Die Anwendung lipidhaltiger Nasensalbe bei allergischer Rhinitis — eine Therapieoption?

Background

Some 10–20% of the population suffer from allergic rhinitis. A recently discussed and interesting, albeit disputed therapy option is the use of a lipid-based nasal ointment.

Method

To test the efficacy of this nasal ointment as an adjuvant therapy for allergic rhinitis, a two-centre, prospective, open, randomized, controlled clinical study was carried out.

Result

In the study, 17 patients using the test agent were compared with 16 who did not. For the group using the test agent, before and after comparisons showed a significant (about 40%) improvement in the medium, relative total range of symptoms (Wilcoxon-Mann-Whitney U-test, P<0.01) based on the individual parameters of sneezing attacks, nasal itching, nasal secretion and nasal obstruction. In the control group, non-use of the test agent meant that the total range of symptoms remained unchanged. No side effects were recorded.

Conclusion

The test agent used in our study contains a lipid fraction, in this case in the form of high purity, long chain hydrocarbons. By local application, a significant improvement of the total symptomatology was shown. The mechanism has not been clarified. Owing to the efficacy and low risk of side effects, this seems to be a promising adjuvant therapy for allergic rhinitis. The probetoric use of this nasal ointment as a supportive therapeutic option should be reviewed in further clinical studies.     

Objektiv gemessene Stimmlippenschwingungsirregularität vs. subjektiver Eindruck der Rauigkeit

For routine clinical purposes dysphonic voices are assessed using the GRBAS scale or analogues. An objective measurement often includes jitter measurements. Here we raised the question of whether roughness estimates correlate with a computer-aided measurement of the vocal fold cycle irregularity in 78 patients who read a standard text ("Nordwind und Sonne"). The samples were evaluated by 19 speech and voice therapy students according to the degree of roughness. The irregularity index was calculated according to the procedures suggested by Fourcin. Data were subjected to correlation analysis. A significant correlation was found between the irregularity index and the subjective roughness scaling. These data indicate that objective measurements of vibratory cycle irregularity during text reading can be used for clinical purposes in addition to subjective roughness scaling.     

Open vs. endoscopic cricopharyngeal myotomy; Is there a difference?

Introduction

The upper esophageal sphincter (UES) is composed largely of the cricopharyngeus muscle (CP) and acts as the gatekeeper to the esophagus. There are multiple methods of treating UES dysfunction, but myotomy has been shown to be the most definitive means. We aim to evaluate the difference between open and endoscopic CP myotomy (CPM).

Ulnaris- vs. Radialisunterarmlappen in der Rekonstruktion von Mundh?hle und Gesichtsregion

The microvascular ulnar forearm flap is compared with the radial forearm flap for soft tissue reconstruction in the head and neck region. In 67 patients 44 ulnar forearm and 23 radial forearm flaps were applied. The two groups were compared regarding flap dissection, suitability of the flap for the recipient region, complication rate and secondary morbidity of the donor region. The ulnar forearm flap is favoured due to the less hairy skin of the ulnar forearm region and the more conveniently located donor area. The ulnar forearm flap pedicle is long compared with alternative transplants but shorter than the radial pendant.     

Infektionsh?ufigkeit und Keimspektrum nach Paukendrainage im KindesalterGoldr?hrchen vs. Silikonr?hrchen Goldr?hrchen vs. Silikonr?hrchen

