2nd Scientific Conference ‘Guidelines in otorhinolaryngology, audiology and phoniatrics’

For the second time already the Institute of Physiology and Pathology of Hearing with the Institute of Sensory Organs and the Center of Hearing and Speech ‘Medincus’ had organized the scientific conference ‘Guidelines in otorhinolaryngology, audiology and phoniatrics’ under the patronage of the National Consultant in Otorhinolaryngology Prof. Henryk Skarżyński. The Conference took place in Zakopane on 9-11 March, with participation of over 500 specialists from all Poland.

I trust that this conference will be remembered by its participants as an important scientific, organizational and education event – had said Prof. Henryk Skarżyński in his welcome speech to the participants, among whom there were the experienced experts as well as many your doctors. – This Conference is an occasion to teach the young generation to share knowledge and experience – had added Prof. Skarżyński.

Guidelines figuring in the Conference’s title are the routine of the clinical work. They not only facilitate patient management, but also make easier comparing the treatment results with other clinical centers, as said Prof. Paweł Stręk in his opening lecture. In present situation, when patients more and more frequently sue, often with the help of lawyers, guidelines can also serve as a kind of insurance policy for a physician. Knowing the guidelines and using them in daily clinical work are therefore crucial, although some experts would say that following set procedures is contrary to the general conviction that medicine is art.

The scope of the scientific program of the Zakopane Conference was very broad, including topics relating to diagnostics, treatment and rehabilitation of hearing and speech disorders, such as the newest possibilities of surgical treatment in patients who are unilaterally deaf and have hearing disorders in the other, hearing ear. This had been a topic of an opening lecture presented by Prof. Henryk Skarżyński. Many years of experience have led to the development of standards allowing the effective surgical treatment of the only hearing, or partially hearing, ear, had said Prof. Skarżyński. We perform such operation without hesitation in cases of inflammatory processes in the ear, when it is necessary to save patient’s health or sometimes even life. Surgical treatment is today considered in patients with various defects causing sensorineural hearing loss in the only hearing ear, or in patients with otosclerosis.

In cases of hearing loss in the only hearing ear, when trials with hearing aids are unsuccessful, we propose implants – highlighted Prof. Skarżyński. The type of hearing implant should be suitable for the type of hearing loss. When correcting hearing loss in the only, partially hearing ear, we can use bone conduction implants, middle ear implants or cochlear implants. An appropriate electrode selection allows preserving intact structures of the inner ear and residual hearing.

Otosclerosis management has always been a challenge for doctors. Performing a surgery in a pathological ear when the other ear is totally deaf is even a greater challenge. But for these patients surgery can be the only chance to save their hearing. Not every ear surgeon is able to undertake such surgery and to perform it successfully. Prof. Henryk Skarżyński has the enormous experience in this area – in 35 years of his surgical career he had performed 19 thousand otosclerosis procedures, including almost 500 surgeries in patient already deaf in one ear.

When in 1998, on one of the world congresses, preparing for the national meeting of ear surgeons and round table discussion I had asked the best ear surgeons in the world about their opinions with regard to the surgery of the only hearing ear, only three of them had said that such surgery could be performed, with utmost caution. Prevailing opinion had been to fit hearing aids and wait. The problem is that the progress of the disease cannot be stopped. This is why we have been doing everything we could not to postpone the treatment – had Prof. Skarżyński in his lecture.

Presently, there are many possibilities of reconstructing the conductive apparatus in the middle ear with different prostheses replacing the immobilized stapes. One of the models had been designed by Prof. Skarżyński. In the lecture Prof. Skarżyński had underlined that it is crucial to fit the prosthesis for length and sometimes even to modify it so that it fits optimally the anatomy and dimensions of patient’s ear. Prof. Skarżyński had cautioned the ear surgeons listening to his lecture that the piston must be sealed with a blood clot. It is a mistake to use for this purpose a piece of fat, as it is still being done in some centers, said Prof. Skarżyński. As many as one in four procedures performed using fat results in complication such as fistula. It is because fat, contrary to a blood clot, does not integrate well with the mucosa so it does not provide a perfect seal.

