Joanna Majak - Academia.edu (original) (raw)
Papers by Joanna Majak
Polski Przegląd Otorynolaryngologiczny
Introduction: Auditory Processing Disorders (APD) is a syndrome characterized by impairment of th... more Introduction: Auditory Processing Disorders (APD) is a syndrome characterized by impairment of the perception of soundsverbal and non-verbal ones, and weakening cognitive abilities such as auditory attention and auditory memory. This symptoms occur despite correct functioning of the peripheral part of the organ of hearing. Aim: A review of the current literature on diagnostic criteria of APD and its subtypes, clinical symptoms in children, diagnostic procedures and methods and therapeutic interventions. Methods: The study was based on the guidelines of the British Audiological Society (BSA), the guidelines of the American Speech, Language and Hearing Society (ASHA) as well as a literature review in the PubMed database. Results: APD is divided into developmental (without an established cause), acquired (with an established cause) and secondary (a consequence of long-term peripheral hearing loss). Symptoms that indicate the likelihood of APD in schoolaged children include: poor school...
PubMed, Sep 1, 2001
Levels of pro-allergic cytokine IL-4 are increased in asthmatic airways, contributing to allergic... more Levels of pro-allergic cytokine IL-4 are increased in asthmatic airways, contributing to allergic inflammation. The purpose of this study was to define the effect of treatment with triamcinolon, montelukast, and formoterol on serum level of IL-4 and IgE, clinical parameters (symptom score, FEV1) and bronchial hyperreactivity (BHR) in children with moderate asthma. It was 8 week, placebo-controlled and randomized, double blind trial of 99 children with moderate atopic asthma allergic to dust mite. Patients were randomly allocated to receive 400 mg triamcinolon (n = 20), 5 or 10 mg (according to age) montelukast (n = 18), 24 mg formoterol (n = 19), or placebo (n = 42). 80 children completed the study. After treatment with triamcinolon, montelukast, and formoterol the level of IL-4 in blood serum in all study groups significantly decreased, and all clinical parameters improved; treatment with triamcinolon, formoterol, and montelukast had no effect on IgE level in serum. Mean IL-4 levels in serum before and after treatment with triamcinolon were 0.129 pg/ml with 95% Cl, 0.1-0.145 pg/ml and 0.086 pg/ml with 95% Cl, 0.023-0.109 pg/ml respectively (p = 0.02); with montelukast were 0.123 pg/ml with 95% Cl, 0.57-0.82 pg/ml and 0.102 pg/ml with 95% Cl, 0.62-0.82 pg/ml respectively (p < 0.001); with formoterol were 0.128 pg/ml with 95% Cl, 0.108-0.164 pg/ml and 0.113 pg/ml with 95% Cl, 0.096-0.146 pg/ml respectively (p = 0.002). No correlations have been found between changes in serum IL-4 and any other clinical parameters after treatment. This study demonstrates that one of the possible ways by which triamcinolon, montelukast, and formoterol contribute to inhibition of allergic inflammation is by decreasing IL-4 levels.
JAMA Pediatrics, Apr 1, 2023
ImportanceIntranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinus... more ImportanceIntranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinusitis (CRS) in both adults and children, despite the lack of evidence regarding their efficacy in the pediatric population. Similarly, their effect on the sinonasal microbiome has not been well documented.ObjectiveTo assess the clinical, immunological, and microbiological effects of 12 weeks of an INC in young children with CRS.Design, Setting, and ParticipantsThis open-label randomized clinical trial was performed in a pediatric allergy outpatient clinic in 2017 and 2018. Children aged 4 to 8 years with CRS diagnosed by a specialist were included. Data were analyzed from January 2022 to June 2022.InterventionsPatients were randomized to receive intranasal mometasone in an atomizer for 12 weeks (1 application per nostril, once per day) and supplemental 3-mL sodium chloride (NaCl), 0.9%, solution in a nasal nebulizer once a day for 12 weeks (INC group) or 3-mL NaCl, 0.9%, solution in a nasal nebulizer once a day for 12 weeks (control group).Main Outcomes and MeasuresMeasures taken both before and after treatment included the Sinus and Nasal Quality of Life Survey (SN-5), a nasopharynx swab for microbiome analysis by next-generation sequencing methods, and nasal mucosa sampling for occurrence of innate lymphoid cells (ILCs).ResultsOf the 66 children enrolled, 63 completed the study. The mean (SD) age of the cohort was 6.1 (1.3) years; 38 participants (60.3%) were male and 25 (39.7%) were female. The clinical improvement reflected by reduction in SN-5 score was significantly higher in the INC group compared with the control group (INC group score before and after treatment, 3.6 and 3.1, respectively; control group score before and after treatment, 3.4 and 3.8, respectively; mean between-group difference, −0.58; 95% CI, −1.31 to −0.19; P = .009). The INC group had a greater increase in nasopharyngeal microbiome richness and larger decrease in nasal ILC3 abundance compared with the control group. A significant interaction was observed between change in microbiome richness and the INC intervention on the prediction of significant clinical improvement (odds ratio, 1.09; 95% CI, 1.01-1.19; P = .03).Conclusions and RelevanceThis randomized clinical trial demonstrated that treatment with an INC improved the quality of life of children with CRS and had a significant effect on increasing sinonasal biodiversity. Although further investigation is needed of the long-term efficacy and safety of INCs, these data may reinforce the recommendation of using INCs as a first-line treatment of CRS in children.Trial RegistrationClinicalTrials.gov Identifier: NCT03011632
Alergologia Polska - Polish Journal of Allergology
Introduction: The microbiome has been identified as a significant factor in the pathogenesis of v... more Introduction: The microbiome has been identified as a significant factor in the pathogenesis of various inflammatory and autoimmune diseases, including chronic rhinosinusitis (CRS), a condition that affects up to 12% of the global population. Aim: To evaluate the role of innate lymphoid cells (ILC1, ILC2, and ILC3) and their relationship with nasal microbiota in CRS in children. Material and methods: We assessed the clinical, microbiological, and immunological characteristics of 63 children with CRS. We evaluated disease severity using the Sinus and Nasal Quality of Life Survey (SN-5) and measured ILC1, ILC2, and ILC3 levels in nasal scrapings; microbial diversity was expressed as OTU richness. Results: We found a statistically significant relationship between ILC1 levels and CRS severity, suggesting a potential role of ILC1 in the development of the disease. ILC3 levels were significantly associated with lower microbial richness. While atopy was more common in children with high levels of ILC2, the relationship was not significant. Conclusions: Our results indicate that innate lymphoid cells may play a significant role in the inflammatory processes underlying the development and severity of chronic rhinosinusitis, with ILC1 activation being particularly strongly associated with CRS severity in young children. Additionally, ILC3 may play a role in modulating the nasal microbiome in CRS patients, but the relationship is not strong enough to significantly impact the clinical characteristics.
