Semantic paraphasia.

In the present paper a large corpus of semantic word selection errors from a severe Wernicke's aphasic is analyzed in accordance with a taxonomy recently proposed in the literature. In an attempt to demonstrate the systematicity of the aphasic substitutions, the errors are classified along a wide range of conceptual spheres. In addition, recent theories of the Russian neuropsychologist A. R. Luria are considered in providing an explanation for lexical selection deficits. Finally, comparisons are made between aphasic errors and similar errors seen in "slips-of-the-tongue" in non-brain damaged normal subjects.     

Paraneoplastic syndromes in patients with primary malignancies of the head and neck. Four cases and a review of the literature

Paraneoplastic syndromes rarely affect patients with head and neck cancer. Four patients with different histological types of head and neck cancer are presented in which the primary malignancy was preceded and/or accompanied by a paraneoplastic syndrome. In the first patient erythrodermia preceded the diagnosis of a nasopharyngeal carcinoma. The second patient presented with a B cell lymphoma of the nasopharynx in association with the syndrome of inappropriate secretion of arginine vasopressine (Schwartz-Bartter syndrome). In the third patient paraneoplastic polyarthritis had been diagnosed 5 months before a hypopharyngeal carcinoma was diagnosed. In the last patient the paraneoplastic anti-Hu positive encephalomyelitis was associated with a primary malignancy in the larynx with neck metastases. Diagnostic procedures, treatment and follow-up of these patients are reported and accompanied by a review of the literature.     

Sudden hearing loss with delayed onset following head trauma

Eight cases are reported with an identical history: head trauma with immediate profound deafness and vestibular dysfunction in one ear; then after a long latency, sudden hearing loss in the second ear, recurring and fluctuating with vestibular symptoms. Two cases were surgically explored. In one case 15 years after the trauma a perilymph fistula of the round window was found. In the other case a broad fracture of the basal coil of the cochlea was demonstrated, which had been asymptomatic for 18 years. In a retrospective study, 6 more cases with an identical course could be found. Latency between trauma and onset of symptoms in the second ear ranged from 4 to 33 years. Therapeutic and medico-legal aspects are discussed.     

Explaining and controlling regression to the mean in longitudinal research designs.

This tutorial is concerned with examining how regression to the mean influences research findings in longitudinal studies of clinical populations. In such studies participants are often obtained because of performance that deviates systematically from the population mean and are then subsequently studied with respect to change in the trait used for this selection. It is shown that in such research there is a potential for the estimates of change to be erroneous due to the effect of regression to the mean. The source of the regression effect is shown to arise from measurement error and a sampling bias of this measurement error in the process of selecting on extreme scores. It is also shown that regression effects are greater with measures that are less reliable and with samples that are selected with more extreme scores. Furthermore, it is shown that regression effects are particularly prominent when measures of change are based on changes in dichotomous states formed from quantitative, normally distributed traits. In addition to a formal analysis of the regression to the mean, the features of regression to the mean are demonstrated via a simulation.     

The leishmaniasis - a parasitel infection as differential diagnosis of malignant tumours of oral mucosa. A case report and review of literature]

Although parasitel infections in northern Europe are rare, it must be considered as differential diagnosis of malignant tumours of mucous membrane.With increasing tourisms in endemic areas, infections with parasite pathogen are spreading in non-endemic areas as well. In this case a mucous membrane malignancy with clinical feature of ulcer on unusual location was imitated. In this reported case the patient suffers with hepatitis c, causing cirrhosis of the liver and making a liver transplantation necessary. In this patient a history of a leishmaniosis which had been treated successful by the tropical institute is reported, but because of a new actually leishmaniosis-infection a liver transplantation is contraindicated. Under oral therapy with Miltefosin (IMPADIVO) a remission was successful.The leishmaniosis is a classical tropical disease. WHO reported a morbidity of nearly 12 million people in 88 countries around the world especially in tropical areas. Repeatedly infections in northern Europe caused by the phlebotonus-sandflies are described.Therefore leishmaniosis must be considered as differential diagnosis in suspect lesions of mucous membrane.     

