was revealed that incidence of congenital hearing impairment is 3 times higher. One out of 300 newborns has profound hearing loss (deafness) and 1 in 300 newborns has mild to moderate hearing loss. Moreover, in 1 out of 300 children hearing impairment would develop before the age of 18. In the Czech Republic, the screening of all newborns is still systematical and multilevel conducted in only three regions (Moravskoslezský, Královéhradecký, Pardubický). In these regions, statistics as well as assessments of individual stages of screening are carried out. In other regions, records of the number of screened children, number of rescreened children and detailed statistics of hearing impairment is missing. The authors summarize the basic information about the importance of screening, the history of screening and its organization. Provided information is based on experience with the gradual introduction of screening over recent years in the regions in which they work. Newborn hearing screening should be organized in several stages (1 - screening at maternity hospitals, 2 - rescreening on collaborating otolaryngology/phoniatric workplaces and 3 - detailed hearing examination in centers in children whose screening was negative). The authors focus on problems related to the organization of screening and offer practical advice (e.g. implementation of screening coordinators). They consider it is essential to have statistical evidence of examination at all levels. Introducing of newborn hearing screening is not a short-term task but a long-term (many years) challenge.
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April 2019

Comparison of long-term voice outcomes after vocal fold augmentation using autologous fat injection by direct microlaryngoscopy versus office-based calcium hydroxylapatite injection.

Eur Arch Otorhinolaryngol 2017 Aug 6;274(8):3147-3151. Epub 2017 May 6.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 00, Ostrava, Czech Republic.

The objective is to compare the long-term voice outcomes of vocal fold augmentation (VFA) using autologous fat injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection. Patients with glottal insufficiency and a gap no greater than 3 mm caused by unilateral vocal fold paralysis or vocal fold atrophy were prospectively recruited to the study from September 2012 to September 2015. From September 2012 to May 2014, VFA was only performed using autologous fat via direct microlaryngoscopy under general anesthesia (N = 14). From May 2014 to September 2015, VFA was performed as an office-based procedure using a transoral approach to inject CaHA (N = 17). Videolaryngostroboscopic evaluation, subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection and 12 months after VFA. A total of 31 patients were analyzed. One year after VFA, 67.8% of the patients were satisfied with their voice, with no significant difference between groups (P = 0.247). The mean improvement in VHI in the autologous fat group was 31.6 ± 16.82 versus 35 ± 27.24 in the CaHA group (P = 0.664). MPT improvement was also similar in the two groups: 5.5 ± 2.52 for the autologous fat group versus 6.0 ± 3.98 for the CaHA group (P = 0.823). Both autologous fat injection via direct microlaryngoscopy and office-based CaHA injection have good long-term results. There were no differences in the treatment results of the two procedures 1 year after injection.
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http://dx.doi.org/10.1007/s00405-017-4600-1DOI Listing
August 2017

Sialoendoscopy, sialography, and ultrasound: a comparison of diagnostic methods.

Open Med (Wars) 2016 26;11(1):461-464. Epub 2016 Nov 26.

Department of Otolaryngology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic, Tel. 00420597375801.

Objective: To compare the accuracy of ultrasound, sialography, and sialendoscopy for examining benign salivary gland obstructions.

Methods: In this prospective study, patients with symptoms of obstruction of the major salivary gland duct system presenting at the ENT Clinic University Hospital, Ostrava, from June 2010 to December 2013 were included. All patients (n=76) underwent ultrasound, sialography, and sialoendoscopy. The signs of sialolithiasis, ductal stenosis, or normal findings were recorded after the examinations. Statistical analysis of the sensitivity and specificity of all the methods was performed, as well as a comparison of the accuracy of each method for different kinds of pathology (sialolithiasis or stenosis).