JAMA Pediatrics
ImportanceIntranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinus... more ImportanceIntranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinusitis (CRS) in both adults and children, despite the lack of evidence regarding their efficacy in the pediatric population. Similarly, their effect on the sinonasal microbiome has not been well documented.ObjectiveTo assess the clinical, immunological, and microbiological effects of 12 weeks of an INC in young children with CRS.Design, Setting, and ParticipantsThis open-label randomized clinical trial was performed in a pediatric allergy outpatient clinic in 2017 and 2018. Children aged 4 to 8 years with CRS diagnosed by a specialist were included. Data were analyzed from January 2022 to June 2022.InterventionsPatients were randomized to receive intranasal mometasone in an atomizer for 12 weeks (1 application per nostril, once per day) and supplemental 3-mL sodium chloride (NaCl), 0.9%, solution in a nasal nebulizer once a day for 12 weeks (INC group) or 3-mL NaCl, 0.9%, solution in a nas...
Allergy, 2021
To the Editor, The reduced morbidity of chronic inflammatory disorders of airways in children dur... more To the Editor, The reduced morbidity of chronic inflammatory disorders of airways in children during the COVID19 pandemic has been observed1,2; however, the restriction related to the lockdown may also have a longlasting negative impact on the clinical care of patients.3 Despite this dichotomy, pandemic isolation offers a unique opportunity to understand better the phenomenon of remission (or progression) of chronic rhinosinusitis (CRS) and asthma symptoms in young children. We aimed to determine clinical, immunological, and microbiological factors that could affect the clinical course of CRS and asthma in young children during pandemic isolation. Our cohort of young children with chronic rhinosinusitis with or without asthma was fully described before the COVID19 pandemic.4 Children aged 4– 8 years with CRS diagnosed by otorhinolaryngologists according to the EPOS (European Position Paper on Rhinosinusitis and Nasal Polyps) criteria were included. Asthma was suspected according to the positive modified Asthma Predictive Index and confirmed by a pulmonologist after clinical improvement during antiinflammatory therapy and/or positive bronchial reversibility test. The following procedures were performed in all participants before the pandemic: Facetoface standardized Sinus and Nasal Quality of Life questionnaire, skin prick test, nasopharynx swab, and nasal scrapes collected using RhinoProbe plastic nasal curettes (Figure 1A). Recruitment for the study took place during two subsequent autumnwinter seasons (2017– 2018). During the current study, a telephone followup visit was performed after 5 months of pandemic isolation. Details on study methods are given in the Appendix S1. (ClinicalTrials.gov Identifier: NCT03011632). One hundred and eleven children of the original cohort (84%) of children with CRS were included in the current followup analysis. The clinical characteristics of participants are presented in Table 1. In the fallwinter 2020 season, compared to the 2019 and 2017/2018 seasons, we observed a significant reduction in SN5 score in our patients (Figure 1B). At inclusion during the first study season, asthma was diagnosed in 82 (61.6%) participants. In the fallwinter 2020 season, asthma symptoms and/or antiasthma therapy were reported in 31(27.9%) children (Figure 1C). Children with SN5 score below the median value (3.0) at fallwinter season 2020 were defined as having mild/episodic CRS, and patients above the median as having moderate CRS (Figure 1B). Children without asthma symptoms, and any antiasthma treatment during last year, including fallwinter season 2020, were defined as patients without asthma symptoms (Figure 1C). Both outcomes (CRS and asthma) were included in logistic regression analysis as dependent variables (Tables S1 and S2). The logistic regression analysis in a multivariate approach showed that independent risk factors of moderate CRS were house dust mites (HDM) sensitization and the number of courses of antibiotic therapy at baseline; sensitization to HDM increased the risk nearly fourfold (OR: 3.85; 95% CI: 1.37– 10.79), and each course of antibiotic therapy by over 40% (OR: 1.44; 95% CI: 1.08– 1.93). The logistic regression analysis in a multivariate approach showed that independent risk factors of asthma symptoms were food allergy in infancy (OR: 2.57; 95% CI: 1.08– 6.16) and moderate symptoms of CRS during pandemic isolation (OR: 2.77; 95% CI: 1.12– 6.89). Children with vs. children without HDM sensitization had more frequently reduced biodiversity (reduced Shannon index, one of the features of dysbiosis) in the upper airways at baseline (Table S3). Before the pandemic, we did not observe significant associations between HDM sensitization and CRS severity, antibiotics prescribing frequency, nor the prevalence of asthma symptoms. However, during pandemic isolation, children with HDM sensitization had at least one antibiotic course during fallwinter 2020 and moderate CRS symptoms more frequently compared to those without HDM sensitization (Table S3). We did not observe any association between the size of the skin reaction to HDM in sensitized children and study outcomes (Figure S1). The nasal mucosa in children with moderate CRS was characterized at baseline by a higher expression of IL17 (p = .04; after adjustment for multicomparison p = .046) and Muc5AC (p = .046; after adjustment p = .046) (Figure S2A). In children with asthma symptoms, the nasal mucosa at baseline was characterized by a lower expression of betadefensin 2 (p = .017; after adjustment p = .038) and lower Muc5B expression (p = .029; after adjustment p = .038) (Figure S2A). Children with more frequent antibiotic courses before the pandemic had a lower Shannon index in the upper airways. However, this association was not linear (Figure S2B). Under natural conditions, the effects of allergic rhinitis and dysbiosis as a consequence of being in a preschool environment interact, making clinical interpretation…
