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BackgroundFibrous dysplasia is a slowly progressive benign fibro-osseous disorder that involves one or multiple bones with a unilateral distribution in most cases. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. Temporal bone involvement is the least frequently reported type, especially in children.We reviewed available articles regarding fibrous dysplasia with temporal bone involvement in children and added four patients aged 7 to 17 years who were diagnosed and treated in our institution from 2006 to 2017. The patients’ clinical picture comprised head deformity, external canal stenosis, headache, progressive conductive and/or sensorineural hearing loss, tinnitus, and sudden deafness. Two patients had experienced severe episodic vertigo with nausea and vomiting. Two were referred to us with external canal obstruction and secondary cholesteatoma formation with broad middle ear destruction. One was diagnosed with acute mastoiditis and intracranial complications. Optimal management of fibrous dysplasia is unclear and can be challenging, especially in children. In our two patients with disease expansion and involvement of important structures, surgical treatment was abandoned and a “wait-and-scan” policy was applied. The other two were qualified for surgical treatment. One patient underwent two surgeries: modified lateral petrosectomy (canal left open) with pathological tissue removal, cavity obliteration, and subsequent tympanoplasty. Another patient with extensive destruction of the left temporal bone underwent canal wall down mastoidectomy with perisinus abscess drainage and revision 12 months later. Tympanoplasty was unsatisfactory in both patients because of slow progression of the middle ear pathology. None of our patients underwent pharmacological treatment.ConclusionsIn younger patients, observation and a “wait-and-scan” protocol is relevant until significant function, or cosmetic deficits are obvious. Surgery is not preferred and should be delayed until puberty because fibrous dysplasia has a tendency to stabilize after adolescence. In patients with severe symptoms medical treatment can be implemented, but safety of this treatment in children remain controversial.

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The main points of the management protocol are: initiate a broad-spectrum intravenous antibiotic treatment; mastoidectomy should be performed if the infection fails to be controlled after 48h of administering intravenous antibiotic therapy. We believe that early mastoidectomy prevents serious complications, and our initial observation is that by performing broad mastoidectomy with posterior attic and facial recess exposure, recurrence of acute mastoiditis can be prevented.

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Introduction: Although it is recommended to perform cochlear implantation in both ears at the same time for management of profound hearing loss in children, many centers prefer to perform sequential implantation. There are many reasons as to why a simultaneous bilateral implantation is not commonly accepted and performed. The major risk is the possibility of bilateral vestibular organ impairment. However, it is beyond doubt that children who received the first implant should be given a chance for binaural hearing and associated benefits. In the literature, there are no homogenous criteria for bilateral implantation, and it is hard to find uniform and convincing algorithms for second cochlear implantation. The aim of this study is an attempt to identify a safe way of qualifying for second cochlear implantation in children. Material and methods: Forty children with one cochlear implant were qualified for the second implantation. During qualification, the following were taken into account: time of the first implantation, audiometry results, use of the hearing aid in the ear without an implant and benefit of the device, speech and hearing development, and vestibular organ function. R esults: Fifteen out of forty children (38%) were qualified for the second implantation. In 35% of children, the decision was delayed with possible second implantation in the future. Eleven children (27%) were disqualified from the second surgery. Discussion: During evaluation according to the protocol presented in our study, 38% of children with a single cochlear implant were qualified for the second implantation with a chance for an optimal development and effective use of the second cochlear implant. We are convinced that sequential implantation with a short interval between surgeries and with an examination of the vestibular organ, hearing and speech development as well as an assessment of potential benefits from the second implant (bimodal stimulation) before the second implantation is the safest and most beneficial solution for children with severe hearing loss.

Otitis media with effusion (OME), is a common childhood disease and is characterized by long-term fluid retention in the middle ear spaces without signs of acute infection. Surgical treatment of OME in the form of a tympanostomy is one of the most commonly performed medical procedures by pediatric ENT surgeons worldwide. In February 2022, the Journal of Otolaryngology - Head and Neck Surgery published updated guidelines from the American Academy of Otolaryngology - Head and Neck Surgery for tympanostomy tuba in children between 6 months and 12 years of age. They are aimed at both otolaryngologists and pediatricians, as well as other medical personnel who are directly involved in the care of patients with tympanostomy tuba or are candidates for the procedure. The previous version of the guidelines was developed in 2013. With the cooperation of the Board of Expert chaired by the National Consultant in Pediatric Otorhinolaryngology, Prof. Wieslaw Konopka, PhD, during the VII International Conference "Otology, 2022" which took place on September 15-17, 2022 in Torun, the previously published recommendations and consensuses from other countries, both European and non-European, were analyzed and the task of developing new national diagnostic and therapeutic recommendations for OME was undertaken.

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