Botulinumtoxin für die Behandlung sekretorischer St?rungen im Kopf-Hals-Bereich

Botulinum toxin can be used for the temporary blockade of secretory glands in the head and neck area. Botulinum toxin is increasingly the therapy of choice for the treatment of Frey's syndrome and gustatory tearing, and it is gaining attention for hypersalivation therapy. For nasal hypersecretion, this drug has a very specific use. In comparison to the treatment of skeletal muscles, the individual effect and its duration are more difficult to predict. All indications presented here are for off-label use; therefore, careful counseling and informed consent are necessary. With botulinum toxin, for several diseases, as new treatment options are opening up, well-founded knowledge about the indications and treatment course is important for the ENT surgeon.     

Prediction of Auditory Brainstem Wave V Latency as a Diagnostic Tool of Sensorineural Hearing Loss: La prédiction dela latence de l'onde V de la réponse du tronc cérébral dans le diagnostic des hypoacousies neurosensorielles

The lesion location (cochlear vs. retrocochlear) of sensorineural hearing loss may be differentiated with a diagnostic index (ΔV), which is calculated from the wave V latency of the monaurally evoked auditory brainstem response (ABR), and from the pure-tone hearing threshold at 2 and 4 kHz. The ΔV values obtained from 80 recruiting ears have proven to correlate linearly to the amount of the hearing loss, hence allowing to define appropriate confidence boundaries for cochlear hearing losses. In contrast, the ΔV values obtained from 32 ears of patients with retrocochlear lesions - cerebellopontine angle (CPA) tumors - were all found to exceed the 95% upper confidence limits projected for cochlear lesions, thus giving a 100% rate of true results in the detection of retrocochlear pathology. These results, providing an ABR parametric model for the cochlear hearing loss, suggest a diagnostic strategy for the early detection of CPA tumors based on the exclusion of a cochlear hearing loss.

Le diagnostic différentiel des hypoacousies neurosensorielles entre lésion cochléaire et rétrocochléaire peut ětre effectué avec un indice (ΔV) dérivé de la latence de l'onde V et de la moyenne du seuil tonal à 2 et 4kHz de l'oreille examinée. Les valeurs de ΔV obtenues pour 80 oreilles avec lésion cochléaire ont démontré une relation statistiquement significative avec le degré de la perte tonale qui nous a permis de calculer les limites de la distribution ΔV contre 2-4 dB HL (moyenne du seuil tonal à 2 et 4 kHz) dans les cochléopathies. Sur 32 patients avec lésion rétrocochléaire, les valeurs ΔV se sont révélées toutes en dehors de la zone des cochléopathies (limites de confiance de 95%) obtenant ainsi unpourcentage d'identification parfaite de 100%. Ces résultats, graˇce à la construction d'un modèle ABR des hypoacousies cochléaires, permettent de suivre une stratégie diagnostique pour l'identification précoce des processus expansifs de l'angle pontocérébelleux basée sur l'exclusion d'une lésion cochléaire.     

Stürze und Sturzrisikofaktoren

Background and objective

The risk of falling increases with age. The problem of falls in medical care constantly rises in priority due to demographic changes in Germany. Therefore, the risk of falling should be assessed in all patients. The present study was intended to evaluate the frequency of falls in daily ENT outpatient medical care and the importance of risk factors.

Patients/methods

A multicentre study was performed in six outpatient facilities based on a survey of falls and fall risk factors in patients living at home (n?=?673) aged 60?years and older.

Results

Falls are a frequent problem in the elderly. A total of 23% had one and 13.7% more than one fall within the previous year. Of these, 15% suffered injury, while only 13% used some form of fall prevention. Joint pain and problems of the hip and lower extremities (42.6%), abnormal gait (41.3%), dizziness and balance disorders (38%) as well as impaired activities of daily living (35%) are the most common risk factors for falls and multiple falls in all age groups. Impaired hearing is a fall risk factor in elderly patients.