International Journal of Occupational Medicine and Environmental Health, 2019
The aim of this study was to investigate whether the restriction in neck rotation and increased n... more The aim of this study was to investigate whether the restriction in neck rotation and increased neck muscle tension could be causally related to vertigo and dizziness. Material and Methods: Seventy-one patients reporting vertigo and/or imbalance were divided into 2 groups: 45 subjects with unilateral restriction (R+) and 26 without restriction (R-) of cervical rotation and muscle tension in the clinical flexion-rotation test. The normal caloric test was the inclusion criterion. The control group comprised 36 healthy volunteers with no history of vertigo. The vestibulo-ocular reflex (VOR) and the cervico-occular reflex (COR) were measured through the videonystagmography (VNG) sinusoidal pendular kinetic test in the conditions of not inactivated head and immobilized head, respectively. The VNG-head torsion test (VNG-HTT) nystagmus was recorded. Results: Among the reported complaints, neck stiffness, headaches and blurred vision were more frequent in the R+ group than in both the R-group and the control group. VNG revealed an increased COR gain and the presence of VNG-HTT nystagmus in the R+ group only. Similarly, only in the R+ group a positive relationship between COR and VOR was observed. Conclusions: Patients with asymmetric restriction in neck rotation and increased neck muscle tension reveal the tendency to have an increased response of the vestibular system, along with co-existing COR upregulation. Further research is needed to investigate the relationships between the activation of cervical mechanoreceptors and dizziness pathomechanisms.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2005
Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not es... more Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not established. The aim of present study was to asses diagnostic value of classical radiologic, electronystagmographic (ENG) and transcranial doppler ultrasonographic (TCD) examinations in cervical vertigo diagnostic process. Forty patients with vertigo lasting more than 6 months with radiological evidence of cervical spondylosis participated in the study. All patients had ENG and TCD with neck rotation test. Cervical vertigo was diagnosed in patients with positive neck rotation test in: TCD examination (15% decrease of vertebral artery flow) and/or ENG examination (cervical nystagmus). We diagnosed cervical vertigo in 65% of patients. Multivariate model of logistic regression analysis showed that the best statistical predictors of cervical vertigo were: asymmetry of vertebral artery flow in TCD (OR: 92.2; 95% CI: 6,2-1381) and presence of osteophytes and discopathy in radiological examinatio...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2005
The aim of the study was to assess the effectiveness of kinesitherapy in cervical vertigo treatme... more The aim of the study was to assess the effectiveness of kinesitherapy in cervical vertigo treatment. Thirty two patients with cervical vertigo, aged 20 to 75, were examined. The patients performed kinesitherapy exercises three times a day for four weeks. The effects of therapy were assessed by everyday task self-control cards and ENG examinations. In the present study, objective improvement was noticed in 18,7% patients. Subjective improvement assessed by the patients everyday task self-control cards reached 62.5%. Kinesitherapy seems to be the good method of treating neck-related vertigo, but it should be confirmed in further study on the large group of patients.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2005
The aim of present study was to characterize the association between prevalence of vertigo and ag... more The aim of present study was to characterize the association between prevalence of vertigo and age, grade of radiological changes and positional vertebral (VA) and basilar artery (BA) flow lesion in patients with cervical spondylosis. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained positional vertigo. Patients with neurological symptoms were excluded from the study. ENG was used to exclude patients with another causes of vertigo. TCD evaluations of the distal part of VA and the proximal part of BA were performed with a 2-MHz probe via the suboccipital window. We showed significant and independent association between prevalence of vertigo and age, grade of radiological changes, and positional vertebral and basilar artery flow lesion velocity in multivariate logistic regression model. Spondylotic-induced VA compression may be the reason of decreased blood flow velocity in the basilar artery during head rotation, causing positional ...
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not es... more Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not established. The aim of present study was to asses diagnostic value of classical radiologic, electronystagmographic (ENG) and transcranial doppler ultrasonographic (TCD) examinations in cervical vertigo diagnostic process. Forty patients with vertigo lasting more than 6 months with radiological evidence of cervical spondylosis participated in the study. All patients had ENG and TCD with neck rotation test. Cervical vertigo was diagnosed in patients with positive neck rotation test in: TCD examination (15% decrease of vertebral artery flow) and/or ENG examination (cervical nystagmus). We diagnosed cervical vertigo in 65% of patients. Multivariate model of logistic regression analysis showed that the best statistical predictors of cervical vertigo were: asymmetry of vertebral artery flow in TCD (OR: 92.2; 95% CI: 6,2-1381) and presence of osteophytes and discopathy in radiological examinatio...
