Showing papers in "Laryngologie, Rhinologie, Otologie in 1986"

Papillomviren in benignen und malignen Tumoren des Mundes und des oberen Respirationstraktes

Abstract: A total of 113 benign and malignant tumours of the mouth and upper respiratory tract have been analysed for the presence of papilloma virus DNA. Thirty-four (63%) of 54 papillomatous lesions were found to contain such DNA. Seventy-two percent of the laryngeal papillomas contained HPV 6 or HPV 11 DNA, whereas the oral papillomatoses harboured HPV 6 (15.6%), HPV 11 (9.4%), HPV 7 (9.4%), HPV 13 (12.5%) and HPV 32 (9.4%) DNAs. The high number of HPV 7 DNA-positive lesions was unexpected. In most of the malignant tumours no papilloma-viral DNA was found, with the exception of 3 tongue-base carcinomas, and in a metastasis from one of the tumours, which contained HPV 16 (3 biopsies) and HPV 2 related sequences (1 biopsy).

Epidemiologie des benignen Paroxysmalen Lagerungsschwindels

Abstract: Every ninth patient with a previous history of vertigo at the ENT Hospital of the University of Freiburg suffers from BPPV. The incidence, some important pathogenetic factors and the clinical picture of BPPV are discussed. In young men posttraumatic aetiology dominates, whereas idiopathic BPPV prevails in perimenopausal women. The affected ear tends to be hard of hearing in the high frequencies and is sometimes hypoexcitable by caloric stimulation. The diagnosis is best made by personal examination with Frenzel's glasses in darkness. Electronystagmography, brainstem evoked response audiometry, and CT scanning are of no particular value in confirming the diagnosis of BPPV.

[Immunologic cerebrospinal fluid diagnosis using beta-2-transferrin principles and method].

Abstract: By using this method beta 2-transferrin, a protein variant can be identified. This variant is produced by neuraminidase activity of the brain and up to now could only be found in cerebrospinal fluid (CSF). In the analysis of CSF, by applying immunofixation with an antiserum and silver staining two bands, the beta 1-transferrin and the beta 2-transferrinband can be demonstrated. When examining serum, nasal secretion, tears, saliva and or other body fluids, only one band, the beta 1-transferrinband can be seen. It is therefore possible to identify CSF accurately. First of all methods of taking samples are explained and required analysis briefly described. Two points were of particular interest to us: The sensitivity of the method and Tracing of possible disturbing effects. Following several, different series of tests we got these results: 1 microliter pure CSF (that corresponds to approx. 1/50 of a drop) and 100 microliter CSF (two drops) per 1 ml nasal secretion can be identified by this method. It is possible that disturbing effects may be caused by blood contamination or a high protein content. For this reason haemoglobin must eliminated by using chromatography. Furthermore it is necessary to reduce a protein content of more than 5 g/l with ammonsulfat precipitation. If care is taken in respect of these two points disturbing effects can be avoided. In clinical application the immunological CSF identification seems to have a very high level of sensitivity and, in comparison with other methods many advantages.

[Mesenchymal (non-epithelial) salivary gland tumors. Analysis of 167 tumor cases of the salivary gland register].

Abstract: The total material of the Salivary Gland Register (1965-1985) contained 167 mesenchymal tumours with an intra- or paraglandular localisation. This corresponds to 1.5% of all cases of the Salivary Gland Register or to 5% of all salivary gland tumours. Periglandular tumours without relation to the salivary gland tissue, metastatic tumours or malignant lymphomas were not considered in this study. With respect to the localisation, the age and sex distribution and the histopathological classification the following results were obtained: 90% of all mesenchymal tumours were localised in the parotid gland and 10% in the submandibular gland. In lipomas, the percentage of the parotid gland was even 95%; in lymphangiomas, however, it was only 80%. Angiomas occur preferably in the first and second decades and represent in this age period nearly 90% of all mesenchymal tumours. The age peak of lipomas lies in the fifth to sixth decades, whereas neurogenic tumours are distributed relatively equal over the fourth to seventh decades. A sex disposition was seen in lipomas (85% in males), neurinomas (65% in females) and neurofibromas (75% in males). 90% were benign mesenchymal tumours, 10% sarcomas. Within the benign tumours 47.5% were angiomas, 22.5% lipomas, 16% neurogenic tumours and 4% rare benign tumours. In angiomas (79 cases) haemangiomas (50 cases), lymphangiomas (17 cases), mixed haemangiomas and lymphangiomas (9 cases) and haemangiopericytomas (3 cases) could be seen, in neurogenic tumours (27 cases) neurinomas (12 cases), neurofibromas (12 cases) and neurofibromatoses (3 cases), in sarcomas (17 cases) malignant fibrous histiocytomas (5 cases), malignant schwannomas (5 cases), embryonal rhabdomyosarcomas (4 cases) and other rare sarcomas (one case each myxoid liposarcoma, leiomyosarcoma, malignant haemangioendothelioma).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiofibrolipoma of the tonsil

Abstract: Benign tumors of the pharynx are very rare. The authors report on the remarkable case of a tonsillar angiofibrolipoma.

