Auditorische Synaptopathie/Neuropathie

Auditory synaptopathy/neuropathy (AS/AN) is a special subtype of sensorineural hearing disorders with heterogeneous phenotypes and underestimated incidence. AS/AN generally develops in infancy, occasionally in adulthood. Symptoms include fluctuating, mostly bilateral hearing loss and abnormally reduced speech comprehension, especially in noisy environments. Within audiological assessments, patients with AS/AN present otoacoustic emissions (TEOAE; DPOAE) and cochlear microphonics (CM), absence of stapedius reflexes (SR) as well as absent or pathologically altered auditory evoked brainstem potentials (ABR). Children with AS/AN cannot be identified within OAE-based newborn hearing screening programs. Clinical findings, transtympanic electrocochleography (ECoG) and further diagnostic tools permit further identification of individual characteristics. In individual cases conventional amplification and the use of FM systems may improve hearing and communication skills. If these interventions, accompanied by intensive hearing, speech and language therapy are unsuccessful, cochlear implants (CI) or alternative forms of communication may be useful options for rehabilitation.     

Diagnostik und Therapie der Insektengiftallergie

The increasing incidence and the potentially life-threatening reactions to venom stings indicate the necessity for otolaryngologists to have a basic knowledge of the diagnosis and treatment of venom allergy. The diagnosis of insect venom allergy is based on the history, skin prick testing (ideally performed as a titration series), and in vitro analysis of specific IgE antibodies to venoms. An emergency medication kit should be prescribed for the patient in case of future venom stings, comprising an H1-blocking antihistamine, a steroid and an adrenaline pen for self-injection. Subcutaneous allergen-specific immunotherapy (sSIT) is the standard treatment to avoid allergic reactions following venom stings in the future. SIT is indicated following all immediate-type reactions to venom stings; contraindications relate to the general recommendations of allergen-specific immunotherapy. Aqueous as well as alum-adsorbed depot allergen preparations can be used for subcutaneous injections. The important dose-increase phase can be performed using conventional, cluster, rush or ultra-rush schedules. Specific immunotherapy is successful in nearly 90% to 100% of patients after 3-5 years of treatment.     

Diagnostik und Therapie der Laryngitis gastrica

In einem Therapieversuch werden 64 Patienten mit der Diagnose Laryngitis gastrica mit Antra (Omeprazol) in unterschiedlicher Dosierung, 10, 20, und 40 mg, behandelt. Zur Beurteilung des Therapieerfolgs werden die pH-Metrie des ?sophagus und Hypopharynx, die Laryngoskopie, Mikrostroboskopie, der Stimmstatus und die Messung der stimmlichen Durchdringungsf?higkeit herangezogen. Das Ergebnis zeigt, dass mit Antra (Omeprazol) in der Dosierung 2-mal 20 mg ein geeignetes Medikament zur Therapie der Laryngitis gastrica mit hoher Erfolgsquote zur Verfügung steht. Es werden Probleme bei der Durchführung der Studie, dadurch bedingte Abweichungen von der ursprünglichen Konzeption des Projekts, sowie daraus resultierende neue Gesichtspunkte und Fragestellungen für weitere Untersuchungen diskutiert.     

Diagnostik und Therapie der Laryngitis gastrica

We treated 64 patients with the diagnosis of laryngitis gastrica with Antra (Omeprazol) in doses of 10, 20, and 40 mg. To determine the success of the therapy, pH monitoring of the esophagus and hypopharynx, the voice status and measurement of vocal penetrating capacity were used. The results prove that a 20-mg dose of Antra is suitable for the therapy of laryngitis gastrica with a high rate of success. Problems which arose during the investigation, consequent changes of the original concept of the project as well as new aspects and questions which resulted from this are discussed with respect to further investigation.     