Surgical rehabilitation of neuromuscular swallowing disorders with special regard to cricopharyngeal myotomy and glottopexy]

Surgical Rehabilitation of Neuromuscular Swallowing Disorders with Special Regard to Cricopharyngeal Myotomy and Glottopexy. BACKGROUND: The surgical rehabilitation of patients with swallowing disorders caused by neuromuscular insufficiency with life-threatening aspiration presents a special challenge to the ENT-surgeon. METHODS: In a period of 5 years we decided on a surgical treatment in altogether 12 patients with paralytical dysphagia. In 6 patients we combined a cricopharyngeal myotomy with a complete closure of the glottis, in 5 patients we performed a sole cricopharyngeal myotomy. In another patient we restricted ourselves to glottopexy only. RESULTS: In all cases the dysphagia giving rise to the surgical intervention was regredient so far that the removal of the percutan endoscopic gastrostomy postsurgically was possible. 3 special cases are presented in detail. DISCUSSION: The main part of the therapy is the subtle and complete cricopharyngeal myotomy. Particulary good results are available with a combination of the latter with a reversible glottopexy. CONCLUSIONS: After the failure of conservative therapy the indication for a surgical treatment should be made on a large scale.     

Schwannomas of the head and neck in children

Schwannomas are relatively rare tumors that arise from Schwann cells of the sheaths of peripheral nerves. They may be found in any portion of the body. In reported series of schwannomas, the percentage of tumors in the head and neck varies from 16% to 45%. Usually demonstrating slow growth, they often have a history of long duration, and are most often diagnosed in adults. Approximately 10% of schwannomas are diagnosed in patients under 21 years of age. In this paper two children with large schwannomas of the head and neck are reported. In both, the symptoms were of relatively short duration, but physical findings suggested that the tumors had been present much longer. One patient was a 10-year-old female with a schwannoma filling the anterior and posterior triangles of the left side of her neck and extending superiorly to the base of the skull. The tumor intimately involved the vagus, spinal accessory, and hypoglossal nerves. The other patient was a 12-year-old female with a nasal tumor filling the right naris and nasopharynx. Our management of these patients is discussed.     

Zellbasierte Strategien für die Speicheldrüsenregeneration

Xerostomia as a side effect of radiotherapy or due to Sj?gren's disease leads to considerable impairment of the quality of life of the affected patients. Preventive treatment approaches such as intensity-modulated radiotherapy, surgical transfer of a submandibular gland to a site outside the radiation field or administration of amifostin during radiation treatment are not yet completely established in clinical practice and are not applicable for all patients. Symptomatic treatment with pilocarpin or synthetic saliva leads to an improvement of the symptoms only in some patients, and in the case of pilocarpin significant systemic anticholinergic side-effects might occur. Because large numbers of patients are affected and current treatment options are not satisfactory, it is essential to develop new treatment options. In parallel with the in vitro production of functional salivary gland constructs by means of tissue engineering techniques, attempts are currently under way to experimentally restore salivary gland function by genetic treatment approaches such as transfection of the affected salivary glands with aquaporins or pro-angiogenic factors. In addition, the in vivo application of stem cells is under investigation. In the present paper, we discuss the clinical and radiobiological background of xerostomia and highlight possible innovative future treatment options.     