Results: The sensitivity of ultrasound, sialography, and sialoendoscopy for sialolithiasis findings were 71.9%, 86.7 %, and 100%, respectively. The sensitivity of sialography and sialoendoscopy for stenosis of the duct was 69.0%, and 100%, respectively. The study showed impossibility of ultrasonic diagnostics of ductal stenosis. The sensitivity of sialoendoscopy for both pathologies was significantly higher than that from ultrasound or sialography (p<0.05). The specificity of sialoendoscopy was significantly higher than that from by ultrasound or sialography (p<0.05).

Conclusion: Sialoendoscopy was the most accurate method for examination ductal pathology, with significantly higher sensitivity and specificity than by ultrasound or sialography.
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http://dx.doi.org/10.1515/med-2016-0081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329868PMC
November 2016

Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea.

Biomed Res Int 2016 14;2016:6583216. Epub 2016 Dec 14.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.

The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse ( = 17, 33.3%), followed by palatal and oropharyngeal collapse ( = 12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.
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http://dx.doi.org/10.1155/2016/6583216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192321PMC
February 2017

The role of narrow-band imaging (NBI) endoscopy in optical biopsy of vocal cord leukoplakia.

Eur Arch Otorhinolaryngol 2017 Jan 11;274(1):355-359. Epub 2016 Aug 11.

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic.

The aim of this study was to investigate whether observing microvascular changes by narrow-band imaging (NBI) endoscopy in the area surrounding leukoplakia is sufficient for discriminating between benign and malignant patterns of vocal cord leukoplakia. A total of 282 patients were investigated using white-light high-definition TV laryngoscopy and NBI endoscopy from 6/2013 to 8/2015, and 63 patients with a primary case of laryngeal leukoplakia were enrolled. Patients were divided into two groups based on leukoplakia with surrounding malignant intraepithelial papillary capillary loops (group I; 26/63) and leukoplakia with a surrounding benign vascular network (group II; 37/63), both by NBI endoscopy. All 63 patients were evaluated by blinded histological examination, and results were compared with NBI optical biopsy. Carcinoma in situ or invasive squamous cell carcinoma was confirmed in 22/26 cases (84.6 %) in group I. Hyperkeratosis or low-grade dysplasia was confirmed histologically in 31/37 (83.8 %) and squamous cell carcinoma in 2/37 (5.4 %) cases in group II. Accordance of NBI endoscopy and histopathological features of vocal cord leukoplakia lesions was statistically significant (kappa index 0.77, p < 0.001), with a sensitivity of 88.0 % (95 % CI 67.8-97.5 %) and specificity of 89.5 % (95 % CI 71.2-97.1 %). NBI is convenient for improving evaluation of laryngeal leukoplakias based on optic prehistological diagnosis. The close accordance between NBI features and histological results suggests that a negative NBI endoscopy may be an indication for long-term endoscopy follow-up without histological evaluation.
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http://dx.doi.org/10.1007/s00405-016-4244-6DOI Listing
January 2017

Chronic rhinosinusitis and extraesophageal reflux: Who is the candidate for antireflux treatment?

Am J Rhinol Allergy 2016 Mar-Apr;30(2):e5-9

Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.

Background: During the past decade, extraesophageal reflux (EER) has been hypothesized to be one of the possible factors that contribute to the worsening of chronic rhinosinusitis (CRS). However, the relationship remains indeterminate due to its complexity, and it is not clear whether antireflux treatment is indicated for patients with recurrent CRS and who would benefit from it.

Objective: The aim of the study was to determine the severity of EER in patients with variable durations of CRS and different numbers of previous endoscopic endonasal surgeries (EES).

Methods: Ninety patients with CRS were recruited for the prospective case series. The age, sex, body mass index, reflux symptom index, duration of treatment of CRS with corticosteroids, and the number of ESS within the previous 5 years were ascertained. The severity of EER was evaluated by oropharyngeal pH monitoring by using the Restech system (the presence of EER, value of the RYAN score) and compared among the groups with varying durations of treatment of CRS (≤10 years, 11-20 years, >20 years) and different numbers of ESS within the previous 5 years (no ESS, 1-2 ESS, >2 ESS).