Diagnostik und Therapie lymphoider Tumoren der Orbita

Zusammenfassung Hintergrund: Die Abkl?rung raumfordernder orbitaler Prozesse erfordert neben einer modernen bildgebenden Diagnostik ein interdisziplin?res Konzept, in das der HNO-Arzt wegen der rhinochirurgischen Zugangsm?glichkeit zur Orbita unmittelbar eingebunden ist. Patienten: Innerhalb von 14 Jahren wurde bei 6 Patienten ein prim?res malignes Lymphom der Orbita sowie bei 9 Patienten ein Pseudotumor orbitae bzw. Pseudolymphom diagnostiziert. Leitsymptome waren in den meisten F?llen eine Protrusio bulbi, schmerzhafte Lidschwellung mit Diplopie und in 3 F?llen eine Visusminderung. In der bildgebenden Diagnostik lie?en sich homogene, von den Orbitastrukturen unscharf abgrenzbare Gewebevermehrung erkennen, die über eine mediale Orbitotomie biopsiert wurden. Ergebnisse: Therapeutisch wurde bei den isolierten Lymphomen eine Bestrahlung durchgeführt, w?hrend bei den Patienten mit einem „Pseudotumor orbitae” zun?chst eine Steroidgabe versucht wurde. In 2 F?llen wurde zus?tzlich eine Bestrahlung veranla?t. W?hrend es bei keinem Fall eines „Pseudotumors orbitae” zu einer malignen Transformation gekommen ist, verstarben 2 Patienten an einem sp?ter disseminierten Non-Hodgkin-Lymphom. Schlu?folgerung: Die Abgrenzung orbitaler lymphatischer Raumforderungen ist mit indirekten Verfahren nicht zuverl?ssig m?glich, weswegen in jedem unklaren Fall eine histologische Abkl?rung erforderlich ist. Je nach Lokalisation des Prozesses bietet sich hierbei ein komplikationsarmer rhinochirurgischer Zugang zur Durchführung der Biopsie und gegebenenfalls Exstirpation des Tumors an. Eingegangen am 28. Januar 1997Angenommen am 25. M?rz 1997     

Diagnostik und Therapie von Pseudotumoren der Orbita

Der Pseudotumor der Orbita ist ein unspezifischer entzündlicher Prozess dessen Genese unbekannt ist und der histologisch in 3 Gruppen unterteilt wird: der granulomat?se, lymphoide und sklerosierende Typ. Zwischen 1995 und 1998 haben wir 12 Patienten mit einem Pseudotumor der Orbita behandelt. Es handelte sich dabei um F?lle vom granulomat?sen (n=6), lymphoiden (n=3) und sklerosierenden (n=3) Typ. Bei 7 Patienten war der Pseudotumor im medialen Bereich der Orbita und in 4 F?llen im lateralen Bereich lokalisiert. Bei einer Patientin lag eine diffuse Infiltration ann?hernd aller orbitalen Strukturen vor. Die Probebiopsie wurde in 6 F?llen endonasal, in 2 F?llen über eine mediale Orbitotomie und bei 4 Patienten über eine laterale Orbitotomie durchgeführt. Die gut abgrenzbaren lymphoiden (n=3) und sklerosierenden (n=3) Pseudotumoren konnten im Rahmen der Probebiopsie komplett entfernt werden, so dass die Patienten nach wenigen Wochen beschwerdefrei waren. Bei den 6 Patienten mit einem granulomat?sen Pseudotumor wurde nach der definitiven Histologie eine prim?re Kortikosteroidtherapie durchgeführt. In 3 der 6 F?lle kam es dadurch zu einem Rückgang der Beschwerden mit kompletter Ausheilung. Bei den restlichen 3 Patienten war eine erneute Kortisontherapie erforderlich wobei diese nur in 2 F?llen erfolgreich war. Der Nachbeobachtungszeitraum betrug 6–28 (Mittel 16) Monate. Postoperative Komplikationen traten nicht auf.     

Diagnostik und Therapie von Pseudotumoren der Orbita

Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that can be divided histopathologically into three basic types: granulomatous, lymphoid, and sclerosing. Between 1995 and 1998, 12 patients with pseudotumor orbitae were treated in the ENT Department of the University of Saarland. Histopathological examination showed granulomatous type of pseudotumor in six, lymphoid in three, and sclerosing in three patients. In seven cases the pseudotumor orbitae were medially located and in four cases laterally. In one patient nearly all orbital structures were infiltrated. Diagnostic biopsy was taken endonasally in six cases, via medical orbitotomy in two cases, and via lateral orbitotomy in four cases. Due to their good delimitation lymphoid and sclerosing tumors were extracted completely during diagnostic biopsy and patients were free of complaints after a few weeks. The six patients with granulomatous pseudotumor were treated primarily with steroids after the diagnosis had been definitely confirmed by histology. In three of those six cases a second course of steroid therapy had to be given, with positive results in two cases. Follow-up was between 6 and 28 months (mean 16 months). There were no postoperative complications. The clinical and radiographic presentation of the pseudotumors can vary greatly. Therefore, the differential diagnosis of specific infections or neoplasms can only be established through diagnostic biopsy. Different rhinosurgical approaches provide clear biopsy results and in some cases the pseudotumor is even completely removed.     

