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Background: There is no consensus in the pertinent literature regarding the optimal antibiotic prophylaxis (AP) for cochlear implantation (CI). This study evaluates the implementation of standardized risk-based AP combined with application of an adhesive film dressing., Materials and Methods: All CI cases since September 2019 were retrospectively reviewed for postoperative wound complications. While all patients received preoperative AP with ceftriaxone, postoperative AP after CI in patients older than 7 years was no longer routinely performed in our clinic. Exceptions were made according to predefined criteria for an increased risk of infection. The wound was covered with a transparent adhesive polyurethane film., Results: In 72% of the 219 cases, we did not perform postoperative AP. The overall wound complication rate was 2.7% (in the groups with and without postoperative AP, 4.9% and 1.9%, respectively). Wound infection did not occur in any of the patients without postoperative AP older than 70 years (n = 32), with controlled diabetes mellitus (n = 19), or with reimplantation due to technical defect (n = 19). The film did not need to be changed until the suture material was removed., Conclusion: Standardized risk-based AP can avoid prolonged administration of antibiotics in selected patients. The film dressing permits continual examination and sufficient wound protection., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The piezoelectric instrument (PEI) offers a novel technique for bone removal in ear surgery with a combination of micro-oscillation and cavitation. The aim of this review is to explore the advantages, disadvantages, and limitations of this instrument in comparison to the drill., Materials and Methods: We conducted a search of PubMed/MEDLINE and Google Scholar in accordance with the PRISMA recommendations. The primary selection included all studies reporting on the use of PEI in ear surgery or its effect on the inner ear. Only studies with a control group were included in the secondary selection., Results: The first search identified 49 studies between 2003 and 2022. These reported on a total of 1162 ear operations, during which PEI was used for various indications. Most data were based on uncontrolled retrospective studies or case reports (76%). Only one of the five controlled clinical studies was prospective and randomized. The advantages of PEI weighed against its limitations and disadvantages were critically analyzed in comparison to the drill., Conclusion: Piezoelectric surgery is an innovative and promising surgical technique in the temporal bone. PEI appears to enable safer and more precise bone removal in close proximity to soft tissue when compared to the drill. The slower bone removal and cost factors represent current limitations to its wider use in ear surgery., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The piezoelectric instrument (PEI) offers a novel technique for bone removal in ear surgery with a combination of micro-oscillation and cavitation. The aim of this review is to explore the advantages, disadvantages, and limitations of this instrument in comparison to the drill., Materials and Methods: We conducted a search of PubMed/MEDLINE and Google Scholar in accordance with the PRISMA recommendations. The primary selection included all studies reporting on the use of PEI in ear surgery or its effect on the inner ear. Only studies with a control group were included in the secondary selection., Results: The first search identified 49 studies between 2003 and 2022. These reported on a total of 1162 ear operations, during which PEI was used for various indications. Most data were based on uncontrolled retrospective studies or case reports (76%). Only one of the five controlled clinical studies was prospective and randomized. The advantages of PEI weighed against its limitations and disadvantages were critically analyzed in comparison to the drill., Conclusion: Piezoelectric surgery is an innovative and promising surgical technique in the temporal bone. PEI appears to enable safer and more precise bone removal in close proximity to soft tissue when compared to the drill. The slower bone removal and cost factors represent current limitations to its wider use in ear surgery., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: To evaluate the safety profile and surgical technique for removal of symptomatic exostoses and osteoma of the external auditory canal with a micro-oscillating piezoelectric device., Method: A chart review was conducted on patients undergoing piezoelectric canalplasty between 2019 and 2021 at tertiary referral hospital. Surgery was performed by two surgeons with varying experience. Bone removal was achieved using both osteotomy and osteoplasty. Postoperative complications, operative time and hearing outcome were evaluated., Results: The study comprised 16 patients (16 ears). No major complications occurred. The skin of the auditory canal was completely preserved in all patients without injury to the tympanic membrane. Except for one patient with known noise-induced hearing loss, there was no postoperative deterioration of the bone-conduction threshold more than 10 dB HL at any frequency. The difference of the bone-conduction threshold in pure-tone audiometry (average for 0.5, 1, 2 and 4 kHz) three weeks postoperatively had a median of 0.6 dB ± 5.7. One patient complained of temporary new tinnitus. One patient had prolonged wound healing. Mean operative time was comparable with literature data., Conclusion: The atraumatic characteristics of the piezoelectric instrument enable low-risk removal of external auditory canal exostoses and osteoma. Through the combination of precise osteotomy and osteoplasty, this novel instrument has the potential to become established in routine canalplasty., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To assess the applicability of the piezoelectric device in translabyrinthine-approach exposure of the internal auditory canal., Methods: In three cases with vestibular schwannoma, the bone around the internal auditory canal was completely removed by means of piezosurgery. Evaluation was performed by an experienced surgeon, and a second relatively inexperienced surgeon., Results: Irrespective of surgical experience, piezosurgery proved to be a safe method for exposure of the internal auditory canal. Compared with the conventional procedure it provides an improved surgical view and more precise bone removal in a narrow operating field. This novel technique has the characteristics to reduce the corresponding risk of accidental slipping with consequent thermal and mechanical injury to the dura and neurovascular structures. The major disadvantage of piezosurgery is the longer time required for bone removal., Conclusion: The micro-oscillating piezoelectric device is a useful adjunct to the rotating burr during removal of the bone around the internal auditory canal in translabyrinthine approach. It could reduce the risk of injury to neurovascular structures at the bone-to-soft tissue interface.