Funktionelle Elektrostimulation des denervierten M. posticus im Tierversuch: Histo- und biochemische Ergebnisse

Abstract: Histochemical and biochemical investigations have been carried out in 2 sheep following unilateral recurrent laryngeal nerve paralysis and direct electrical stimulation of the denervated posticus muscles. The stimulation effect was determined histochemically (standard ATP-ase staining) and compared with the fibre pattern of normal posticus muscles. In addition, one-dimensional gel electrophoresis of myosin heavy-chain isoforms was carried out and correlated with the histochemical results. A dramatic increase of type I fibres could be seen after long-term low-frequency direct electrical stimulation of denervated posticus muscles of the sheep. Biochemically the amount of slow myosin heavy-chain isoforms was higher than in normal muscles.

History of intubation

Abstract: The Arabian doctor Avicenna (980-1037) described the first orotracheal intubation in dyspnoea The history of peroral endotracheal intubation actually begins in the 18th century At that time obstetricians and lifesavers used breathing tubes In 1880 Macewen preoperatively intubated a patient to prevent the aspiration of blood during extirpation of a tumour from the base of the tongue Regular peroral intubation to keep the respiratory tract clear during narcosis was first applied by Franz Kuhn in 1900; unfortunately, the pioneer himself did not live to see his method become a routine procedure It was only as late as 1945, that endotracheal intubation became part of hospital practice at our clinic

Failures and complications following otoplasty

Abstract: Success of failure of otoplasties can be assured by individual aesthetic and objective evaluation. Objective complications after correction of prominent ears are discussed in the present paper: Complications following wrong operation techniques. Early complications such as haematoma, infection, fistuli and granuloma, allergic reactions, ulceration and asymmetry of the ears. Late complications such as reprotrusion, "telephoneear", cut edges, keloids, overcorrection and finally the so called "catastrophicear". Causes, prevention and therapy of these complications are presented.

Nuclear magnetic resonance tomography in the diagnosis of head and neck tumors. A comparison of methods

Abstract: 36 patients with carcinomas of different ENT regions were investigated by means of MRI, CT and B-mode ultrasonography (US). The images were evaluated by parameters of clinical importance: tumour detectability marginal appearance, internal architecture, regional extension, and artifact degradation. The results were compared with the clinical tumour staging in accordance with the TNM system. In MRI, a multiplanar imaging of tumour extension with horizontal, frontal and sagittal sections is possible. Together with a good contrasting of the tumour against the surrounding structures, these are major advantages over CT in the imaging of carcinomas of the tonsils, the hypopharynx and the larynx. For both methods, tumours of the tongue base and the floor of the mouth are a real challenge. Lymph node metastases can be visualised with MRI, but US is the method of choice for the evaluation of cervical lymph nodes.

[The Helium-neon laser effect on skin and oral mucosal tissue].

Abstract: The biological effects of the helium-neon (He-Ne) laser on skin and oral mucosa were examined for the first time electron microscopically. Canine epidermis, gingiva and sublingual regions were subjected to treatment by the helium-neon laser with varying exposure times. The exposed tissues were excised immediately after radiation and studied with an electron microscope. Depending on the exposure times, ultrastructural alterations were observed such as cytoplasmic vesiculation and vacuolization, mitochondrial changes, dilation of the endoplasmic reticulum, the Golgi cisternae and other endomembranes of the keratinocytes. Furthermore, ultrastructural changes were seen in stromal cells, endothelial cells of the blood and lymphatic vessels, nerves, muscle cells and in the extracellular compartment of the lamina propria. The ultrastructural alterations of different cell and tissue structures following helium-neon laser radiation were compared with the effects induced by other types of lasers. The results are discussed in light of the stimulation of biological cell processes by low-energy lasers.

Zur operativen Therapie der Schlucklähmung

Abstract: Disorder of deglutition is one of the severest signs in postoperative or posttraumatic paresis of the caudal cranial nerves. The main problem in these cases is aspiration. It is a serious disorder with potentially life-threatening pulmonary sequelae. In cases with unilateral paresis of the vagus and glossopharyngeal nerve we can consider the problem of surgical rehabilitation of swallowing as to be solved very well, as described in the present paper. However, in cases with bilateral vagus paresis we are faced with many more problems especially in the high-grade aspiration syndrome. The surgical procedures are described.