Epidemiologic patterns in childhood hearing loss: a review

In an attempt to clarify international epidemiologic trends, a review of the published literature pertaining to childhood hearing loss is presented. Inconsistencies of methodology and classification, which complicate the interpretation of data and make difficult the quantification of the influence of genuine population differences, are discussed. Selective review of the literature allows certain crude statements to be made regarding childhood hearing loss. In developed countries, serous otitis media is the most common cause of hearing loss in children, affecting up to two thirds of preschool children. In addition, 1.0-2.0/1000 children have bilateral SNHL of at least 50 dB. In underdeveloped countries, suppurative middle ear disease is common and is still frequently associated with either an intratemporal or intracranial complication. SNHL appears to occur almost twice as often as in developed countries, with a greater proportion being of infectious etiology. In specific populations, the Inuits, Amerindians and Aboriginals, acute and chronic suppurative otitis media are almost endemic, yet both cholesteatoma and serous otitis media are uncommon.     

S-100 immunoreactivity identifies a subset of hair cells in the utricle and saccule of a fish

Certain hair cells of fish exhibit strong immunoreactivity to an S-100 antibody. By their spatial locations in the utricle and saccule, these hair cells appear to possess a relatively short kinocilium and a roughly ovoid cell shape. In the utricle, these cells are predominantly located in the striola. In the saccule, these cells are found within the central area of the epithelium. In both of these epithelia the strongly immunoreactive hair cells coincide with the locations of hair cells possessing F1 ciliary bundles.     

Procedure in case of suspected mycobacterial infection of lymph nodes of the neck. 2. Therapy

In the treatment of tuberculosis the patients normally receive a two month daily treatment with Isoniazid, Rifampicin, Pyrazinamid and Ethambutol, followed by a daily treatment with Isoniazid and Rifampicin for four month. The atypical mycobacterial infections can be addressed as a local infection and are amendable to surgical therapy, eventually followed by a daily treatment with antibiotics for four to twelve weeks. In Germany it is obligatory to inform the local public health department about typical mycobacterial infections. Hygiene procedures following German law are discussed in this review.     

In vitro experiments with Nd:YAG laser surgery on the turbinates

BACKGROUND: Turbinate surgery is a therapeutic method for the treatment of the obstruction of nasal respiration. In this paper the dimensions of the laser lesions are described. In addition macro- and microscopical findings after laser surgery are given. METHODS: 10 human lower and 4 middle turbinates in vitro were treated with the Nd:YAG-laser in the non-contact mode (1064 nm, 2.5-25 W, cw). Stripe-like lesion with 3 cm length were produced. In addition the posterior end of the lower turbinates and the head of the middle turbinates were vaporized. RESULTS: Width, depth and volume of the lesions are given in dependence of laser power and irradiation time. The histological changes immediately after laser treatment are described. CONCLUSIONS: The energy doses for a clinical relevant stripe-like laser lesion of 3-4 cm in length of the lower turbinate is about 1500 Ws using Nd:YAG-laser. For evaporation of a posterior end of the lower turbinate 360 Ws are required using Nd:YAG-laser. For evaporation of the head of the middle turbinate a doses of about 1500 Ws are required using Nd:YAG-laser.     

Voice rehabilitation after total laryngectomy in West Germany. Current state of the art

In 1987 Lopez published the results of a survey of voice rehabilitation after total laryngectomy as carried out by 400 North American ENT surgeons. In order to obtain the same information on the current state of voice rehabilitation in the German Federal Republic we did a similar survey of 103 ENT clinics. Ninety-five (92%) questionnaires were evaluated. Each year, 2200 laryngectomies are carried out in Germany. Oesophageal speech is the most frequently used form of voice rehabilitation in both countries. In the USA voice prostheses are fitted by 88% of the surgeons questioned to a total of 30% of patients; in Germany only 22% of the clinics in which laryngectomy is carried out fit these devices to a total of 5.6% of patients. External vibrators are used with equal frequency (28%). In contrast to the United States, where intraoral aids are currently used in 15% of patients, we do not employ these at the present time at all. Voice shunt operations (Staffieri, Asai, Amatsu etc.) are still carried out in 7 clinics (6.7%) on 0.7% of all patients (USA: 16% of surgeons on 15% of patients). In the United States 9% of patients are not rehabilitated compared with 6.7% in the Federal Republic.     