H?ufigste Komplikation nach Paukenr?hrcheneinlage ist die postoperative Otorrh?. Zur Paukendrainage werden in Deutschland vielfach Silikonr?hrchen (SR) und Goldr?hrchen (GR) benutzt. Interessant sind diesbezüglich In-vitro-Untersuchungen, bei denen eine steigende Silikonkonzentration im N?hrmedium das Wachstum von Staphylococcus aureus stimulierte. Wir haben deshalb die Otorrh?h?ufigkeit und das Keimspektrum von SR und GR retrospektiv untersucht. Ziel war es zu kl?ren, ob SR mit einem h?heren Infektionsrisiko behaftet sind oder ob sie das Wachstum bestimmter Keimarten begünstigen. Innerhalb von 2 Jahren wurden bei 144 Kindern 186 SR und 59 GR implantiert und in folgende 3 Untergruppen eingeteilt: Ersteinlage, Rezidiveinlage und Implantation in ein infiziertes Ohr bei Mastoidektomie. In allen 3 Gruppen fand sich zwar kein Unterschied bezüglich der Otorrhoeh?ufigkeit; SR waren jedoch signifikant h?ufiger mit Pseudomonas aeruginosa infiziert als GR (p=0,025). Bei 20% der Ohren mit Mastoiditis ergab der intraoperative Abstrich eine Infektion mit Pseudomonas aeruginosa. All diese infizierten, mastoidektomierten Ohren wurden mit GR versorgt. Keines dieser Ohren zeigte jedoch postoperativ eine Infektion mit Pseudomonas aeruginosa. Im Rahmen einer Mastoidektomie sollten daher unbedingt GR implantiert werden, die einen protektiven Effekt gegenüber Pseudomonas aeruginosa zeigen. Unter dem Aspekt, da? die durch mangelnden Wasserschutz bedingten Paukenr?hrcheninfektionen recht h?ufig sind und Pseudomonas aeruginosa typischerweise im feuchten Milieu vorkommt, ist eine generelle GR-Implantation zur Paukendrainge durchaus zu vertreten.     

Tratamiento endoscópico combinado vs. abierto en el divertículo de Zenker

IntroductionZenker's diverticulum is a superior esophagus sphincter disease with a surgical management in symptomatic cases. This treatment has undergone important changes in recent years.Material and methodA retrospective review was carried out of 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used as well as a combined endoscopic approach with stapler and CO₂ laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay and occurrence of relapses were analyzed.ResultsThe endoscopic approach was used in 8 patients, with a conversion to conventional open surgery being necessary in 2 cases. Operating time was of 90 min for the open approach and 45 in the endoscopic. Oral feeding could be reintroduced 36 hours after open surgery and 24 h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in the 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery, one case was treated with the endoscopic approach and another with the open approach.ConclusionsThe combined endoscopic approach offers good results in patients with symptomatic Zenker's diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when a good endoscopic exposure is not possible.     

Wo soll die Rehabilitation nach Cochlear-Implant-Versorgung stattfinden? Ambulante vs. stationäre Betreuung

Wir befinden uns in einer Phase der Umstrukturierung des gesamten Gesundheitsmarktes, von der auch die Therapie mittels “Cochlear Implant” (CI) betroffen sein wird. Immer mehr station?re Therapien werden in den ambulanten Bereich verlagert. Fischer et al. befassen sich in diesem Heft auf Seite 832–838 mit der Problematik der ambulanten Versorgung nach CI-Therapie. Doch ist diese unter allen Umst?nden wünschenswert?     

Ein Fremdkörper in der rechten Tuba Eustachii. — Abszefs an der Schädelbasis. — Eitrige Erkrankung der Atlanto-occipital-Gelenke. — Aneurysma der linken Arteria vertebralis. — Tod durch Ruptur desselben

Ohne Zusammenfassung     

Index vocalis; Sprachindex. — Auditus

Ohne Zusammenfassung     

Does Postthyroidectomy Syndrome Really Exist Following Thyroidectomy? Prospective Comparative Analysis of Open vs. Endoscopic Thyroidectomy