Diagnostik und Therapie von Verletzungen der Frontobasis

The role of ENT surgery in the management of anterior skull base defects has become increasingly important in recent years. Transnasal endoscopic surgical techniques and intraoperative navigation enable a minimally invasive approach in a large proportion of patients, thus helping to avoid morbidity typically associated with neurosurgical subfrontal approaches. Whereas traffic accidents and sport injuries are the main causes of anterior skull base trauma in the civilian setting, penetrating injuries caused by gunshots and improvised explosive devices (IEDs) play an increasing role in the military arena and terroristic attacks. Minor injuries to the anterior skull base are usually managed by ENT surgeons. Major injuries, involving the midface or neurocranium, require an interdisciplinary approach including maxillofacial surgeons and neurosurgeons. A centre for head and neck medicine and surgery is an ideal setting for such interdisciplinary teams to provide appropriate care for patients with complex skull base trauma in cooperation with ophthalmologists and interventional neuoradiologists. The present article describes concepts for the treatment of anterior skull base trauma established at the head, neck and skull base center at the Ulm military hospital in Germany.     

Erfahrungen mit der Diagnostik und Therapie von Fazialisneurinomen

Ohne Zusammenfassung     

Moderne Konzepte zur Diagnostik und Therapie der Sialolithiasis

Sialoliths are the underlying cause of salivary gland obstructive disease in 60%–70% of cases. Modern minimally invasive techniques have enabled accurate diagnosis and findings-specific therapy with the aim of full gland-function preservation. This article provides an overview of the current diagnostic measures for and therapy of sialolithaisis. Ultrasound is the investigation of first choice and is able to recognize stones in well over 90% of cases. Sialendoscopy is a directly visualizing technique which is superior to all other diagnostic measures for the assessment of pathologic changes in the salivary duct system and the detection of stones. Treatment was significantly improved with the introduction of extracorporal shock wave lithotripsy (ESWL), sialographic-controlled techniques, surgical procedures of the duct system and in particular by interventional sialendoscopy. Interventional sialendoscopy, especially when combined with other treatment modalities, has a success rate of 85%–95%. Cases which respond poorly to therapy can be treated successfully with the endoscopic transcutaneous approach in about 90% of cases. When sialendoscopy is performed in combination with other minimally invasive treatment options the gland can be preserved in 95%–98% of all cases.     

Aktuelle Aspekte in der Diagnostik und Therapie der obstruktiven Schlafapnoe

Over the past years, the diagnostic tools and therapeutic approaches for obstructive sleep apnea (OSA) have further evolved. Based on a review of current literature and the personal experiences of the authors, the most relevant developments are summarized in this article and discussed with regard to their impact on the clinical management of this disease. In the third edition of the “International Classification of Sleep Disorders”, the classification of sleep-disordered breathing was modified. Notably, additional clinical criteria for the diagnosis of OSA were established and out-of-center sleep testing was introduced as an alternative to polysomnography. Recent technical advancement of new diagnostic tools (e.?g., peripheral arterial tonometry and pulse wave analysis) has further expanded the diagnostic possibilities. Drug-induced sleep endoscopy enables reliable assessment of the level and degree of upper airway obstruction. Whether this gain in diagnostic information leads to an improvement in surgical outcome is, however, still under discussion. The relevance of positional OSA has received increasing attention—the proportion of patients in whom sleeping position significantly impacts disease is reported to be above 50?%. For these patients, the introduction of the sleep position trainer has made a new therapeutic option available. Furthermore, hypoglossal nerve stimulation (upper airway stimulation) has substantially expanded the surgical spectrum of OSA treatment. For the established surgical treatment options, randomized trials with superior methodology have been published, particularly for bimaxillary advancement and tonsillectomy with uvulopalatopharyngoplasty. These developments are of particular interest for the otolaryngologist and will influence daily practice.     

