„Ein-Schuss-CO2-Laser-Stapedotomie“

BACKGROUND: In order to further optimize the surgical technique with CO(2) laser in stapes surgery, a scanner system was used to obtain a footplate perforation of 0.5-0.6 mm with only one laser application ("one-shot" stapedotomy). PATIENTS AND METHODS: A total of 255 patients with otosclerosis were submitted to primary CO(2) laser stapedotomy with a SurgiTouch scanner. This study discusses the surgical technique and clinical results. RESULTS: An adequately large perforation diameter could be achieved with a single shot in 68% of the patients treated. In 14% of the patients, a second laser application at the same site was necessary. In 18% the perforation had to be enlarged by several slightly overlapping laser applications without using the scanner. There was no evidence of laser dependent inner ear affections. CONCLUSION: CO(2) laser, combined with modern scanner systems, is well suited for application in stapes surgery.     

Das „ancient schwannoma“

"Ancient schwannomas" of the mouth floor are rare, benign neoplasms derived from the nerve sheath of peripheral nerves. They show many degenerative changes such as necrosis and vascular thrombosis. Ancient schwannomas show histopathological features, such as degenerative changes and atypical nuclei, and may easily be confused with malignant neoplasms. B-scan sonography for the mouth floor and MRT imaging may be helpful in differential diagnosis. Here, we report on a patient with ancient schwannoma of the floor of the mouth.     

Die „idiopathische“ Perichondritis der Ohrmuschel und das „spontane“ Othämatom

Ohne Zusammenfassung     

Sind „Totalaufgemeisselte“ kriegsidensttauglich?

Ohne Zusammenfassung     

Der Bochumer Nachsorgepass „Tumorerkrankungen HNO“

Background

The damage caused by cancer disease is multidimensional, affecting a patient physically, emotionally, and intellectually. A post-cancer documentation system is necessary that takes into account a patient’s psychosocial well-being. With this objective in mind, the aftercare journal was developed for tumor diseases in otorhinolaryngology in the Department of Otorhinolaryngology of the Ruhr University Bochum.

Methodology and patients

From April 2002 to May 2003, 112 patients received a standardized questionnaire to evaluate the aftercare journal newly introduced in Germany for ENT tumor diseases. Six items were presented: outer appearance, format/size of the journal, clarity in the design, recording areas relevant to the disease, improvement in the tumor aftercare, and personal feeling of safety. An evaluation scale of zero to four points served as the basis for assessment. A high point value represented the higher degree of patient satisfaction for each respective item.

Results

In all six items, the assessment of the journal predominantly showed agreement of the patients. Assessing the improvement in tumor aftercare and providing a personal feeling of safety, patients with shorter disease remission had a tendency to allocate low point values.

Conclusion

The aftercare journal for ENT sets the trend for documentation systems in cancer aftercare. The study proved the need to consider concerns of the disease related to medical and psychosomatic factors in patients as a standard for modern psychosocial oncology.     

„Field cancerization“ im oberen Aerodigestivtrakt

The term "field cancerization" was coined by Slaughter in1953 when describing multifocal synchronous and metachronous carcinogenesis in the upper aerodigestive system. Patients suffering from head and neck cancer (HNC) have or develop a second esophageal squamous cell cancer (ESCC) or bronchial cancer (BC) in 5-14% of cases. When a second esophageal cancer occurs in a patient with HNC, the prognosis is generally determined by the ESCC, and, unfortunately, it is poor. Screening and surveillance by Lugol chromoesophagoscopy enable early detection and curative treatment of second esophageal neoplasias. Surveillance appears to result in a survival benefit for HNC patients. Vice versa, patients with ESCC or BC have a risk of about 10% for developing HNC. Periodic pharyngolaryngoscopy is recommended for curatively treated ESCC or BC patients. Patients with field cancerization should be surveilled by a multidisciplinary approach.     

Die „Münsteraner Klassifikation“

Background

Slight high frequency hearing loss following cisplatin chemotherapy can be proof of an ototoxic effect even when hearing ability is not yet clinically affected. To answer scientific questions, such as the relationship between cisplatin ototoxicity and drug regime or individual tolerance, early detection of ototoxicity and a classification relating to intensity and the affected frequencies are required. A search for relevant literature resulted the WHO-classification (1991) describing clinically relevant hearing loss and two high frequency hearing loss classifications published by Khan et al. (1982) and Brock et al. (1991). Their application is compared to a new, proprietary classification.