Results: Pathologic EER was present significantly more often in patients with CRS treated for >10 years (p = 0.0054) and in patients who underwent >2 ESS within the previous 5 years (p = 0.0001).

Conclusion: Patients with CRS treated for >10 years and those who had undergone >2 ESS within the previous 5 years had significant EER. Antireflux therapy (e.g., proton pump inhibitors) can be recommended for these patients. However, its effect has to be confirmed in further studies.
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http://dx.doi.org/10.2500/ajra.2016.30.4286DOI Listing
December 2016

Micro- and Nanosized Particles in Nasal Mucosa: A Pilot Study.

Biomed Res Int 2015 1;2015:505986. Epub 2015 Jun 1.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ostrava, 17. Listopadu 1790, 708 52 Ostrava, Czech Republic ; Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.

Objective: The aim of this prospective study is to evaluate presence and quantity of micro- and nanosized particles (NPs) and interindividual differences in their distribution and composition in nasal mucosa.

Methods: Six samples of nasal mucosa obtained by mucotomy from patients with chronic hypertrophic rhinosinusitis were examined. Samples divided into 4 parts according to the distance from the nostrils were analyzed by scanning electron microscopy and Raman microspectroscopy to detect solid particles and characterize their morphology and composition. A novel method of quantification of the particles was designed and used to evaluate interindividual differences in distribution of the particles. The findings were compared with patients' employment history.

Results: In all the samples, NPs of different elemental composition were found (iron, barium, copper, titanium, etc.), predominantly in the parts most distant from nostrils, in various depths from the surface of the mucosa and interindividual differences in their quantity and composition were found, possibly in relation to professional exposition.

Conclusions: This study has proven the possibility of quantification of distribution of micro- and nanosized particles in tissue samples and that the NPs may deposit in deeper layers of mucosa and their elemental composition may be related to professional exposition to the sources of NPs.
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http://dx.doi.org/10.1155/2015/505986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466340PMC
March 2016

Comparison of Three Methods Used in the Diagnosis of Extraesophageal Reflux in Children with Chronic Otitis Media with Effusion.

Gastroenterol Res Pract 2015 6;2015:547959. Epub 2015 May 6.

Department of Otorhinolaryngology, University Hospital Ostrava, 17 Listopadu 1790, 708 52 Ostrava, Czech Republic ; Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.

Objectives. Detection of extraesophageal reflux (EER) in children with chronic otitis media with effusion (OME) using three different diagnostic methods. Methods. Children between 1 and 7 years with OME who underwent adenoidectomy and myringotomy with insertion of a ventilation tube were included in this prospective study. EER was detected using three methods: oropharyngeal pH was monitored for 24 hours using the Restech system; detection of pepsin in middle ear fluid obtained during myringotomy was done using Peptest, and detection of pepsin in an adenoid specimen was done immunohistochemically. Results. Altogether 21 children were included in the study. Pathological oropharyngeal pH was confirmed in 13/21 (61.9%) children. Pepsin in the middle ear fluid was present in 5/21 (23.8%) children; these 5 patients were diagnosed with the most severe EER established through monitoring of oropharyngeal pH. No specimen of adenoids tested was positive for pepsin upon immunohistochemical examination. Conclusions. Diagnosis of EER in patients with OME using Restech is sensitive but less specific when compared to the detection of pepsin in middle ear fluid using Peptest. Pepsin in the middle ear was consistently present in patients with RYAN score above 200, and these patients in particular could potentially profit from antireflux therapy.
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http://dx.doi.org/10.1155/2015/547959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438165PMC
June 2015

Patients with chronic rhinosinusitis and simultaneous bronchial asthma suffer from significant extraesophageal reflux.

Int Forum Allergy Rhinol 2015 Oct 5;5(10):944-9. Epub 2015 Jun 5.

Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic.