Conclusions

Falls are a frequent problem in patients in ENT outpatient medical care. Fall prevention is advisable in the context of an interdisciplinary approach.     

Aspects cliniques de quelques formes pathologiques particulières des réponses du nerf auditif chez l'homme

Clinical, audiometric and electro-cochleographic data in typical pathological conditions of the inner ear, eighth nerve and central nervous system are presented and discussed. The occurrence of the different types of electro-cochleographic responses in routine clinical investigations is underlined. Their significance for the differential diagnosis of deafness and otological disorders is temptatively presented.     

Evaluation des Freiburger Einsilbertests im Störschall

Background

The Freiburg speech test has been the gold standard in speech audiometry in Germany for many years. Previously, however, this test had not been evaluated in assessing the effectiveness of a hearing aid in background noise. Furthermore, the validity of particular word lists used in the test has been questioned repeatedly in the past, due to a suspected higher variation within these lists as compared to the other word list used.

Patients and methods

In this prospective study, two groups of subjects [normal hearing control subjects and patients with SNHL (sensorineural hearing loss) that had been fitted with hearing aid] were examined. In a first group, 113 control subjects with normal age- and gender-related pure tone thresholds were assessed by means of the Freiburg monosyllabic test under free-field conditions at 65 dB. The second group comprised 104 patients that had been fitted with hearing aids at least 3 months previously to treat their SNHL. Members of the SNHL group were assessed by means of the Freiburg monosyllabic test both with and without hearing aids, and in the presence or absence of background noise (CCITT-noise; 65/60 dB signal-noise ratio, in accordance with the Comité Consultatif International Téléphonique et Télégraphique), under free-field conditions at 65 dB.

Results

The first (control) group exhibited no gender-related differences in the Freiburg test results. In a few instances, inter-individual variability of responses was observed, although the reasons for this remain to be clarified. Within the second (patient) group, the Freiburg test results under the four different measurement conditions differed significantly from each other (p>0.05). This group exhibited a high degree of inter-individual variability between responses. In light of this, no significant differences in outcome could be assigned to the different word lists employed in the Freiburg speech test.

Conclusion

The Freiburg monosyllabic test is able to assess the extent of hearing loss, as well as the effectiveness of a fitted hearing aid, in the presence or absence of background-noise (CCITT-noise). The present study could not evidence statistically significant differences in outcome when using the different word lists in this test battery.     

超声波治疗Méniére病

高频超声波可损伤生物组织。不同组织对超声波的作用有明显不同的敏感性,皮肤、骨、结缔组织和血管的敏感性远低于神经纤维及感觉细胞。在人体中,神经组织被认为是对超声波最敏感的组织。超声波为一种既能选择性破坏前庭迷路而又保留听力的治疗方法。超声波可作用于前庭的神经上皮及分泌上皮,故不但可减少内淋巴液的分泌进而减轻迷路内水肿,而且可以抑制前庭终器的功能。在Meniere病的治疗中,选用1兆周/秒或以上频率的超声波。超声波的生物学作用是复杂的,总的来说可能基于机械性、热及化学性三个因素。简言之,超声波对组织的机械作用就是产生一种具有破坏性的颤动。热作用是组织吸收了能量的结果,骨有较高的热吸收率,故可变得很热。临床研究证明,用3瓦的电源持续照射软     

Mikrovaskulär anastomosierte Transplantate

Surgical tumor removal is often the treatment of choice in patients with head and neck squamous cell carcinoma. Depending on the extent of tumor resection, large defects are often produced in the individual head and neck regions, necessitating reconstructive surgery to avoid further functional impairment. In principle, this decision depends on the size and location of the defect, the aesthetic importance of the region and the functional significance of the area to be replaced. Reconstructive free flap procedures in patients who have undergone radiotherapy or exhibit vessel depletion in the neck due to multiple previous surgical interventions are particularly challenging. In order to ensure the best possible outcomes of surgical oncology therapies under difficult circumstances, this paper discusses the important factors and variables that can increase the success rate of microvascular grafts in irradiated or multiply resected patients.     

