© Borgis - New Medicine 2/2002, s. 46-48
Mieczysław Chmielik, Anna Bielicka, Cezary Ranocha, Lechosław Chmielik
History and present situation of Paediatric ENT Surgery in Poland and in other Central East European countries
Department of Paediatric Otorhinolaryngology, The Medical University of Warsaw, Poland
Head: prof. Mieczysław Chmielik M.D.
One of the first paediatric ENT centres in the world was the research group managed by Jan Danielewicz in Warsaw. It was organised on the basis of progress clinics and paediatric ENT wards, and a programme of specialisation was established (1, 2). Almost simultaneously, in the sixties of the twentieth century, centres for paediatric ENT were established in Prague, Berne, Bratislava, Budapest, Bucharest and Sophia. In the nineteen-seventies these were in touch with the centre for paediatric ENT in Italy, which was the pioneer in this speciality in West Europe. The effect of this contact was the creation of the European Federation of Oto-Rhino-Laryngology Societies, and the International Federation of Oto-Rhino-Laryngological Societies (IFOS), and further dynamic progress in this specialisation.
Children have always been the largest group of patients for laryngologists. Almost everyone in childhood has had disease of the upper airways and ears many times. These problems initially exceed the competence of laryngologists and paediatricians. It was necessary to teach doctors who examined and treated laryngological conditions to understand the needs and potential of infants. The vigorous development of medicine in the twentieth century caused many countries to organise groups of doctors with the above-mentioned skills. This was the beginning of paediatric otorhinolaryngology. These centres usually grew within paediatric hospitals. This happened due to the fact that these hospitals offered better opportunities to achieve a satisfactory service for infants and small children. These opportunities did not include the paediatric ENT departments localised in large laryngological centres. This situation set back the development of paediatric ENT in laryngological departments in hospitals for adults, but stimulated its development in laryngological departments connected with paediatric hospitals.
Central East Europe is a very diversified region for cultural and ethnic considerations. In this region there are countries connected strictly and for many centuries with both Latin and with Greek civilisation. Favourable socio-economic conditions in these countries in the forties to sixties of the twentieth century allowed possibilities for the development of paediatric laryngology. In Poland paediatric laryngology was created by Dr Jan Danielewicz, in Prague by Professor O. Blahova, in Bratislava by Prof. Klaczański, in Budapest by Prof. Labas and Prof. I. Hirschberg, in Bucharest by Dr C. Paunescu, and in Sofia by Dr T. Karczew (3).
Significant paediatric laryngological departments appeared in those countries on the former territory of the Union of Soviet Socialist Republics too: in Moscow, in Kiev, in Mince, in Vilna, and in Tallinn. The development of the paediatric laryngology idea in countries of Central East Europe depended, on the one hand, on the economic possibilities of particular countries, and on the other hand on research results exchanged with other centres in the world. Both of these circumstances were satisfied in Poland. In Poland a distinguished authority on these issues, a world-famous laryngologist, was Doctor Jan Danielewicz. The First European Congress of Paediatric Otorhinolaryngology was organised by him in Warsaw in 1979, with the co-operation of paediatric laryngologists from Western Europe, especially R. Pracy from England and C. Gatti Manacini from Italy. At this congress the members of the European Working Group for Paediatric Otorhinolaryngology were chosen. In view of the interest in paediatric laryngology throughout the world, and because of contacts with doctors from USA and Japan, it was named the International Society of Paediatric Otorhinolaryngology.
The economic and political changes that followed in Central East Europe at the beginning of the nine-teen-nineties assigned new aims to paediatric laryngologists. In many countries laryngologists who treated adults wanted to destroy the autonomy of paediatric laryngology. This seems incomprehensible, because for example cardiologists, nephrologists or surgeons treating adults must co-operate with paediatric cardiologists, paediatric nephrologists or paediatric surgeons. The International Organisation of Child Rights working with the United Nations Organisation (UNO) passed a document called The Declaration of Child Rights, in which the eighth point recommends that children should be treated by doctors specialising in paediatric medical practice (4).
I would like to set out the present situation of paediatric laryngology in Central East Europe. There are independent societies of paediatric laryngology in Bulgaria and in Poland (table 1). Paediatric laryngology edits its own journal in Poland and in the Ukraine (table 1).