A complement to the opening lecture presented by Prof. Henryk Skarżyński had been sessions dedicated to ear surgery, progress in cochlear and hearing implants which he had chaired. It had been an occasion to present the optimal results of treatment achieved by the specialists from the Institute of Physiology and Pathology of Hearing using various implants in different types of hearing loss. Assoc. Prof. Eng. Artur Lorens had presented the newest results of studies performed in the Implants and Auditory Perception Department of the Institute demonstrating that in patients with single sided deafness or asymmetric hearing loss cochlear implantation can restore not only binaural hearing, but also hearing directionality. After implantation and rehabilitation patients are able to correctly indicate the source of the sound, which leads to significant improvement of their communication abilities.

In a session dedicated to cochlear implants, large interest awoke the lecture presented by Ass. Prof. Piotr H. Skarżyński reporting publications of new types of hearing implants, their applications and ideas of hearing loss treatment. There was much discussion about presented reports about first attempts on robotic implantation. Robotics is one of the newest trends in medicine. First two procedures performed using specially programmed robots will take place in an ear surgery center in Berlin, reported Ass. Prof. Skarżyński. Referring to the experiments with the optical (laser) stimulation of the auditory nerve conducted in Japan and regeneration of faulty hair cells with application of stem cells, he had underlined that also the cochlear implant users will be able to take advantage of these treatments (whenever they become available). As it has been repeatedly mentioned during the Conference, the method of introducing an electrode into the cochlea through the round window, developed by Prof. Henryk Skarżyński, is atraumatic and allows preserving inner ear structures.

An important topic had been tinnitus, especially with regard to the 1st World Tinnitus Congress being organized in Warsaw in May. Dr. Agnieszka Szczepek had dedicated her opening lecture to etiology, diagnostics and therapy of tinnitus. Dr. Szczepek has been for 11 years working in the largest university hospital in Europe – Charite. She is an author of 4 books on tinnitus and member of the European research network, Tinnet, studying and developing novel standards of tinnitus diagnostics and classification. In her lecture Dr. Szczepek had presented an overview of therapies for tinnitus. From the whole range of therapeutic approaches, these currently considered effective are the cognitive-behavioral method and gingko biloba. The cognitive-behavioral method is similar to the one used in arachnophobia – you expose patient to spiders and gradually he gets used to and not afraid of them – explained Dr. Szczepek. In tinnitus this method is aimed at accustoming the patient to phantom sounds. In pharmacology, gingko biloba preparations have been proven to have some effect, said Dr. Szczepek in her lecture.

The subject of tinnitus had been continued in a session chaired by Dr. Danuta Raj-Koziak, head of Tinnitus Department of the Institute of Physiology and Pathology of Hearing. That session had been an opportunity to discuss new ideas of tinnitus therapy, whose efficacy is confirmed by research results. From the Institute of Physiology and Pathology of Hearing, Dr. Rafał Milner presented the results of patients with chronic tinnitus who had undergone Slow Cortical Potential Neurofeedback Therapy. There is a lack of effective treatment for chronic tinnitus. Studies conducted by Dr. Milner show that neurofeedback can be an alternative treatment in these cases. After training patients were showing a number of beneficial changes in brain activity, such as normalization of the resting state EEG in regions and networks participating in tinnitus generation or responsible for emotions. Moreover, questionnaire studies have shown that patients after neurofeedback therapy are coping better in life. Also an experiment, in which patients with chronic tinnitus are training, twice a week, yoga with a certified yoga teacher from India, had positive effects. EEG tests in this group before and after several weeks of training have shown that exercises involving muscles and breath have influence of bioelectric brain activity, resulting in emotional calming. After yoga training, researchers have also observed changes in the activity of brain areas considered crucial in tinnitus generation. Results presented Małgorzata Ganc and Dr Iwona Niedziałek. Participants had been interested also in reports on so-called psychological retreats, conducted by psychologists from the Institute of Physiology and Pathology of Hearing in the International Rehabilitation Center in Łeba. Good effects of group therapy aimed at patients’ adaptation to tinnitus were presented by Małgorzata Fludra and Izabela Sarnicka.