Medycyna Pracy, 2015
Background: Several subjects exposed to neurotoxins in the workplace need to be assessed for cent... more Background: Several subjects exposed to neurotoxins in the workplace need to be assessed for central auditory deficit. Although central auditory processing tests are widely used in other countries, they have not been standardized for the Polish population. The aim of the study has been to evaluate the range of reference values for 3 temporal processing tests: the duration pattern test (DPT), the frequency pattern test (FPT) and the gaps in noise test (GIN). Material and Methods: The study included 76 normal hearing individuals (38 women, 38 men) at the age of 18 to 54 years old (mean ± standard deviation: 39.4±9.1). All study participants had no history of any chronic disease and underwent a standard ENT examination. Results: The reference range for the DPT was esta blished at 55.3% or more of correct answers, while for the FPT it stood at 56.7% or more of correct answers. The mean threshold for both ears in the GIN test was defined as 6 ms. In this study there were no significant associations between the DPT, FPT and GIN results and age or gender. Symmetry between the ears in the case of the DPT, FPT and GIN was found. Conclusions: Reference ranges obtained in this study for the DPT and FPT in the Polish population are lower than reference ranges previously published for other nations while the GIN test results correspond to those published in the related literature. Further investigations are needed to explain the discrepancies between normative values in Poland and other countries and adapt tests for occupational medicine purposes. Med Pr 2015;66(2):145-152
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2006
The aim of our investigations was to characterize the relationship between basilar artery (BA) fl... more The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes, prevalence of vertigo, and decreased blood flow velocity through vertebral arteries (VA) after head rotation. A prospective, controlled study in academic neurotology was conducted. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained of positional vertigo lasting more than 6 months. Patients were examined by transcranial Doppler ultrasound with head rotations. We showed significant association between velocity flow in basilar artery after neck rotation and age, prevalence of vertigo, grade of radiological changes, and positional vertebral artery flow lesion. Spondylotic-induced VA compression may be the reason for decreased blood flow velocity in the basilar artery during head rotation, which may be of particular importance for older patients, especia...
B-ENT, 2006
A comparative assessment of toxic element concentrations in serum and tissue bioptates in patient... more A comparative assessment of toxic element concentrations in serum and tissue bioptates in patients with laryngeal papilloma or cancer was performed. Examinations were conducted in 60 patients (40 men and 20 women) aged 20-88 years (average 59 +/- 05). Patients were divided into 3 groups; 20 patients with laryngeal papilloma were in group I, 20 with laryngeal cancer were in group II, and 20 with deviated nasal septums were included as a control group (III). Diagnosis of laryngeal papilloma (removed by direct microlaryngoscopy--Kleinsasser method) and laryngeal cancer (removed by the Rethi method) was histopatologically confirmed in patients from groups I and II, respectively. Patients in the control group received functional surgery to repair deviated nasal septums. Serum and tissue samples were obtained from all patients before surgery. Aluminum and lead concentrations were analysed by inductively coupled plasma atomic emission spectrometry (ICP-AES) using a Spectroflame M spectrome...
International journal of occupational medicine and environmental health, 2005
The aim of the study was to assess the influence of short-term impulse noise on the size and dyna... more The aim of the study was to assess the influence of short-term impulse noise on the size and dynamics of temporary threshold shift, which precedes permanent threshold shift, i.e. noise-induced hearing loss. It was hoped to use the findings for preventive activities. The study included 80 healthy subjects (160 ears), aged 19-23 years, divided into two groups: group I comprised 40 recruit soldiers put to the shooting training, and group II consisted of 40 young male controls. All subjects had to show normal hearing with pure tone audiometric thresholds between 10-15 dB. Transient evoked otoacoustic emission (TOAE) measurements were performed by ILO 292 Echoport Otodynamics device 3-5 min before shooting and then 2 min, 1, 2 and 3 h, respectively after shooting. In group II the time intervals were similar. It was found that the gunshot impulse noise from the kbk AKMS rifle caused temporary hearing threshold shift (TTS) at 1, 2, 3, 4 and 5 kHz frequencies of 1.07, 0.96, 1.41, 0.88 and 1...
An analysis of selected diagnostic examinations results in patients with cer An analysis of selec... more An analysis of selected diagnostic examinations results in patients with cer An analysis of selected diagnostic examinations results in patients with cer An analysis of selected diagnostic examinations results in patients with cer An analysis of selected diagnostic examinations results in patients with cer An analysis of selected diagnostic examinations results in patients with cervical vertigo and vical vertigo and vical vertigo and vical vertigo and vical vertigo and positive neck rotation test positive neck rotation test positive neck rotation test positive neck rotation test positive neck rotation test
Otolaryngology–Head and Neck Surgery, 2007
OBJECTIVE: The aim of the study was to assess the influence of short-term impulse noise to tempor... more OBJECTIVE: The aim of the study was to assess the influence of short-term impulse noise to temporary threshold shift in soldiers using hearing protectors. STUDY DESIGN AND SETTING: The study included 80 subjects with correct tympanic membrane and thresholds measured by pure-tone audiometry less than 20 dB. There were two groups: 40 soldiers protected during shooting and 40 young males who didn't shoot. TEOAE were performed by ILO 292 Echoport Otodynamics device 3 to 5 minutes before shooting and 2 minutes and 1, 2, and 3 hours after shooting. RESULTS: Short-term exposure to impulse noise generated by five gunshots from the rifle kbk AKMS hasn't induced temporary threshold shift of hearing for chosen frequencies in soldiers using hearing protectors. Spectral analysis for chosen frequencies revealed that measurement reproducibility, stimuli level, and probe stability appeared to be comparable and repeatable. CONCLUSION: Our results show that the use of hearing protectors safeg...
