Introduction: Swallowing disorders constitute a diagnostic and therapeutic challenge across numerous medical specialties, affecting, among others, patients’ quality of life, exacerbations of chronic diseases, development of lower respiratory tract infections, malnutrition and sarcopenia. In the case of oropharyngeal dysphagia, instrumental assessments, like flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS), are considered the gold standard. The development of standardized protocols tailored to the clinical and legal frameworks of a given country is essential for ensuring safe and effective patient care.Material and Methods: This paper is based on an analysis of European and American clinical guidelines and recommendations, national legal regulations, and medical specialization curricula in Poland. A comprehensive review of Polish- and English-language literature was performed, including validated scales and questionnaires adapted into Polish, as well as postgraduate educational opportunities available within the European Union.FEES and VFSS Standards: The presented standards for FEES and VFSS encompass the following elements: type of examination, organizational framework including interdisciplinary team roles, indications, contraindications and associated risks, technical equipment and additional accessories required for the procedures, as well as the information necessary for preparing a comprehensive report and communicating results to the patient.Some components of these standards are universal (independent of the country in which the procedure is performed), while others reflect the specific organization of professional training, healthcare systems, and legal regulations in Poland. It should be emphasized that the aim of these procedures is not merely to confirm the presence of swallowing disorders, but to understand the underlying pathophysiological mechanisms of dysphagia in a given clinical case. This allows for establishing a diagnosis within a general medical context and implementing the most effective therapeutic strategy (rehabilitation, conservative treatment and/or surgical intervention).Conclusions: Instrumental swallowing assessments involve significant responsibility and require specialized expertise, technical preparation, access to high-quality equipment and the establishment of interdisciplinary teams. Incorrect therapeutic decisions may pose a direct threat to patient health and life. The primary goal of standardization is to improve the organization of procedures; however, individualized clinical decision-making remains essential in every case. Currently FEES and VFSS are not recognized as independent procedures in the International Classification of Medical Procedures (ICD-9).Keywordsoropharyngeal dysphagia, FEES, VFSS, IDDSI, aspiration, penetration, malnutrition, sarcopenia
Introduction: Carotid body tumors are rare neoplasms originating from paraganglionic cells, located near the bifurcation of the common carotid artery. These lesions are usually benign and asymptomatic, but when carotid body tumors increase in size they may begin to cause symptoms. Carotid body paragangliomas are treated surgically, with preoperative embolization performed in some cases. There is ongoing debate as to whether preoperative embolization provides benefits for patients. Aim: The aim of the study was to evaluate the influence of preoperative carotid body paraganglioma embolization on surgical safety, operative time, and overall treatment outcome. Materials and methods: A cohort of 36 patients (26 women, 10 men) with a mean age of 51 years, treated at three clinical centers over the past 15 years, was included. Operative times, lengths of hospital stay, postoperative complications, perioperative blood loss, and treatment outcomes were compared. Additionally, demographic and clinical data were collected from medical history and physical examination. Conclusions: Preoperative embolization offers benefits compared with surgery alone, including fewer complications and a shorter mean operative time. The mean length of hospital stay was comparable between the two groups. No reduction in blood loss was observed among patients who underwent embolization prior to surgery.
Introduction: Obstructive sleep apnea (OSA) is a disorder with a complex, most often multilevel pathophysiology. In patients with tongue base involvement, transoral robotic surgery (TORS) is one of the modern surgical treatment options. Aim: To assess postoperative outcomes of transoral robotic surgery for OSA and to evaluate the role of drug-induced sleep endoscopy (DISE) in preoperative assessment and surgical planning. Materials and methods: A retrospective single-center analysis was performed in 30 consecutive adult patients operated on for OSA between 2023 and 2026. All patients were qualified for surgery based on suspected tongue base obstruction. In each case, DISE was performed in the operating room immediately before surgery using a standardized propofol-based anesthetic protocol. The extent of surgery was individualized according to the clinical assessment and DISE findings and included single-level or multilevel procedures. Transoral robotic surgery using the da Vinci Xi system was performed at the palatal level (robot-assisted modified UPPP), the tongue base, or both. Treatment efficacy was assessed on the basis of changes in the apnea-hypopnea index (AHI) and the proportion of patients meeting Sher criteria for surgical success. Postoperative assessment was based on follow-up polygraphy performed at least 6 months after surgery. Results: The study group included 5 women (17%), and patient age ranged from 28 to 73 years. Mean age was 50 years, and mean preoperative AHI was 34/h. DISE showed palatal obstruction in 97% of patients, while significant tongue base involvement was confirmed in 83%. Postoperative polygraphy performed at least 6 months after surgery was available in 24 of the 30 patients. The remaining 6 patients declined follow-up assessment. The analysis of AHI outcomes and surgical success was based on the 24 patients with postoperative polygraphy. Mean AHI reduction was 43.3% and Sher success criteria were met in 14 of 24 patients (58.3%). In patients with moderate OSA the mean AHI reduction was 28.9%, compared with 73.4% in severe OSA. Two cases of prolonged intubation related to tongue edema and two cases of postoperative bleeding were recorded. Conclusions: In this cohort, individualized surgical treatment using TORS was associated with a reduction in AHI, while DISE was useful in planning the extent of surgery. Patients with severe OSA showed greater mean AHI reduction and a higher Sher success rate than those with moderate OSA.