The role of connexins in human disease

Connexins are the building blocks of gap junctions. In forming a gap junction, six connexins oligomerize to form a hexameric torus called a connexon. The number of gap junctions in a cell ranges from a few to over 105 and imparts to interconnected cells a uniform phenotype. The crucial role that gap junctions play in normal physiology is reflected by the diverse spectrum of human diseases in which allele variants of different gap junction genes are implicated. In particular, mutations in GJB2 are a major cause of autosomal recessive non-syndromic deafness. This discovery has impacted medical practice and makes it incumbent on clinicians to familiarize themselves with the genetic advances that are rapidly occurring in our field.     

Radiofrequency vs laser in the management of mild to moderate obstructive sleep apnoea: does the number of treatment sessions matter?

OBJECTIVE AND HYPOTHESIS: Obstructive sleep apnea (OSA) is a relatively common and serious problem with many medical and social consequences. Laser and radiofrequency are two recent techniques used to treat OSA and they can be carried out under local anaesthesia, but they need multiple sessions to achieve satisfactory outcome and are associated with better short-term than long-term outcomes. In this work we compare the two modalities as regards the optimal number of treatment sessions needed to achieve a favourable outcome in the short and long term. STUDY DESIGN: A total of 150 patients with apnoea hypopnoea index (AHI) between 5 and 30 events per hour, no morbid obesity and retropalatal site of obstruction were included in this prospective study. METHODS: Patients were randomly and equally divided into two groups, each comprising 75 patients. The first group was treated with bipolar radiofrequency volumetric tissue reduction of the palate (BRVTR) and the second group was treated with laser-assisted uvulopalatoplasty (LAUP). Each group was further subdivided into five subgroups each consisting of 15 patients. The first group received one treatment session, the second received two sessions, the third received three sessions, the fourth received four sessions and the fifth group received five treatment sessions. Evaluation of efficiency of both techniques in treating OSA was assessed objectively by polysomnography. RESULTS: In those treated with BRVTR; at least three sessions were needed to achieve a favourable outcome in OSA in the short and long term. In those treated with LAUP, a single treatment session was enough to achieve a favourable outcome on OSA in the short term, while two sessions were needed to achieve the same long-term outcome. DISCUSSION: In OSA, fewer treatment sessions are needed with LAUP (one session) than with BRVTR (three sessions) to achieve a favourable outcome. In LAUP more treatment sessions (two) are needed to maintain a longer-term favourable outcome than those needed to achieve short-term favourable outcome (one session), which is not the case with BRVTR (three sessions are needed to achieve both short- and long-term favourable results).     

The Final Stage of Cholinergic Differentiation Occurs Below Inner Hair Cells During Development of the Rodent Cochlea

To gain further insights into the cholinergic differentiation of presynaptic efferent terminals in the inner ear, we investigated the expression of the high-affinity choline transporter (ChT1) in comparison to other presynaptic and cholinergic markers. In the adult mammalian cochlea, cholinergic axons from medial olivocochlear (OC) neurons form axosomatic synapses with outer hair cells (OHCs), whereas axons from lateral OC neurons form axodendritic synapses on afferent fibers below inner hair cells (IHCs). Mouse brain and cochlea homogenates reveal at least two ChT1 isoforms: a nonglycosylated ∼73 kDa protein and a glycosylated ∼45 kDa protein. In mouse brain, ChT1 is preferentially expressed by neurons in periolivary regions of the superior olive consistent with the location of medial OC neurons. In the adult mouse cochlea, ChT1-positive terminals are located almost exclusively below OHCs consistent with a medial OC innervation. Between postnatal day 2 (P2) and P4, ChT1-positive terminals are below IHCs and occur after the expression of growth-associated protein 43, synapsin, and the vesicular acetylcholine transporter. By P15, ChT1-positive terminals are mostly on OHCs. Accounting for differences in gestational age, the developmental expression of ChT1 in the rat cochlea is similar to the mouse. However, in older rats ChT1-positive terminals are below IHCs and OHCs. In both rat and mouse, our observations indicate that the onset of ChT1 expression occurs after efferent terminals are below IHCs and express other presynaptic and cholinergic markers. In the mouse, but not in the rat, ChT1 may preferentially identify medial OC neurons.     