Polski Przegląd Otorynolaryngologiczny
Introduction: Auditory Processing Disorders (APD) is a syndrome characterized by impairment of th... more Introduction: Auditory Processing Disorders (APD) is a syndrome characterized by impairment of the perception of soundsverbal and non-verbal ones, and weakening cognitive abilities such as auditory attention and auditory memory. This symptoms occur despite correct functioning of the peripheral part of the organ of hearing. Aim: A review of the current literature on diagnostic criteria of APD and its subtypes, clinical symptoms in children, diagnostic procedures and methods and therapeutic interventions. Methods: The study was based on the guidelines of the British Audiological Society (BSA), the guidelines of the American Speech, Language and Hearing Society (ASHA) as well as a literature review in the PubMed database. Results: APD is divided into developmental (without an established cause), acquired (with an established cause) and secondary (a consequence of long-term peripheral hearing loss). Symptoms that indicate the likelihood of APD in schoolaged children include: poor school...
PubMed, Sep 1, 2001
Levels of pro-allergic cytokine IL-4 are increased in asthmatic airways, contributing to allergic... more Levels of pro-allergic cytokine IL-4 are increased in asthmatic airways, contributing to allergic inflammation. The purpose of this study was to define the effect of treatment with triamcinolon, montelukast, and formoterol on serum level of IL-4 and IgE, clinical parameters (symptom score, FEV1) and bronchial hyperreactivity (BHR) in children with moderate asthma. It was 8 week, placebo-controlled and randomized, double blind trial of 99 children with moderate atopic asthma allergic to dust mite. Patients were randomly allocated to receive 400 mg triamcinolon (n = 20), 5 or 10 mg (according to age) montelukast (n = 18), 24 mg formoterol (n = 19), or placebo (n = 42). 80 children completed the study. After treatment with triamcinolon, montelukast, and formoterol the level of IL-4 in blood serum in all study groups significantly decreased, and all clinical parameters improved; treatment with triamcinolon, formoterol, and montelukast had no effect on IgE level in serum. Mean IL-4 levels in serum before and after treatment with triamcinolon were 0.129 pg/ml with 95% Cl, 0.1-0.145 pg/ml and 0.086 pg/ml with 95% Cl, 0.023-0.109 pg/ml respectively (p = 0.02); with montelukast were 0.123 pg/ml with 95% Cl, 0.57-0.82 pg/ml and 0.102 pg/ml with 95% Cl, 0.62-0.82 pg/ml respectively (p < 0.001); with formoterol were 0.128 pg/ml with 95% Cl, 0.108-0.164 pg/ml and 0.113 pg/ml with 95% Cl, 0.096-0.146 pg/ml respectively (p = 0.002). No correlations have been found between changes in serum IL-4 and any other clinical parameters after treatment. This study demonstrates that one of the possible ways by which triamcinolon, montelukast, and formoterol contribute to inhibition of allergic inflammation is by decreasing IL-4 levels.
JAMA Pediatrics, Apr 1, 2023
ImportanceIntranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinus... more ImportanceIntranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinusitis (CRS) in both adults and children, despite the lack of evidence regarding their efficacy in the pediatric population. Similarly, their effect on the sinonasal microbiome has not been well documented.ObjectiveTo assess the clinical, immunological, and microbiological effects of 12 weeks of an INC in young children with CRS.Design, Setting, and ParticipantsThis open-label randomized clinical trial was performed in a pediatric allergy outpatient clinic in 2017 and 2018. Children aged 4 to 8 years with CRS diagnosed by a specialist were included. Data were analyzed from January 2022 to June 2022.InterventionsPatients were randomized to receive intranasal mometasone in an atomizer for 12 weeks (1 application per nostril, once per day) and supplemental 3-mL sodium chloride (NaCl), 0.9%, solution in a nasal nebulizer once a day for 12 weeks (INC group) or 3-mL NaCl, 0.9%, solution in a nasal nebulizer once a day for 12 weeks (control group).Main Outcomes and MeasuresMeasures taken both before and after treatment included the Sinus and Nasal Quality of Life Survey (SN-5), a nasopharynx swab for microbiome analysis by next-generation sequencing methods, and nasal mucosa sampling for occurrence of innate lymphoid cells (ILCs).ResultsOf the 66 children enrolled, 63 completed the study. The mean (SD) age of the cohort was 6.1 (1.3) years; 38 participants (60.3%) were male and 25 (39.7%) were female. The clinical improvement reflected by reduction in SN-5 score was significantly higher in the INC group compared with the control group (INC group score before and after treatment, 3.6 and 3.1, respectively; control group score before and after treatment, 3.4 and 3.8, respectively; mean between-group difference, −0.58; 95% CI, −1.31 to −0.19; P = .009). The INC group had a greater increase in nasopharyngeal microbiome richness and larger decrease in nasal ILC3 abundance compared with the control group. A significant interaction was observed between change in microbiome richness and the INC intervention on the prediction of significant clinical improvement (odds ratio, 1.09; 95% CI, 1.01-1.19; P = .03).Conclusions and RelevanceThis randomized clinical trial demonstrated that treatment with an INC improved the quality of life of children with CRS and had a significant effect on increasing sinonasal biodiversity. Although further investigation is needed of the long-term efficacy and safety of INCs, these data may reinforce the recommendation of using INCs as a first-line treatment of CRS in children.Trial RegistrationClinicalTrials.gov Identifier: NCT03011632
Alergologia Polska - Polish Journal of Allergology
Introduction: The microbiome has been identified as a significant factor in the pathogenesis of v... more Introduction: The microbiome has been identified as a significant factor in the pathogenesis of various inflammatory and autoimmune diseases, including chronic rhinosinusitis (CRS), a condition that affects up to 12% of the global population. Aim: To evaluate the role of innate lymphoid cells (ILC1, ILC2, and ILC3) and their relationship with nasal microbiota in CRS in children. Material and methods: We assessed the clinical, microbiological, and immunological characteristics of 63 children with CRS. We evaluated disease severity using the Sinus and Nasal Quality of Life Survey (SN-5) and measured ILC1, ILC2, and ILC3 levels in nasal scrapings; microbial diversity was expressed as OTU richness. Results: We found a statistically significant relationship between ILC1 levels and CRS severity, suggesting a potential role of ILC1 in the development of the disease. ILC3 levels were significantly associated with lower microbial richness. While atopy was more common in children with high levels of ILC2, the relationship was not significant. Conclusions: Our results indicate that innate lymphoid cells may play a significant role in the inflammatory processes underlying the development and severity of chronic rhinosinusitis, with ILC1 activation being particularly strongly associated with CRS severity in young children. Additionally, ILC3 may play a role in modulating the nasal microbiome in CRS patients, but the relationship is not strong enough to significantly impact the clinical characteristics.