Patients and methods

55 patients (32 boys, 23 girls) undergoing cisplatin chemotherapy at Muenster University Hospital from 1999 to 2004 underwent audiometric tests in our department. From this data we developed a grading system, that was based on the WHO classification, but paid special attention to early ototoxic effects, to intensity of hearing loss and to the frequencies affected: Grade 0 (normal hearing) includes hearing loss of not more than 10 dB in all frequencies. Grade 1 (beginning hearing loss) encompasses >10 dB up to 20 dB in at least one frequency or tinnitus. Grade 2 (moderate impairment) describes hearing loss ≥4 kHz and differentiates 2a (>20 to 40 dB), 2b (>40 to 60 dB) and 2c (>60 dB). Hearing loss <4 kHz >20 dB in grade 3 (severe impairment, hearing aids needed) is further classified according to grade 2 in a, b and c. Grade 4 (loss of function) finally decribes average hearing loss <4 kHz of at least 80 dB. This classification is compared to the two high frequency hearing loss classifications (Khan et al. and Brock et al.).

Results

The Muenster classification, compared to Khan et al. and Brock et al., demonstrated the best results in the early detection of hearing loss: All children with hearing loss of at least 20 dB after therapy had already shown pathological audiograms during treatment, when those audiograms were assessed by our classification. All children whose audiograms were flagged as pathological by our classification finally developed hearing loss. In terms of the prediction of hearing loss, our classification evualated processing audiograms with a sensitivity, specifity and efficiency of 1.0. Progressive hearing loss was detected in 45 patients (Khan et al. 30, Brock et al. 38). Therefore our classification showed a better suitability for monitoring hearing loss than the other classifications.

Conclusion

The Muenster classification is a suitable new basis for scientific questions concerning cisplatin ototoxicity. It detects hearing loss earlier and maps progression of hearing loss more precisely than the existing high frequency classifications (Khan et al. and Brock et al.).     

Ueber die sogenannte „Electro-Otiatrik“ Brenner's

Ohne Zusammenfassung     

Untersuchungen zum „Informational Masking“ bei Kochleaimplantat-Nutzern

Background

Informational masking (IM) refers to the problem of understanding target speech in the simultaneous presence of a masking speech signal. The adverse effects are attributable to the additional information provided by the competing talker. Cochlear implant (CI) recipients are not able to understand speech satisfactorily in situations such as these. The aim of the present study is to examine the extent to which CI recipients are able to use differences between the speakers with respect to level (target-to-masker ratio, TMR) and fundamental frequency (f0) in order to improve speech intelligibility.

Subjects and methods

Target (TS) and masker sentences (MS) were selected from the Oldenburg Sentence Test (OlSa) and were modified and superimposed. The TS were explicitly labelled using a keyword. The MS were changed with respect to TMR and f0. The TS intelligibility of different modifications was measured in six post-lingually deafened CI recipients and six normal listeners (NL).

Results

The NL revealed speech understanding close to 100% even for small differences in f0 of 40 Hz or level differences of 5 dB. In CI recipients, a significant change in intelligibility could only be demonstrated with increased TMR, but not with differences in f0.

Conclusions

In CI recipients, IM cannot be reduced by means of differences in f0 between the competing talkers, but only by level differences. This might be explained by the restricted spectral resolution and the insufficient transmission of f0 in CIs. Adverse effects in NL can predominantly be attributed to IM, while additional masking effects take place in CI recipients.     

„Die Nachbehandlung der Totalaufmeisselung ohne Tamponade“

Ohne ZusammenfassungBemerkung zur Arbeit des Herrn Dr. Stein-Königsberg i. Pr.(A. f. O. Bd. 70, S. 271.)     

„Zur Endoskopie des Ostium pharyngeum tubae“

Ohne Zusammenfassung     

Die nasenrückenerhaltende „Dorsal-Preservation“-Septorhinoplastik

HNO - In der ästhetischen und funktionellen Nasenchirurgie ist die Höhenreduzierung des Nasenrückens ein wichtiges Werkzeug. Hierfür stehen mehrere technische Optionen zur...     

2. „Zur Mechanik des Mittelohres.“

Ohne ZusammenfassungBemerkungen zu dem Artikel von Gustav Zimmermann.