Der monoklonale Antikörper UW 21/123: Klinische Anwendung und diagnostische Spezifität bei Kopf- und Halskarzinomen*

Abstract: In addition to the originally described monoclonal antibody (MAB) against laryngeal carcinoma cells (Arch. Otorhinolaryngol. 233 (1981) 161) a new MAB was induced by means of somatic cell hybridisation techniques. The MAB UW 21/123 enables recognition of a group of squamous cell carcinomas of the head and neck. An in-vitro assay was designed allowing clinical diagnosis of malignancy in 18% out of 211 tumour patients.

Hyperbare Oxygenation - eine sinnvolle Zusatztherapie bei Otitis Externa Maligna

Abstract: This study shows the effect of hyperbaric oxygenation as an adjunctive therapy in malignant external otitis on the basis of three cases: one stage I, one stage II, two stages III (according to Ganz). Due to the successes achieved, and basing on a comparative study of the literature, we can conclude, even without a control group, that hyperbaric oxygenation exercises a positive influence on the reduction of Pseudomonas aeruginosa in the external auditory canal, and on the symptoms of pain and regeneration of cerebral nerves injured with a broad-spectrum allergy to antibiotics, even the exclusive application of the hyperbaric oxygenation proved successful.

Bewertung der Real-time-Sonographie im prätherapeutischen Staging maligner Zungen- und Mundbodentumoren*,**

Abstract: Based on our three years experience with about 200 transcutaneous real-time sonographies of the tongue and the floor of mouth, an assessment of the determination of size and site of 38 pretherapeutically examined malignant tumours (35 squamous cell carcinomas) was made. The patients were examined in reclined position, the head retroflected. Curved array transducers of 5 or 7.5 MHz and a silicon elastomer block as interface turned out to be optimal. All tumours could be detected by sonography as hypoechoic, more or less homogeneous, ill-defined areas. Two thirds of the tumour ulcerations could be seen as hard hyperechoic reflexes within the hypoechoic areas. When comparing the maximal diameter of tumours of the 20 operated patients, we found an agreement (5 mm tolerance) of sonography with the surgical specimen in 14 of 20 tumours (70%), of sonography with the clinically estimated diameter in 10 of 20 tumours (50%), whereas the clinically estimated diameter was in agreement with the surgical specimen in only 8 of 20 tumours (40%). A peritumoral inflammatory infiltration can simulate a larger tumour size in sonography. The extent of tumours within the tongue, to the floor of mouth, the lateral pharyngeal wall and the preepiglottic space was documented correctly in most cases. In three cases a previously unknown spread across the midline was found sonographically. Including the sonographic findings in the TNM classification, 5 T1 tumours would have been staged as T2 and one T3 tumour as T4. Inflammatory diseases of the tongue can show the same sonomorphology as malignant tumours.

Therapeutic limits of endonasal fenestration of the maxillary sinus

Abstract: The endoscopical examination of the diseased maxillary sinus is a common procedure. In cases with obstruction of the ostium the intranasal antrostomy is carried out. 117 operations were followed up 1-7 years postoperatively. In 25.6% of the cases the windows into the inferior meatus were closed. The operation did not yield any improvement of the clinical features in 37% of the cases. There was no correlation to a open or closed window. In these patients the endoscopical and radiological examinations now revealed a diseased ethmoid. Instead of intranasal antrostomy, endoscopical endonasal surgery of the anterior ethmoid (technique of Messerklinger) is recommended. With this procedure, reestablishment of free ventilation of the maxillary sinus is combined with the diagnosis and the therapy of the diseased anterior ethmoid.

[Low-molecular-weight hydroxyethyl starch or low-molecular-weight dextran in acute inner ear disorders? A randomized comparative study].

Abstract: In two independently conducted randomised studies, the therapeutic effects of the low-molecular weight plasma expander dextran 40 (Thomaedex 40) and 6% hydroxyethyl starch 40/05 (Expafusin) in cases of sudden deafness and acute acoustic trauma were compared. No significant differences were observed regarding hearing gain and alleviation of tinnitus. The measured hearing gains corresponded to those reported for dextran in the literature. Hydroxyethyl starch has the advantage that there is no need to take preventive steps against allergies, but is expelled more rapidly than dextran by the body with simultaneous deposition of minimal quantities in the liver. For the time being, the main factor affecting the decision between these two substances will be their sales price.