ObjectivesThis study prospectively evaluated postthyroidectomy syndrome (PTS) through objective and subjective voice changes following thyroidectomy of open vs. endoscopic thyroidectomy.MethodsA prospective clinical trial (SCHBC IRB 09 26) was performed from Jan 2008 to Aug 2010 to compare the open thyroidectomy (OPEN group) and endoscopic thyroidectomy (ENDO group). Of the 110 patients, 75 completed the evaluation before and 1 and 6 months after surgery. Subjective parameters included perceptual analysis (GRBAS [grade, roughness, breathiness, asthenia, and strain] scale), stroboscopic or flexible fiberscopic analysis, voice handicap index, and 5-point visual analog scales for vocal fatigue, singing difficulty, difficulty with high-pitch phonation, and neck discomfort. Objective parameters included acoustic, aerodynamic analysis and the electroglottograph.ResultsFor the ENDO group (n=36), the operation time was longer than in the OPEN group (n=39; P<0.01). For the OPEN group, two objective and five subjective parameters were worse 1 month postoperatively; of these, two subjective parameters persisted for 6 months (P<0.05). For the ENDO group, three objective and six subjective parameters were worse 1 month postoperatively, and three of the subjective parameters persisted 6 months postoperatively (P<0.05).ConclusionPTS really exists following simple thyroidectomy and are very common for both OPEN and ENDO groups. Most of the parameters improved gradually over time, but some subjective changes persisted 6 months postoperatively.     

Infektionshäufigkeit und Keimspektrum nach Paukendrainage im Kindesalter Goldröhrchen vs. Silikonröhrchen

Otorrhea is the most common complication after tympanostomy tube insertions. In Germany there are currently two commonly used types of tympanostomy tubes: silicon tubes (ST) and gilded silver tubes (GT). Previously published in vitro studies by Tajima uncovered a positive correlation between the silicon concentration in culture fluid and the rate of growth of Staphylococcus aureus. Our study retrospectively evaluates the types of bacteria and rates of otorrhea after ST and GT insertions. The present study was undertaken to determine which of these tubes had a higher incidence of otorrhea and then whether silicon tubes stimulated the growth of certain types of bacteria, such as Staphylococcus aureus. In all, 186 ST and 59 GT were placed in 245 ears of 144 children. Both ST and GT were separated into three groups: first insertion of a tympanostomy tube, second implantation and insertion of a tympanostomy tube in an infected ear in the course of a mastoidectomy. No differences between ST and GT in causing otorrhea were found in the three groups. Nevertheless, ST in comparison to GT was associated with a higher incidence of infections with Pseudomonas aeruginosa. In contrast, a higher incidence of Staphylococcus aureus related to ST could not be proved. Twenty percent of the ears with mastoiditis were found to have Pseudomonas aeruginosa, but none of these ears implanted with a GT developed postoperative otorrhea. Our findings show that GT should be used when a ventilation tube is used during a mastoidectomy. Further, it is tenable to implant only GT because postoperative otorrhea in many cases is caused by insufficient water protection and water is frequently polluted with Pseudomonas aeruginosa.     

Drenaje percutáneo ecoguiado vs. drenaje quirúrgico en abscesos cervicales profundos de origen odontógeno. Ensayo clínico controlado y aleatorizado

IntroductionThe most common cause of deep neck infections is dental infection. They are diagnosed with physical examination, imaging studies, ultrasound, or computed tomography. Surgical drainage of collections should always be performed early in a classical or percutaneous way, depending on the case. The aim of the study was to compare ultrasound-guided percutaneous drainage techniques vs. surgical drainage in deep cervical abscesses of odontogenic origin in a controlled and randomized trial.MethodsA randomized controlled clinical trial was performed from January 2015 to December 2019. Hospital stay was evaluated as an efficiency variable. Epidemiological and secondary variable data (tumour, trismus, fever, pain), leukocytosis, cosmetic result comparing both techniques were analysed. Statistical analysis was carried out with STATA v 14.0.Results128 patients were analysed, 51 women and 77 men. Average age 27.3 (SD = 10.13). The percutaneous group had a mean hospital stay of 3.03 (SD = 2.86) days and the surgical group 5.46 (SD = 2.96). The p-value was <.001. Cosmetic results showed differences favouring the percutaneous drainage group. None of the other variables showed statistically significant results.DiscussionSurgical treatment (cervicotomy and debridement) should be undertaken early with evidence of extensive collection in deep spaces. Minimally invasive image-guided procedures are an alternative. These can be performed in well-located, unilocular collections, without compromising of the patient's airway. Percutaneous drainage and suction techniques if necessary, serially, or drainage placement may be performed.ConclusionsUltrasound-guided and serially guided percutaneous drainage is the best therapeutic option in patients with mild and/or moderate dental infections.     