Table 1. Societies of paediatric laryngologists and their journals in Central East European countries.
| ||Are paediatric laryngologists represented by a laryngological society?||Do paediatric laryngologists edit any Journal?|
Juvenile papillomatosis, prenatal and perinatal diagnostics of congenital anomalies in ENT field and their surgical treatment, functional endoscopic sinus surgery (FESS), cicatricial strictures of the larynx, trachea and oesophagus are the main therapeutic problems seen in the last ten years. The majority of laryngologists recognise microsurgery of the larynx, FESS, and the application of topical steroid therapy as the greatest achievements of paediatric laryngology in the last ten years (table 2).
Table 2. The greatest achievements of paediatric otorhinolaryngology in the last ten years.
| ||The greatest achievements of paediatric ENT surgery in the last ten years|
|Czech||Surgical treatment of hearing disorders. |
Prevention and treatment of otitis media with effusion and cholesteatoma.
|Estonia||Cochlear implants. |
New antihistamines, intranasal corticiodes, cephalosporines of the third generation.
|Hungary||Nasal endoscopy and sinuscopy.|
|Lithuania||Emergency service of stenotic laryngitis and foreign bodies.|
|Poland||Plastic reconstruction of the nasal function. |
Stent therapy of laryngeal and oesophageal stenosis.
|Romania||Microscopical laryngology. |
Microsurgery of the nose and sinuses.
|Slovakia||Early diagnosis of hearing loss. |
In most of the countries of Central East Europe paediatric ENT departments have put one-day surgery into practice. Similarly, laryngological emergency services for children exist in most countries in the region (table 3).
Table 3. One-day surgical ENT procedures and laryngo-logical emergency services for children in Central East Eu-ropean countries.
| ||Is there a one day surgical ENT procedure?||Are there laryngological emergency services for children?|
In all countries of this region there are ENT departments or clinics for children, but their number in particular countries is different (table 4).
Table 4. Departments of paediatric ENT in Central East European countries.
| ||Number of paediatric ENT departments in particular countries||Paediatric ENT departments connected with paediatric hospitals|
Paediatric laryngology is a distinct speciality in the Czech Republic, in the Ukraine, and in Poland. In other countries this speciality is not recognised formally, but doctors may instruct in paediatric laryngology. This instruction lasts from 5 to 15 years (table 5).
Table 5. Paediatric laryngology as a distinct speciality.
| ||Is paediatric ENT a distinct speciality?||How many ENT paediatric specialists are in the country?||How many years does a doctor need to qualify as a specialist in paediatric laryngology?|
|Hungary||Yes||80||ENT + 2|
|Poland||Yes||321||3 + 3|
|Romania||No||40||5 + 6|
The goal of paediatric laryngology development is still alive nowadays, and despite economic difficulties in the region the number of departments and specialists in the field of paediatric laryngology continues to increase (5). In Central East Europe there is a substantial intellectual potential and organising possibilities in the field of paediatric laryngology. I would like to emphasise the role of frequent contacts and exchanges through the congresses of paediatric laryngology organised in Central East Europe and beyond our region. I think the book written by T. Sih on paediatric laryngology and recommended by ESPO deserves special notice. This book is the basis of the creation of text-books devoted to paediatric laryngology in our national languages.
1.Ranocha C. et al.: Polish Paediatric ENT surgery in the XIX-th century. New Medicine 1999 (vol. 3), 52-53. 2. Stool S.E.: A brief history pediatrict otolaryngology. Otolaryngol Head Neck Surg. 1996, 115:278-282. 3. Verwoerd C.D.A., Verwoerd-Verhoeef H.L.: Pediatric otorhinolaryngology in Europe. In: Ruben R.J., Karma P.: Advances in Pediatric Otorhinolaryngology – file://D:START.HTM. 4. Sih T. et al.: II Manual of Paediatric Otorhinolaryngology IAPO/IFOS. 2001 Interamerican Association of Pediatric Otorhinolaryngology. 5. Alberti P.W.: Pediatric ENT services demands and resources a global perspective. In: Ruben R.J., Karma P.: Advances in Pediatric Otorhinolaryngology – file://D:START.HTM.