[Hearing disorders in Paget's disease].

Abstract: The audiometric data of 41 patients with Paget's disease of the bone show that hearing loss exceeds the age-related presbycusis in patients with deformities of the temporal bone as demonstrated by X-ray (27%). The usual type of hearing loss is a sensorineural one. 80% of these patients showed hair cell damage, 32% of them a retrocochlear lesion, depending on the degree of deformity of the temporal bone. Conductive hearing loss of the otosclerosis type was found in only 20%. The Paget-related hearing loss can be regarded as a consequence of the deformation occurring both at the bone surrounding the cochlea and at the internal auditory canal.

Arzneimittelnebenwirkungen auf die Nasenschleimhaut und den Geruchssinn

Abstract: Several drugs may induce pathologic changes of the nasal mucosa, especially at a long-term treatment. The clinical appearance of an allergic or vasomotoric rhinopathy, a chronical hyperplastic or an atrophic rhinitis, hemorrhagic changes of the mucosa with the incidence of epistaxis or smelling disorders may be caused by several drugs. The ENT-specialist, therefore, should always take in consideration the various drugs, which the patient received but mostly have been prescribed by another doctor.

[Kaposi's sarcoma of the larynx].

Abstract: Kaposi's sarcoma of the larynx is a rarely observed manifestation of AIDS. Possible concomitant symptoms are hoarseness up to aphonia, urge to cough or stridor. Expectoration of small parts of tissue of Kaposi's sarcoma may be an additional sign. Similar to Kaposi's sarcoma in the oral cavity Kaposi's sarcoma of the larynx is characterised by a purplish, spongy nodule. Its surface can be verrucous due to deposits of dry secretion. Local extirpation of Kaposi's sarcoma removes the laryngeal signs and symptoms.

[Limited function of the large salivary glands of the head. A new aspect for the etiopathogenesis of cancers of the oral cavity, oropharynx and hypopharynx]

Abstract: Function and morphology of the major salivary glands were investigated in patients suffering from carcinomas of the oral cavity, the oropharynx and the hypopharynx. In comparison to the results obtained from healthy control subjects, the tumour patients showed significantly decreased flow-rates of parotid and submandibular saliva. Furthermore the excretion of IgA, lysozyme and total protein and the pH-value in both, the parotid and the submandibular saliva of the patients was significantly lowered. The histological feature of the salivary glands of the patients was characterized by interstitial deposition of fat. In several cases a swelling and a degranulation of the acinar cells was observed additionally. Other patients showed an atrophy of the acinar cells. Sometimes an inflammatory reaction could also be noted in the submandibular and/or the parotid glands of patients suffering from head and neck cancer. The decreased salivary gland function reflects a reduction of the protective mechanisms of the oral cavity and the pharynx. Additionally it enables an increased penetration of environmental carcinogens through the mucous surface, and therefore has to be discussed as a factor for the etiology of carcinomas of the upper aerodigestive tract.

Zur Wirkung von Aminoglykosiden auf den experimentell erzeugten endolymphatischen Hydrops

Abstract: Gentamycin or kanamycin have no effect on endolymph formation in experimental induced endolymphatic hydrops. The increase of endolymphatic volume after obliteration of endolymphatic duct and sac is not influenced by aminoglycosides as well as the decrease of DC-potential and the increase of sodium-activity in endolymphatic hydrops. The way of action of intratympanal injected gentamycin seems to be in a partial chemical induced labyrinthectomy.

Significance of computerized tomography in middle ear diagnosis

Abstract: Due to the important improvement represented by the latest computed tomography (CT) technology in respect of detail and excellent contrast resolution normal and pathological structures of the inner and middle ear can be visualised The clinical and diagnostic value of CT in comparison to standard x-rays and tomography is prospectively evaluated on the basis 74 patient examinations Today CT is unsurpassed in the diagnosis of cholesteatomas and glomus tumours and ranks first among all imaging modalities Chronic inflammatory diseases and deformities of the middle ear can be evaluated in most cases on the basis of standard x-rays and tomography The importance of CT is primarily complementary, except in preoperative cases Fractures should be visualised first via standard x-rays In cases of questionable complications (eg tympanic or intracranial haematomas), CT should be the next step Conventional tomograms are not necessary

[Gustatory sweating following parotidectomy. Frey's syndrome].