JAMA Pediatrics
ImportanceIntranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinus... more ImportanceIntranasal corticosteroids (INCs) remain the first-line treatment of chronic rhinosinusitis (CRS) in both adults and children, despite the lack of evidence regarding their efficacy in the pediatric population. Similarly, their effect on the sinonasal microbiome has not been well documented.ObjectiveTo assess the clinical, immunological, and microbiological effects of 12 weeks of an INC in young children with CRS.Design, Setting, and ParticipantsThis open-label randomized clinical trial was performed in a pediatric allergy outpatient clinic in 2017 and 2018. Children aged 4 to 8 years with CRS diagnosed by a specialist were included. Data were analyzed from January 2022 to June 2022.InterventionsPatients were randomized to receive intranasal mometasone in an atomizer for 12 weeks (1 application per nostril, once per day) and supplemental 3-mL sodium chloride (NaCl), 0.9%, solution in a nasal nebulizer once a day for 12 weeks (INC group) or 3-mL NaCl, 0.9%, solution in a nas...
Allergy, 2021
To the Editor, The reduced morbidity of chronic inflammatory disorders of airways in children dur... more To the Editor, The reduced morbidity of chronic inflammatory disorders of airways in children during the COVID19 pandemic has been observed1,2; however, the restriction related to the lockdown may also have a longlasting negative impact on the clinical care of patients.3 Despite this dichotomy, pandemic isolation offers a unique opportunity to understand better the phenomenon of remission (or progression) of chronic rhinosinusitis (CRS) and asthma symptoms in young children. We aimed to determine clinical, immunological, and microbiological factors that could affect the clinical course of CRS and asthma in young children during pandemic isolation. Our cohort of young children with chronic rhinosinusitis with or without asthma was fully described before the COVID19 pandemic.4 Children aged 4– 8 years with CRS diagnosed by otorhinolaryngologists according to the EPOS (European Position Paper on Rhinosinusitis and Nasal Polyps) criteria were included. Asthma was suspected according to the positive modified Asthma Predictive Index and confirmed by a pulmonologist after clinical improvement during antiinflammatory therapy and/or positive bronchial reversibility test. The following procedures were performed in all participants before the pandemic: Facetoface standardized Sinus and Nasal Quality of Life questionnaire, skin prick test, nasopharynx swab, and nasal scrapes collected using RhinoProbe plastic nasal curettes (Figure 1A). Recruitment for the study took place during two subsequent autumnwinter seasons (2017– 2018). During the current study, a telephone followup visit was performed after 5 months of pandemic isolation. Details on study methods are given in the Appendix S1. (ClinicalTrials.gov Identifier: NCT03011632). One hundred and eleven children of the original cohort (84%) of children with CRS were included in the current followup analysis. The clinical characteristics of participants are presented in Table 1. In the fallwinter 2020 season, compared to the 2019 and 2017/2018 seasons, we observed a significant reduction in SN5 score in our patients (Figure 1B). At inclusion during the first study season, asthma was diagnosed in 82 (61.6%) participants. In the fallwinter 2020 season, asthma symptoms and/or antiasthma therapy were reported in 31(27.9%) children (Figure 1C). Children with SN5 score below the median value (3.0) at fallwinter season 2020 were defined as having mild/episodic CRS, and patients above the median as having moderate CRS (Figure 1B). Children without asthma symptoms, and any antiasthma treatment during last year, including fallwinter season 2020, were defined as patients without asthma symptoms (Figure 1C). Both outcomes (CRS and asthma) were included in logistic regression analysis as dependent variables (Tables S1 and S2). The logistic regression analysis in a multivariate approach showed that independent risk factors of moderate CRS were house dust mites (HDM) sensitization and the number of courses of antibiotic therapy at baseline; sensitization to HDM increased the risk nearly fourfold (OR: 3.85; 95% CI: 1.37– 10.79), and each course of antibiotic therapy by over 40% (OR: 1.44; 95% CI: 1.08– 1.93). The logistic regression analysis in a multivariate approach showed that independent risk factors of asthma symptoms were food allergy in infancy (OR: 2.57; 95% CI: 1.08– 6.16) and moderate symptoms of CRS during pandemic isolation (OR: 2.77; 95% CI: 1.12– 6.89). Children with vs. children without HDM sensitization had more frequently reduced biodiversity (reduced Shannon index, one of the features of dysbiosis) in the upper airways at baseline (Table S3). Before the pandemic, we did not observe significant associations between HDM sensitization and CRS severity, antibiotics prescribing frequency, nor the prevalence of asthma symptoms. However, during pandemic isolation, children with HDM sensitization had at least one antibiotic course during fallwinter 2020 and moderate CRS symptoms more frequently compared to those without HDM sensitization (Table S3). We did not observe any association between the size of the skin reaction to HDM in sensitized children and study outcomes (Figure S1). The nasal mucosa in children with moderate CRS was characterized at baseline by a higher expression of IL17 (p = .04; after adjustment for multicomparison p = .046) and Muc5AC (p = .046; after adjustment p = .046) (Figure S2A). In children with asthma symptoms, the nasal mucosa at baseline was characterized by a lower expression of betadefensin 2 (p = .017; after adjustment p = .038) and lower Muc5B expression (p = .029; after adjustment p = .038) (Figure S2A). Children with more frequent antibiotic courses before the pandemic had a lower Shannon index in the upper airways. However, this association was not linear (Figure S2B). Under natural conditions, the effects of allergic rhinitis and dysbiosis as a consequence of being in a preschool environment interact, making clinical interpretation…