A comparative study of sequential vs. simultaneous type I tympanoplasty in patients with bilateral chronic otitis media – Mucosal type

BackgroundPatients with bilateral chronic otitis media – mucosal type have been conventionally treated with sequential tympanoplasty. Bilateral simultaneous tympanoplasty is usually not preferred because of the theoretical risk of iatrogenic sensorineural hearing loss. With the advent of modern surgical instruments and surgical techniques, the risk is expected to be lower. This study compares the clinical outcomes in type I tympanoplasty performed simultaneously and sequentially.Materials & methodsThis randomized prospective study was carried out in a tertiary care hospital between August 2015 and July 2017. A total of 30 patients were divided into two groups of 15 each. This study analyzed the graft uptake, pure tone audiogram findings pre- and post-operatively, duration of surgery and number of hospital visit for each patient and the outcomes were compared between both the groups.ResultPatients undergoing bilateral simultaneous tympanoplasty had significantly lesser mean duration of surgery and number of hospital visits than the patients undergoing sequential tympanoplasty. Graft uptake and postoperative wound infections were similar in both the groups. Postoperative hearing improvement was significantly better in the bilateral simultaneous tympanoplasty group. However, further studies are needed to authenticate this observation. None of the patients had a postoperative deterioration of hearing or sensorineural hearing loss.ConclusionBilateral simultaneous tympanoplasty is not only feasible but also better than sequential tympanoplasty, especially in terms of operating time, follow-up and overall financial implications on the patient.     

Tinnitus characteristics in patients with hyperacusis and vertigo (including Ménière's disease) vs. hyperacusis alone

Introduction and objectivesTo compare clinical and psychoacoustic tinnitus characteristics in patients with the comorbidity of hyperacusis, hyperacusis and vertigo, and with Ménière's disease (MD).Materials and methodsThree hundred and twenty-nine tinnitus patients underwent audiological and otoneurological evaluation. Records of 94 individuals younger than 65 years, 40 women and 54 men (mean age 41.8, range 24–64 years), who complained of tinnitus and hyperacusis, were analyzed. One hundred and thirty-one ears with tinnitus were identified: 67 in the group of patients with tinnitus and hyperacusis (group 1; 41 patients); 28 in the group fulfilling criteria of MD diagnosis (group 2; 28); and 36 in the group with tinnitus, hyperacusis and typical symptoms of vertigo (group 3; 25).Results and conclusionsMean value of interaural difference in canal paresis in group 1 was 6.3%; in group 2: 23.7%; and in group 3: 25.9%; p < .001. Mean tinnitus pitch value was significantly lower in group 3 (1679 Hz; SD = 1139) and group 2 (2250 Hz; SD = 1162) compared to group 1 (4538 Hz; SD = 3123; p = .012). Values of tinnitus intensity and other characteristics did not significantly differ between the groups. Tinnitus and hyperacusis were most frequently preceded by acoustic trauma. Tinnitus coinciding with hyperacusis and vertigo was observed in patients after head trauma.Mean tinnitus pitch was lower in the groups of patients with hyperacusis and peripheral labyrinthine lesion than in tinnitus sufferers with hyperacusis alone. Tinnitus sufferers with low tinnitus pitch should undergo vestibular system evaluation. Hyperacusis and vertigo are likely comorbidities in tinnitus patients after head trauma. Hyperacusis may coincide in tinnitus patients after head trauma.     

Peritonsillar dexamethasone–bupivacaine vs. bupivacaine infiltration for post-tonsillectomy pain relief in children: a randomized,double-blind,controlled study

European Archives of Oto-Rhino-Laryngology - Post-tonsillectomy pain is one of the most frequent morbidities of tonsillectomy surgery. Currently, there is no standard protocol for...