Grundlagenuntersuchungen für Stimmlippendynamik

Background

The understanding of normal and pathological vocal fold dynamics is the basis for a pathophysiological motivated voice therapy. Crucial vocal fold dynamics concerning voice production occur at the medial part of the vocal fold which is seen as the most critical region of mucosal wave propagation. Due to the limited size of the larynx the possibilities of laryngeal imaging by endoscopic techniques are limited.

Material and methods

This work describes an experimental set-up that enables quantification of the entire medial and superior vocal fold surface using excised human and in vivo canine larynges.

Results

The data obtained enable analysis of vocal fold deflections, velocities, and mucosal wave propagation. The reciprocal dependencies can be examined and different areas of vocal fold dynamics located. The vertical components obscured in clinical endoscopy can be visualized. This is not negligible.

Conclusions

In particular it is shown that the vertical deflection, which cannot be observed by clinical examination, plays an important part in the dynamics and therefore cannot be omitted for therapeutic procedures. The theoretically assumed entrainment and influence of the two main vibration modes enabling normal phonation is confirmed.     

声创伤诱发Méniére综合征

目前声创伤作为Meniere病(MD)可能病因的报道甚少,作者研究了不同程度声创伤的患者1800例,其中诊断为Meniere综合征(MS)8例(1/225人),另有3例因不符合本文制定的MS标准而未列入研究。8例患者均为男性,平均年龄40.5岁,其中5例为现役军人,都遭受时间长短不一的高强度噪声暴露;另3例也曾受明显的噪声暴露。对所有患者都详细地询问了病史,并作了全面检查,包括血常规、肝肾功能试验、血清葡萄糖和电解质测定、甲状腺功能试验、病毒血清学检查、心电     

总和电位与Méniére病

本文就耳蜗受强声刺激使听毛细胞产生的直流电位与Méniére病关系的有关资料进行综述,普遍认为Méniére病人耳蜗电图中总和电位有改变,对Méniére病的诊断及疗效评价可能有一定参考价值。     

Störungen durch Augenlidschluß bei der Elektro-Nystagmographie

Ohne ZusammenfassungMit 5 Textabbildungen.     

Désobstruction laryngée au laser CO2

Options in the management of a patient with an obstructive laryngeal tumour include tracheotomy proximal to the tumour, emergency intubation followed by total laryngectomy, endoscopic laser debulking procedure. Previous tracheotomy procedures have been associated with an increased infection rate after total laryngectomy and an increased incidence of peristomal recurrence. Emergency total laryngectomy was usually carried out after a limited local, regional, metastatic and general assessment. The advent of carbon dioxide laser in the end of the 70’s has permitted the development of endoscopic laryngeal debulking. This technique is now well codified and commonly utilized; it permits to secure the airway and, most of the time, to avoid emergency tracheotomy. It may be repeated if necessary, and does not jeopardize subsequent definitive treatment. Laryngeal laser debulking can be utilized as pre-treatment in the airway management, for the implementation of a chemotherapy, and a better nutritional and psychological preparation of the patient for surgery or radiation therapy. It can also be utilized as a palliative procedure avoiding tracheotomy and resulting in a better quality of life.     

Békésy测听的临床应用

报告对20耳正常耳和由不同病因导致听力损害的123耳进行Bekesy测听的结果,证实Jerger对测听描记曲线进行分型基本符合临床表现,尤对判断蜗内性聋及蜗后性聋具有重要的定位价值;对蜗内性聋加掩蔽测试更能表现重振特性。     