International Journal of Occupational Medicine and Environmental Health, 2019
The aim of this study was to investigate whether the restriction in neck rotation and increased n... more The aim of this study was to investigate whether the restriction in neck rotation and increased neck muscle tension could be causally related to vertigo and dizziness. Material and Methods: Seventy-one patients reporting vertigo and/or imbalance were divided into 2 groups: 45 subjects with unilateral restriction (R+) and 26 without restriction (R-) of cervical rotation and muscle tension in the clinical flexion-rotation test. The normal caloric test was the inclusion criterion. The control group comprised 36 healthy volunteers with no history of vertigo. The vestibulo-ocular reflex (VOR) and the cervico-occular reflex (COR) were measured through the videonystagmography (VNG) sinusoidal pendular kinetic test in the conditions of not inactivated head and immobilized head, respectively. The VNG-head torsion test (VNG-HTT) nystagmus was recorded. Results: Among the reported complaints, neck stiffness, headaches and blurred vision were more frequent in the R+ group than in both the R-group and the control group. VNG revealed an increased COR gain and the presence of VNG-HTT nystagmus in the R+ group only. Similarly, only in the R+ group a positive relationship between COR and VOR was observed. Conclusions: Patients with asymmetric restriction in neck rotation and increased neck muscle tension reveal the tendency to have an increased response of the vestibular system, along with co-existing COR upregulation. Further research is needed to investigate the relationships between the activation of cervical mechanoreceptors and dizziness pathomechanisms.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2005
Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not es... more Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not established. The aim of present study was to asses diagnostic value of classical radiologic, electronystagmographic (ENG) and transcranial doppler ultrasonographic (TCD) examinations in cervical vertigo diagnostic process. Forty patients with vertigo lasting more than 6 months with radiological evidence of cervical spondylosis participated in the study. All patients had ENG and TCD with neck rotation test. Cervical vertigo was diagnosed in patients with positive neck rotation test in: TCD examination (15% decrease of vertebral artery flow) and/or ENG examination (cervical nystagmus). We diagnosed cervical vertigo in 65% of patients. Multivariate model of logistic regression analysis showed that the best statistical predictors of cervical vertigo were: asymmetry of vertebral artery flow in TCD (OR: 92.2; 95% CI: 6,2-1381) and presence of osteophytes and discopathy in radiological examinatio...
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2005
The aim of the study was to assess the effectiveness of kinesitherapy in cervical vertigo treatme... more The aim of the study was to assess the effectiveness of kinesitherapy in cervical vertigo treatment. Thirty two patients with cervical vertigo, aged 20 to 75, were examined. The patients performed kinesitherapy exercises three times a day for four weeks. The effects of therapy were assessed by everyday task self-control cards and ENG examinations. In the present study, objective improvement was noticed in 18,7% patients. Subjective improvement assessed by the patients everyday task self-control cards reached 62.5%. Kinesitherapy seems to be the good method of treating neck-related vertigo, but it should be confirmed in further study on the large group of patients.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2005
The aim of present study was to characterize the association between prevalence of vertigo and ag... more The aim of present study was to characterize the association between prevalence of vertigo and age, grade of radiological changes and positional vertebral (VA) and basilar artery (BA) flow lesion in patients with cervical spondylosis. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained positional vertigo. Patients with neurological symptoms were excluded from the study. ENG was used to exclude patients with another causes of vertigo. TCD evaluations of the distal part of VA and the proximal part of BA were performed with a 2-MHz probe via the suboccipital window. We showed significant and independent association between prevalence of vertigo and age, grade of radiological changes, and positional vertebral and basilar artery flow lesion velocity in multivariate logistic regression model. Spondylotic-induced VA compression may be the reason of decreased blood flow velocity in the basilar artery during head rotation, causing positional ...
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not es... more Cervical spine spondylotic changes are known to cause vertigo, but diagnostic criteria are not established. The aim of present study was to asses diagnostic value of classical radiologic, electronystagmographic (ENG) and transcranial doppler ultrasonographic (TCD) examinations in cervical vertigo diagnostic process. Forty patients with vertigo lasting more than 6 months with radiological evidence of cervical spondylosis participated in the study. All patients had ENG and TCD with neck rotation test. Cervical vertigo was diagnosed in patients with positive neck rotation test in: TCD examination (15% decrease of vertebral artery flow) and/or ENG examination (cervical nystagmus). We diagnosed cervical vertigo in 65% of patients. Multivariate model of logistic regression analysis showed that the best statistical predictors of cervical vertigo were: asymmetry of vertebral artery flow in TCD (OR: 92.2; 95% CI: 6,2-1381) and presence of osteophytes and discopathy in radiological examinatio...