Mehrdimensionale Diagnostik und Therapie bei Sprachneurosen

Ohne Zusammenfassung     

Leitlinien für Diagnostik und Therapie in der Mund-, Kiefer- und Gesichtschirurgie

Ohne ZusammenfassungDieses Vorwort bezieht sich auf den Artikel verfügbar unter     

Diagnostik und Therapie atypischer Refluxsymptome bei fehlendem PPI-Ansprechen

Gastroesophageal reflux disease (GERD) is a frequent chronic disorder occurring in two forms: on the one hand, typical symptoms such as heartburn and acid regurgitation are seen, while on the other hand atypical (extraesophageal) symptoms such as chronic cough, hoarseness, recurrent sinusitis, globus sensations in the throat, a burning feeling on the tongue, dental erosions and the constant need to clear the throat can be associated with gastroesophageal reflux. The standard therapeutic medical procedure comprises the administration of acid-suppressive agents, proton pump inhibitors (PPI). However, this therapy has proved to be ineffective in a number of patients, especially in atypical GERD. Only after reliable identification of the GERD patient by using valid diagnostic tools medical or interventional therapeutic options can be applied individually. In the absence of atypical GERD symptoms, the diagnosis of GERD becomes very unlikely and other causes of the symptoms need to be taken into consideration.     

Ein Beitrag zur pathologischen Anatomie,Diagnostik und Therapie der otogenen Pachymeningitis interna infectiosa

Ohne ZusammenfassungHerrn Prof.Zange zum 60. Geburtstag.     

Klinik und Therapie der Orbital- und Lidtumoren

Ohne Zusammenfassung     

Pathophysiologische Grundlagen und Therapie der Bronehialstenose

Summary The bronchial mechanics in health and obstructive lung disease are initially described. The calibre of thoracic airways during quiet breathing depends on elastic lung recoil, pleural pressure and compliance of bronchial walls. During forced expiration and during coughing the airways are compressed. However in the healthy individual expiratory airflow increases steadily with increasing pleural pressure while in obstructive lung disease a progressive limitation of airflow occurs which is due to pathologic tracheobronchial collapse. - The differential diagnosis of airways obstruction is established by auscultation, spirometry and plethysmography, by control of flow and pressure during forced expiration, by correlation of the forced expiratory volume with airways resistance and by determination of bronchial compliance. - Localization of the main zone of airways obstruction is attempted by bronchoscopy, bronchography and by measurement of bronchial pressure within the different segments of the bronchial tree. - Finally the therapeutic measures in airways obstruction are dicussed which are directed against infection, retention of mucus, increased sputum viscosity, swelling of mucosa and bronchospasm. The treatment of highly collapsible airways is reserved to special surgical techniques.

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Pathophysiologische Grundlagen und Therapie der Bronehialstenose

Zusammenfassung Einleitend wird die Mechanik des gesunden and des obstruierten Bronchialbaumes dargestellt. Das Kaliber der thorakalen Luftwege ist bei ruhiger Atmung abhängig von der elastischen Lungenspannung, vom Pleuradruck Bowie von der Compliance der Bronchialwände, Faktoren zu denen während forcierter Ausatmung oder beim Husten noch die Kompression der Luftwege hinzukommt. Während steigender Pleuradruck beim Gesunden eine lineare Zunahme des Luftflusses bewirkt, wird bei den meisten obstruktiven Lungenkrankheiten der exspiratorische Flow progressiv beschrankt. - Für die Diagnostik and die Differenzierung der Luftwegsobstruktion dienen die Auskultation, Spirometrie and Plethysmographie, das Druckströmungsdiagramm bei maximal forcierter Ausatmung, die Korrelation von Sekundenkapazität und Bronchialwiderstand and die Bestimmung der bronchialen Compliance. Die Ortsbestimmung der Luftwegsstenose erfolgt mit Bronchoskopie, Bronchographie und Bronchialdruckmessung in verschiedenen Abschnitten des Bronchialbaumes. -Abschließend werden therapeutische MaBnahmen bei Luftwegsstenosierung besprochen, welche gegen die Infektion, Sekretstagnation, gesteigerte Sputumviscositat, Schleimhautschwellung and Brochospasmus gerichtet sind. Die Behandlung des Tracheobronchialkollapses bei hochgradigem Stabilitätsverlust bleibt chirurgischen Methoden vorbehalten.

     

Diagnostik und Therapie von Schilddrüsenerkrankungen in Beziehung zur Oto-Rhino-Laryngologie

Ohne Zusammenfassung     

Therapie der rezidivierten und fernmetastasierten Kopf-Hals-Tumoren

This year particularly phase II studies were presented at the 2016 ASCO Annual Meeting, in which new drugs (monoclonal antibodies, small molecules) were investigated in patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M-HNSCC). Notably, there was a great number of studies investigating carcinoma of the nasopharynx. The studies presented in this article summarize the different therapeutic concepts in the treatment of R/M-HNSCC and represent the variety of therapeutic approaches in the recurrent and metastatic setting.