Békésy自动描记听力计使用法

一、Békésy自动描记听力计自动描记听力计是以它的发明者Békésy的名字命名的。这种仪器利用一个频率范围从100—10000Hz的拍频振荡器发出脉冲的或连续的纯音讯号,脉冲音讯号持续200ms,中断200ms(亦有“开”260ms,“关”260ms,上升下降时间40ms)。讯号频率的转换用一个电动马达来控制,它可以在100—10000Hz(或8000Hz)的频率范围内以从低到高的形式来增加讯号的频率。即扫频方式。电动马达也可以被阻断而由检查者来操纵频率的转换装置,以便对听力计频率范围内的任何单一频率进行连续测试,即固定频率的方式。纯音讯号的强度由受试者操纵的衰减器马达手控开关来控制。衰减器马达使测试讯号的强度均匀而平稳的增加,当病人听到声音的时候,他按压手控开关,使衰减器马达倒转而引起讯号的强度减低。当病人听不到声音的时候,将手控开关放松,则衰减器马达使讯号的强度重新     

当今耳蜗透析治疗Méniére病

耳蜗透析的基本原理是应用高渗溶液灌注鼓阶,减轻内淋巴水肿。将1.31g甘露醇加入5％葡萄糖溶液至100ml时,即可制得透析液,消毒后备用。该透析液渗透浓度为350毫渗量/升,与蜗管内淋巴的300毫渗量/升相比,是高渗溶液。作者报道自1981～1986年采用此法治疗重度单侧Meniere病30例,疾病严重程度在术前可用250Hz～3KHz纯音听阈检查来估计,听阈大于70dB者20例,介于40～70dB者9例,仅1例为40dB。男13例、女17例。眩晕症状持续3～40年,平均10.5年。手术期年龄28～80岁,平均49.5岁。全部病例经各种内科治疗均     

Contributions of von Békésy to psychoacoustics

This paper reviews the contributions of von Békésy to psychoacoustics, comparing his findings and interpretations to those that have emerged since his work. The areas covered include the perception of pitch for pure tones and complex tones, the effect of frequency on the apparent location of pure tones, estimation of the velocity of the traveling wave on the basilar membrane using judgments of lateralization, and the relative loudness of monaural and diotic sounds. While subsequent research has failed to replicate some of his findings, other findings have stood the test of time. There is no doubt that von Békésy made very substantial contributions to psychoacoustic research.     

Trichterförmige Fascienplastik des Trommelfells aus mehreren Stücken mit Knorpelbrücke zum Stapes nach Radikaloperation des Ohres und das Gehör bei dickerem Trommelfell

Ohne Zusammenfassung     

Beidohriger Zahlentest im St?rger?usch nach Sauer

Objective

For the determination of speech intelligibility in the expertise of hearing loss, the Freiburg speech test (number test and monosyllable test) is recommended in the Federal Republic of Germany. In the former German Democratic Republic, Sauer’s binaural number test with 70?dB background noise (“beidohriger Zahlentest”, BZT) was a standard element in expert opinions and was used in the calculation of bodily injury (“K?rperschaden”). In the current practice, a hearing test in noise is still lacking. The present study analyzes whether and to what degree the impairment (“Grad der Sch?digungsfolgen”, GdS) changes when also considering Sauer’s test.

Material and methods

In a collective of 78 patients with hearing loss (66 patients with high-frequency hearing loss and 12 patients with pancochlear hearing loss) and 22 normal hearing controls, the following audiometric measurements were conducted: pure tone audiometry, speech audiometry (Freiburg speech test), free field audiometry with and without noise, and Sauer’s test. Subsequently, the hearing loss for both sides was calculated taking into consideration the values obtained with and without Sauer’s test, and the respective GdS was determined.

Results

Patients with high-frequency hearing loss and pancochlear hearing loss had a trend for higher GdS (approximately 2 and 5%, respectively), compared to the established algorithm without the use of hearing tests in noise. However, neither the Mann–Whitney U-test nor the Bland–Altman analysis yielded relevant differences between the two methods to calculate the GdS.

Conclusion

The routine implementation of Sauer’s test in the expertise of hearing loss cannot be recommended, since no relevant change in the GdS can be expected. This is especially true for high-frequency hearing loss. In pancochlear hearing loss, use of Sauer’s test can be considered if problems concerning hearing in situations with background noise are present—at least until more advanced hearing tests optimized for use in noise have been integrated into the tables for GdS calculation.