Studies presented on the conference confirm that, as Dr. Szczepek had mentioned in her lecture, tinnitus is strongly related to stress. This correlation had been fist noted by an American psychiatrist Edmund Jacobson, creator of relaxation and biofeedback therapies. This is the reason why, as emphasized Dr Szczepek, patient reporting tinnitus must never hear that his condition is untreatable. A doctor should show optimism: ‘It is very good that you have come with this problem, we will do something about it’. A problem of tinnitus should not be taken lightly. More than 10 per cent of patients with tinnitus suffer from depression, as noted Prof. Jurek Olszewski, head of the ORL, Laryngological Oncology, Audiology and Phoniatrics Clinic of the University Clinical Hospital in Łódź, who was also participating in the Conference.

Much attention during the Conference had been given to rhinology, especially sinusitis treatments. Prof. Paweł Stręk, President of the Rhinology and Plastic Surgery Section of the Polish Society of ORLHNS, had presented in his opening lecture the guidelines of the American Academy of ORLHNS on paranasal sinusitis treatment in adults. During the Conference there was a separate session dedicated to the endoscopic methods of treatment of paranasal sinusitis, in which Dr Iwona Gwizdalska had spoken in detail about the role of biofilms in sinusitis and discussed surgical methods of treatment, e.g. with balloons.

Specialists from the Institute of Physiology and Pathology of Hearing presented also the results of their current research in otology, objective hearing tests and rehabilitation. That latter subject had been a topic of a round table chaired by Dr. Anna Geremek-Samsonowicz, head of the Rehabilitation Clinic of the Institute. Opening the discussion she had reminded the participants the guidelines of hearing rehabilitation elaborated by Dr. Joanna Szuchnik after the first in Poland cochlear implantation performed by Prof. Henryk Skarżyński that are still applicable. At that time we had little hope in achieving speech understanding, today our aim is that CI patient should understand speech well not only in silence, but also in noise – said Dr. Geremek.

The spectrum of topics discussed during the Conference was very wide. It included genetics, imaging studies, central hearing disorders, neurootology (there was a specials session dedicated to vertigo), speech disorders, voice therapy, pediatric laryngology and oncology. There was a special round table dedicated to facial neoplasms that are more and more frequent in ageing populations.

The Conference included, beside the lectures, also 21 training workshops, and a test for doctors looking to specialize in ORL as well as two sessions for young scientists.

For young people taking their first steps in scientific research, the opportunity to present their papers in the presence of established medical authorities (this session was co-chaired by Prof. Henryk Skarżyński, Prof. Jurek Olszewski and Dr. Anna Geremek-Samsonowicz) had been a unique learning experience. Young researchers had presented results of studies on olfactory dysfunctions, cochlear implantation in a patient with the Cogan syndrome (autoimmune disease with symptoms of keratitis and hearing dysfunction), or burden of tinnitus before and after cochlear implantation. Such papers, after little work, could well be presented on international congresses, commented Prof. Henryk Skarżyński, encouraging young scientists to take part in a series of large international conferences organized by the Institute of Physiology and Pathology of Hearing and the Institute of Sensory Organs.

Already in May 2017, two international meetings will take place in Warsaw: the 1st World Tinnitus Congress / XII International Tinnitus Seminar and the XXV International Evoked Response Audiometry Study Group Biennial Symposium (IERASG). In 2018, the 4th International Symposium on Otosclerosis and Stapes Surgery will be organized in Kraków, the city in which Prof. Jan Kowalski, one of the pioneers in otosclerosis research and treatment, had lived and worked. In 2019 – the 32nd Politzer Society Meeting /2nd World Congress of Otology, and in 2020 – the XXXV World Congress of Audiology.

All these meetings we organize with an intention of showing to the international scientific community our Polish achievements in these specialties – emphasized Prof. Skarżyński.

Prof. Skarżyński had announced also the 3rd edition of the Festival ‘Beats of Cochlea’, underlining that its participants, people with hearing disorders who, after receiving hearing implant, can hear well enough to develop their musical talents, are the best demonstration of the progress that has been achieved in science and medicine. These people represent the success of the Institute of Physiology and Pathology of Hearing and of the entire ORL community. – It is important that someone who has hearing problems and faces a difficult decision about treatment, can see what opportunities have opened for people who had already underwent that treatment – said Prof. Skarżyński. Motivation for organizing such events – underlined Prof. Skarżyński – is the loyalty towards our patients and our entire community.