Medycyna Pracy, 2015
Background: Several subjects exposed to neurotoxins in the workplace need to be assessed for cent... more Background: Several subjects exposed to neurotoxins in the workplace need to be assessed for central auditory deficit. Although central auditory processing tests are widely used in other countries, they have not been standardized for the Polish population. The aim of the study has been to evaluate the range of reference values for 3 temporal processing tests: the duration pattern test (DPT), the frequency pattern test (FPT) and the gaps in noise test (GIN). Material and Methods: The study included 76 normal hearing individuals (38 women, 38 men) at the age of 18 to 54 years old (mean ± standard deviation: 39.4±9.1). All study participants had no history of any chronic disease and underwent a standard ENT examination. Results: The reference range for the DPT was esta blished at 55.3% or more of correct answers, while for the FPT it stood at 56.7% or more of correct answers. The mean threshold for both ears in the GIN test was defined as 6 ms. In this study there were no significant associations between the DPT, FPT and GIN results and age or gender. Symmetry between the ears in the case of the DPT, FPT and GIN was found. Conclusions: Reference ranges obtained in this study for the DPT and FPT in the Polish population are lower than reference ranges previously published for other nations while the GIN test results correspond to those published in the related literature. Further investigations are needed to explain the discrepancies between normative values in Poland and other countries and adapt tests for occupational medicine purposes. Med Pr 2015;66(2):145-152
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2006
The aim of our investigations was to characterize the relationship between basilar artery (BA) fl... more The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes, prevalence of vertigo, and decreased blood flow velocity through vertebral arteries (VA) after head rotation. A prospective, controlled study in academic neurotology was conducted. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained of positional vertigo lasting more than 6 months. Patients were examined by transcranial Doppler ultrasound with head rotations. We showed significant association between velocity flow in basilar artery after neck rotation and age, prevalence of vertigo, grade of radiological changes, and positional vertebral artery flow lesion. Spondylotic-induced VA compression may be the reason for decreased blood flow velocity in the basilar artery during head rotation, which may be of particular importance for older patients, especia...
B-ENT, 2006
A comparative assessment of toxic element concentrations in serum and tissue bioptates in patient... more A comparative assessment of toxic element concentrations in serum and tissue bioptates in patients with laryngeal papilloma or cancer was performed. Examinations were conducted in 60 patients (40 men and 20 women) aged 20-88 years (average 59 +/- 05). Patients were divided into 3 groups; 20 patients with laryngeal papilloma were in group I, 20 with laryngeal cancer were in group II, and 20 with deviated nasal septums were included as a control group (III). Diagnosis of laryngeal papilloma (removed by direct microlaryngoscopy--Kleinsasser method) and laryngeal cancer (removed by the Rethi method) was histopatologically confirmed in patients from groups I and II, respectively. Patients in the control group received functional surgery to repair deviated nasal septums. Serum and tissue samples were obtained from all patients before surgery. Aluminum and lead concentrations were analysed by inductively coupled plasma atomic emission spectrometry (ICP-AES) using a Spectroflame M spectrome...
International journal of occupational medicine and environmental health, 2005
The aim of the study was to assess the influence of short-term impulse noise on the size and dyna... more The aim of the study was to assess the influence of short-term impulse noise on the size and dynamics of temporary threshold shift, which precedes permanent threshold shift, i.e. noise-induced hearing loss. It was hoped to use the findings for preventive activities. The study included 80 healthy subjects (160 ears), aged 19-23 years, divided into two groups: group I comprised 40 recruit soldiers put to the shooting training, and group II consisted of 40 young male controls. All subjects had to show normal hearing with pure tone audiometric thresholds between 10-15 dB. Transient evoked otoacoustic emission (TOAE) measurements were performed by ILO 292 Echoport Otodynamics device 3-5 min before shooting and then 2 min, 1, 2 and 3 h, respectively after shooting. In group II the time intervals were similar. It was found that the gunshot impulse noise from the kbk AKMS rifle caused temporary hearing threshold shift (TTS) at 1, 2, 3, 4 and 5 kHz frequencies of 1.07, 0.96, 1.41, 0.88 and 1...
An analysis of selected diagnostic examinations results in patients with cer An analysis of selec... more An analysis of selected diagnostic examinations results in patients with cer An analysis of selected diagnostic examinations results in patients with cer An analysis of selected diagnostic examinations results in patients with cer An analysis of selected diagnostic examinations results in patients with cer An analysis of selected diagnostic examinations results in patients with cervical vertigo and vical vertigo and vical vertigo and vical vertigo and vical vertigo and positive neck rotation test positive neck rotation test positive neck rotation test positive neck rotation test positive neck rotation test
Otolaryngology–Head and Neck Surgery, 2007
OBJECTIVE: The aim of the study was to assess the influence of short-term impulse noise to tempor... more OBJECTIVE: The aim of the study was to assess the influence of short-term impulse noise to temporary threshold shift in soldiers using hearing protectors. STUDY DESIGN AND SETTING: The study included 80 subjects with correct tympanic membrane and thresholds measured by pure-tone audiometry less than 20 dB. There were two groups: 40 soldiers protected during shooting and 40 young males who didn't shoot. TEOAE were performed by ILO 292 Echoport Otodynamics device 3 to 5 minutes before shooting and 2 minutes and 1, 2, and 3 hours after shooting. RESULTS: Short-term exposure to impulse noise generated by five gunshots from the rifle kbk AKMS hasn't induced temporary threshold shift of hearing for chosen frequencies in soldiers using hearing protectors. Spectral analysis for chosen frequencies revealed that measurement reproducibility, stimuli level, and probe stability appeared to be comparable and repeatable. CONCLUSION: Our results show that the use of hearing protectors safeg...