Abstract: 398 out of 700 patients (= 56.8%), who underwent parotidectomy in the years 1969-1982 at the ENT-Clinic, University of Munster, answered a follow-up study on the postoperative onset of the auriculotemporal syndrome. We investigated the relations between marked sweating and different surgeons, surgical techniques, histology, lesions of the facial nerve, first appearance and mechanisms to elicit the sweating. The results are discussed with regard to the different hypotheses on the development of Frey's syndrome. No unequivocal indications regarding the cause of Frey's syndrome could be established.

Ein Plasmozytom der Ohrspeicheldrüse

Abstract: Extramedullary plasmocytomas of the salivary glands are extremely rare. Not more than four cases have been described in the literature. A further case of an extended extramedullary plasmocytoma of the parotid gland is presented. Radiotherapy of 40 Gy was sufficient for a complete remission of this tumour. Only three months later, however, the patient developed multiple medullary plasmocytoma, which could not be influenced by cytostatic drug treatment. Twelve months after diagnosis, the patient died from medullary plasmocytoma, but without any signs of local recurrence in the parotid gland. The prognosis of extramedullary plasmocytomas of the salivary glands seems to be poor, as about half of the presented cases developed multiple medullary plasmocytoma. Local recurrence at the primary site, however, was not seen in any case. Surgical treatment of extramedullary plasmocytomas of the salivary of extramedullary plasmocytomas of the salivary glands is recommended for those cases where complete removal of the tumour masses seems possible without greater functional damage. Extended plasmocytomas, especially of the parotid gland, should be treated by radiotherapy. They have an excellent radiosensitivity, and the high risk of multiple medullary plasmocytoma in these cases does not seem to justify a mutilating surgery including hemimandibulectomy or sacrifice of the facial nerve.

How important is preservation of the accessory nerve in neck dissection

Abstract: Preservation of the spinal accessory nerve in radical or modified neck dissection is oncologically accepted in order to avoid the sequelae of the so called "shoulder syndrome". In 23 patients, on whom 29 neck dissections had been performed, the functional results were evaluated on an average 2.6 years postoperatively. 19 patients were radiated post surgery. Clinical and electromyographic examination revealed paresis of 62% of the preserved accessory nerves. Nevertheless, only 48% of the patients suffered from the shoulder syndrome, the remaining were able to innervate or compensate for the resulting deficit. Postoperative functional exercises are mandatory to prevent the shoulder syndrome and to make the preservation technique a worthwhile concept.

[Was Beethoven's deafness caused by Paget's disease? Report of findings and study of skull fragments of Ludwig van Beethoven].

Abstract: Paget's disease of bone (osteitis deformans) has been repeatedly named as a possible cause for Ludwig van Beethoven's deafness. In 1985 a descendent of Franz Romeo Seligmann (a Viennese medical historian who in 1863 had studied Beethoven's mortal remains on the occasion of their relocation) presented to us three bone fragments allegedly from Beethoven's cranium. They represented fragments of the left parietal bone and the occiputum. It was possible to prove nearly with certainty that these bone fragments actually are Beethoven's. They did not show signs of Paget's disease of bone. It must therefore be concluded that Beethoven's deafness was not caused by Paget's osteitis deformans.

An implant for stimulation of the acoustic nerve with 12 channels

Abstract: A portable hearing aid for direct stimulation of the eighth cranial nerve was developed and translated into reality. The system (Fig. 1) consists of two components, the portable transmitter and the receiver to be implanted in the mastoid. The speech signal, received in a microphone, is divided into 12 frequency bands in the transmitter (Fig. 2). The outputs are transferred via a vocoder system with pulse amplitude modulation and using a small transmitting device for signals and for energy to the receiver. The implantable receiver (Figs. 3 and 8) transfers the signals in the 12 channels into the electrical stimuli of the electrodes which are pushed into the nerve in a form of a bunch (Fig. 9). In this manner--similar to normal hearing, although much coarse--tonotopic frequency-place transformation can be achieved.

Cisplatin ototoxicity. A clinical study

Abstract: The ototoxicity of cis-DDP (cisplatin) has been known for some time. It affects the outer and inner hair cells of the cochlea which are damaged. So far, the data laid down in the literature concerning extent and frequency of hearing defects differ widely. In the present study we analysed the ototoxic effect of cis-DDP in 124 patients with different types of carcinoma. We investigated a possible dependence of ototoxicity of the patient's age, the platinum dose, the manner of administration, and of the previously existing audiometric anomaly. In 48% of the patients studied we found a therapy-induced, dose-dependent hearing defect mainly at a high frequency range (4-8 kilohertz). Its degree is influenced by the mode of cisplatin application. The most serious hearing defects were caused by a dose of 100 mg per square metre body surface. The results of our investigations are discussed and compared with those of other clinical studies.