Background: The aim of this study was to determine the severity of extraesophageal reflux (EER) in patients with various degrees of chronic rhinosinusitis (CRS), and particularly in patients with simultaneous bronchial asthma.

Methods: Patients with different severity of CRS were invited to participate in the study. Group I consisted of patients with CRS without nasal polyps or bronchial asthma; group II consisted of patients with CRS with nasal polyps but without bronchial asthma; group III consisted of patients with CRS with nasal polyps and bronchial asthma. The age, gender, Reflux Symptom Index, severity of EER evaluated using the Restech system, and number of previous functional endoscopic sinus surgeries (FESSs) were compared between groups.

Results: A total of 90 patients (30 in each group) were recruited for the study. Pathological EER was significantly often present in group III when compared with group I and group II in all parameters analyzed (RYAN score, number of EER episodes, total percentage of time below pH 5.5). Furthermore, patients from group III had undergone more surgeries in the past.

Conclusion: Patients with CRS with nasal polyps and simultaneous bronchial asthma suffer from significant EER. Antireflux therapy can be recommended for these patients. However, the effect has to be confirmed in further studies.
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http://dx.doi.org/10.1002/alr.21560DOI Listing
October 2015

Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest.

Int J Pediatr Otorhinolaryngol 2015 May 19;79(5):677-9. Epub 2015 Feb 19.

Department of Otorhinolaryngology, University Hospital Ostrava, 17, listopadu 1790, 70852 Ostrava, Czech Republic; Faculty of Medicine University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic. Electronic address:

Introduction: The aim of the study was to investigate whether Peptest, an immunoassay used to detect pepsin, could be used to diagnose extraesophageal reflux (EER) in children with chronic otitis media with effusion (OME). The results obtained using this fast, simple and non-expensive method were compared with the results of previous studies.

Methods: Children 1-7 years old who had been diagnosed with OME and who were undergoing myringotomy with insertion of a ventilation tube were included in the prospective study. Middle ear fluid obtained during myringotomy was analyzed with Peptest to determine the presence of pepsin, and hence EER.

Results: Bilateral and unilateral myringotomy was performed in 15/44 (34.1%) and 29/44 (65.9%) children, respectively. Pepsin in the middle ear was detected in 14/44 (31.8%) children and in 19/59 (32.2%) middle ear specimens. Serous and mucous samples were positive for pepsin in 11/32 (34.4%) and 6/27 (22.2%) cases, respectively. Pepsin in the middle ear was detected in 3/7 children (42.9%) with bronchial asthma (p=0.662).

Conclusions: Pepsin was detected in 1/3 of middle ear specimens of patients with OME. These patients probably suffer from more severe reflux and therefore would be potential candidates for antireflux therapy. However, this has to be confirmed in further studies.
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http://dx.doi.org/10.1016/j.ijporl.2015.02.013DOI Listing
May 2015

Atypical Cogan's syndrome: a case report and summary of current treatment options.

Int J Pediatr Otorhinolaryngol 2015 Mar 3;79(3):428-31. Epub 2015 Jan 3.

Department of Otorhinolaryngology, University Hospital Ostrava, 17 listopadu 1790, 708 52 Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.

Cogan's syndrome is a rare chronic vasculitis, characterized in its typical form by progressive sensorineural bilateral hearing loss, vestibular symptoms and non-syphilitic interstitial keratitis. Only a few cases have been reported in children, most of whom have been diagnosed with the typical form. Early diagnosis and treatment are crucial to ensure a favorable prognosis. Systemic treatment usually begins with high dosage corticosteroids. In case the initial treatment fails, other immunosuppressive drugs are used (cyclophosphamide, methotrexate, cyclosporine A and azathioprine). Additional treatment possibilities, such as plasmapheresis, TNF-alpha blockers (etanercept and infliximab), rituximab, tocilizumab and mycophenolate mofetil have been described over the past few years.
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http://dx.doi.org/10.1016/j.ijporl.2014.12.028DOI Listing
March 2015