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We assayed 38 middle ear effusions from 23 children aged 4-13 years (mean 7) undergoing tympanostomy tube placements. All fluid was assayed for tumor necrosis factor (TNF) alpha, interleukin (IL) 1beta, IL-8, and IL-10. Cytokine concentrations were measured by means of an enzyme-linked immunosorbent assay. Detectable levels of IL-1beta, IL-8, and IL-10 were found in all of the effusions. TNF-alpha was detected in 18 of the middle ear effusions (47.4%). The mean concentration of TNF-alpha, IL-1beta , IL-8, and IL-10 was, respectively, 0.423 +/- 1.39, 30.58 +/- 68.7, 7001.9 +/- 6743, and 56 +/- 58.7 pg/ml. There was a strong, statistically significant correlation between the concentrations of TNF-alpha and IL-1beta (r = 0.87, P = 0.001) and between IL-1beta and IL-8 (r = 0.53, P = 0.001). There was no correlation between the concentrations of IL-10 and other cytokines examined or between tympanic membrane pathology and the concentrations of TNF-alpha, IL-1beta , IL-8, or IL-10. The presence of IL-10 in middle ear effusions may be one of the causes of a lack of clinical features of acute inflammation and may lead to a chronic inflammatory state.

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Otitis media with effusion is a leading cause of conductive hearing loss in children. Myringotomy and insertion of tympanostomy tubes is the accepted form of treatment. Recently, several studies utilizing laser myringotomy have been published, but few of them present late results. The objective of this study was to compare late results of the treatment with laser and classical myringotomy. A clinical effectiveness trial was conducted in three groups of children: (1) 37 children treated with laser myringotomy (ML), (2) 29 children treated with laser myringotomy and the insertion of tympanostomy tubes (ML+V) and (3) 43 children treated with classical myringotomy and the insertion of tympanostomy tubes (MC+V). All types of surgery were performed under general anesthesia because adenoidectomy and/or tonsillectomy was done at the same time. The results of treatment were assessed on the basis of the otoscopic examination (recurrences of effusion, condition of the tympanic membrane, and audiological examination (pure-tone audiometry, tympanometry and DPOAE). The minimum follow-up period was 1 year. The recurrence rate was lowest in the ML+V (11%) group, and highest in the ML group (36%). The difference between ML+V and MC+V was not significant. Permanent changes in the tympanic membrane were observed in 8% of the ears after ML, 19% after ML+V and 31% after MC+V. The difference was significant between the ML and MC+V groups. PTA was significantly higher in the MC+V group than in the control group of otologically healthy children. Mean amplitudes of DPOAE, measured in treated children with normal tympanometry results, were significantly lower than in the control group, but within the normal range. The use of CO(2) laser during myringotomy has no negative effect on the function of the cochlea. Healing of the tympanic membrane after laser myringotomy was uneventful with a low percentage of permanent sequelae.

Partial horizontal supracricoid laryngectomy with cricohyoidopexy at the Department of Otolaryngology, Medical University of Białystok, involves resection of the entire thyroid cartilage with the pre-epiglottic and paraglottic spaces. Experience has shown that this technique will permit adequate phonation, respiration and deglutition in selected advanced cases of supraglottic and glottic carcinoma. The purpose of this study was to verify histologically the indications for this surgery by examining sections of whole-organ laryngeal specimens. Post-laryngectomy specimens from 90 patients with otherwise previously untreated supraglottic (48), transglottic (22) and glottic (20) carcinomas were reviewed retrospectively. The majority (66) of the specimens were staged as pT4. Findings showed that 22 of the specimens analyzed (mostly supraglottic tumors) could have been eradicated by supracricoid laryngectomy alone. The present study confirmed the principles of supracricoid laryngectomy for selected large tumors.

A series of 76 cases of laryngeal carcinoma was examined in transverse slices using a motorized slicing machine. Eleven cases of ventriculosaccular carcinoma were detected by this method and the topography and gross appearances of the tumours in the larynges are described. Microscopy of the tumour indicates a keratinizing squamous cell carcinoma the mode of growth of which seems to be by concentric expansion through the whole margin rather than by invading tongues of tumour. In no case was there invasion of laryngeal cartilages or extension to the surgical cut surface of the specimen. The clinical, radiological and biopsy features in 10 of the 11 patients are described. In follow-up studies, which were 12 years or longer in five patients, none had lymph node metastases or recurrences of the laryngeal carcinoma of any sort. The following features may suggest the diagnosis of ventriculosaccular carcinoma before laryngectomy: (1) a ventricular tumour, (2) a supraglottic bulge above it, (3) a paraglottic swelling on CT scan radiology covered by a smooth laryngeal lining and (4) biopsy appearances of a well differentiated 'folded carcinoma'.