Wegener's granulomatosis: otologic and clinico-immunologic aspects]

Clinical, audiometric and immunological data of 26 patients with histological proven Wegener's granulomatosis are presented. In 21 patients the middle ear was involved with serous otitis media, adhesive process or subacute otitis media. 28 of 36 audiometric examinations showed a mild to moderate sensorineural hearing loss. One ear did not recover from a sudden deafness in the early stage of the disease despite of immunosuppressive therapy. Beside clinical and morphological findings in Wegener's granulomatosis the detection of anticytoplasmic antibodies against neutrophil granulocytes (ANCA) is a reliable method in diagnosing the disease. In the present study, the serum of 19 out of 26 patients with histologically proven Wegener's granulomatosis was examined for ANCA by immunofluorescence test. In high activity stage of Wegener's granulomatosis all sera showed a positive ANCA-test. 39 patients with systemic vasculitis served as controls. Only two sera from patients with leucocytoclastic vasculitis and two with panarteriitis nodosa were ANCA positive. The follow-up (35 serum probes) of 8 patients showed no ANCA after immunosuppressive induced remission. In four histologically detected cases of recurrence ANCAs were positive again. ANCAs are very useful in primary diagnosis of Wegener's granulomatosis as well as in the follow-up. In addition, the analysis reveals, that immunosuppressive therapy with cyclophosphamide and prednisone facilitates complete remission and a long survival rate of patients with Wegener's granulomatosis.     

Traumatically-induced foreign bodies of the paranasal sinuses

Foreign bodies of the nose and its related sinuses are a common feature in otorhinolaryngology. Particularly in small children, one will find unilateral rhinorrhea as an initial symptom. In the adult, foreign bodies of the nose or paranasal sinuses are mainly caused by traumatic events. In the present paper the authors report two cases of foreign bodies of the paranasal sinuses. In one case the patient had been suffering from unilateral cephalgia for more than 40 years. The other patient had a short history prior to the extraction of the foreign body from the sphenoid sinuses. Diagnostic and therapeutic procedures are discussed and compared with the relevant literature.     

Laserstapedotomie

In addition to hearing aids, stapesplasty represents the standard treatment of otosclerosis-induced hearing loss. In this procedure, the stapes superstructure is replaced by a prosthesis that is attached to the long process of the incus and communicates through a perforation in the footplate with the perilymphatic space of the inner ear. The removal of the stapes superstructure and perforation of the footplate are the critical steps of this surgical procedure. With the introduction of laser-assisted perforation techniques, the surgical safety of this method has been improved compared to conventional techniques. KTP, argon, as well as diode, Er:YAG and CO(2) lasers are used for stapedotomy. By using the CO(2) laser in conjunction with a scanner system, the number of laser applications required for the perforation of the footplate has been markedly reduced. In contrast to other systems, a more reproducible perforation diameter of the stapes footplate is achieved with a CO(2) laser equipped with a scanner. Complications such as uncontrolled leakage of perilymph, irradiation of inner ear structures or the occurrence of pressure waves with subsequent damage to the inner ear can be reduced by using a CO(2) laser. In this review, the surgical technique of CO(2) laser stapedotomy, including clinically established variants and paying particular attention to the one-shot technique, are described and discussed in comparison to other laser systems.     

The medical treatment of head and neck pain

Head and neck pain are extremely common and in any year, four of five people will experience a headache. In one out of two the headache will be severe enough to interfere with daily activity. In this article the multiple clinical syndromes of head and neck pain are presented and the current medical therapies reviewed.