Introduction: Vestibular schwannomas (VS) are benign tumors of the eighth cranial nerve. Advances in MRI diagnostics allow for detection at stages where preservation of hearing and facial nerve function is feasible. Aim: To analyze the outcomes of surgical treatment for small VS via the middle fossa approach (MFA) and to evaluate the correlation between pre- and postoperative hearing status. Materials and methods: The study included 66 patients (mean age 49.8 years) with small tumors, qualifying for removal via MFA. Hearing was assessed using pure-tone and speech audiometry (AAO-HNS scale), while facial nerve function was evaluated using the House-Brackmann (H-B) scale. Results: In patients with preoperative AAO-HNS class A or B, functional hearing (class A-B) was preserved in 40% of cases. Facial nerve function on the 7th postoperative day was graded I–III (H-B scale) in 85% of patients. The most common complication was cerebrospinal fluid leak (3%). Discussion: MFA provides excellent exposure for tumors smaller than 20 mm. While observation is a valid strategy, data suggest that only 34% of patients maintain hearing after 10 years without intervention. This study found no direct correlation between smaller tumor size and better hearing preservation, highlighting the complexity of cochlear nerve damage. However, only small tumors, that are manageable via MFA approach, were included in the study, which limits the ability to demonstrate the relationship between tumor size and hearing outcomes after treatment. Conclusions: The MFA approach ensures high tumor control, favorable facial nerve outcomes, and a satisfactory hearing preservation rate. It remains the recommended method for young patients with small lesions seeking definitive treatment.
Introduction: Balance disorders and dizziness are common clinical problems that may significantly affect functional mobility, independence, and quality of life. Vestibular rehabilitation is based on adaptation and compensation mechanisms and increasingly incorporates interactive technologies that may support balance training and patient engagement. The Microsoft Kinect system is one such technology that enables interactive, movement-based rehabilitation. Aim: The aim of the study was to evaluate functional changes following rehabilitation using the Microsoft Kinect system compared with posturography-based training in patients with dizziness and balance disorders. Material and methods: The pilot study included 10 women aged 61–70 years with diagnosed dizziness and balance disorders. Participants were randomly allocated to two groups of five patients each. The Kinect group underwent rehabilitation using the SeeMe program and Microsoft Kinect, while the posturography group performed balance exercises using the Synapsys Posturography System. Rehabilitation was performed twice weekly for 20 minutes, with a total of 10 sessions. Functional mobility was assessed using the Timed Up and Go (TUG) test before and after the rehabilitation program. A post-intervention investigator-developed questionnaire was also used to assess patients' subjective perception of the effects of rehabilitation. Results: A reduction in TUG completion time was observed in both groups. In the Kinect group, the median TUG time decreased from 10.79 s (IQR: 10.00–12.00) before rehabilitation to 9.20 s (IQR: 9.00–10.23) after rehabilitation. In the posturography group, the median TUG time decreased from 11.00 s (IQR: 11.00–12.00) to 8.00 s (IQR: 7.00–11.00). Within-group analysis did not demonstrate a statistically significant change in TUG time in either the Kinect group (p = 0.125) or the posturography group (p = 0.125). The between- group comparison of changes in TUG time also showed no statistically significant difference (U = 15.0; p = 0.690). The post-intervention questionnaire indicated a positive subjective perception of rehabilitation and good acceptance of both methods. Conclusions: Both Kinect-based rehabilitation and posturography-based training were associated with a favorable direction of functional change, reflected by a reduction in TUG completion time. However, no statistically significant difference between the two rehabilitation methods was demonstrated in this pilot study. The Kinect system may represent a useful adjunct to balance rehabilitation, although its superiority over posturography was not demonstrated. Further studies involving larger samples, validated assessment tools, and longer follow-up are warranted.