Background: Advances in modern intensive care have led to a sharp increase in the number of tracheotomies performed in intensive care units. In contrast to surgical epithelial tracheostomy (ST), a less sturdy stoma is created by means of percutaneous dilation of tracheotomy (PDT). The advantages of a PDT compared to ST are the simpler logistical efforts, associated cost reduction and minimally invasive nature of the process. However, due to variability in airway management, late complications can cause problems, especially in nursing homes., Material and Methods: Nursing facilities were given a standardized questionnaire which included information about patient type, tracheotomy type, cannula management protocol, TK management protocol, type of complications occuring at the tracheostoma as well as frequency., Results: Nearly 66 % of the patients were treated with PDT. The complication rates of PDT patients were statistically and significantly higher for all observed complication types compared to the group of patients receiving ST care. 80 % of patients treated with PDT required readmission to clinic for tracheostoma revision, versus 23 % in the ST-patients., Discussion: A PDT places special demands on the nursing staff in postoperative aftercare. The decision as to which form of tracheotomy is best suited to a particular patient should be made with a multidisciplinary team and depending on the indication. Given the probable long-term nature of the tracheotomy, a surgical tracheostomy should be the therapy of first choice., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht.

Objective: The efficiency of vibroplasty (coupler-floating mass transducer [FMT] assembly) can be monitored by direct stimulation of the inner ear through the active middle-ear implant system and comparison of the vibroplasty in vivo threshold and the postoperative bone-conduction pure-tone threshold. The aim of this study was to compare the vibroplasty in vivo threshold with the postoperative speech recognition in patients with a high preoperative maximum word recognition score., Study Design: Retrospective cohort study of German-speaking patients implanted with a vibrating ossicular prosthesis (VORP) 502 or VORP 503 and high preoperative maximum word recognition score between the years of 2011 and 2015., Setting: Multicenter study of four German centers., Patients: Twenty-three active middle-ear implant users., Intervention: Rehabilitative., Main Outcome Measures: Bone-conduction pure-tone and vibroplasty thresholds, postoperative aided word recognition score (WRS) at 65 dB SPL (sound pressure level) and preoperative maximum WRS with Freiburg monosyllabic words., Results: The mean postoperative aided WRS at 65 dB SPL was 82%. An increasing difference between vibroplasty thresholds and bone-conduction thresholds was associated with a higher discrepancy between the unaided maximum WRS and the postoperative aided WRS. Only if this difference was less than 20 dB, an articulation index of 0.5 (WRS = 75%) or more was achieved., Conclusions: Audiological outcome after vibroplasty depends on the coupling efficiency reflected by the vibroplasty threshold.

The video head impulse test (vHIT) is a new method for investigating vestibular function that is currently poorly studied in terms of its value for clinical diagnosis in otolaryngology. Both the caloric irrigation and vHIT serve to evaluate the horizontal vestibulo-ocular reflex. In the present study, caloric irrigation and vHIT were compared in 46 patients with vestibular schwannoma. Caloric irrigation exhibits a higher sensitivity than vHIT (72% versus 41%) and both tests show only a moderate correlation. Tumor size and hearing level was significantly correlated with caloric abnormalities but not with vHIT findings. Since caloric irrigation and vHIT measure the hVOR in low and high frequency ranges, respectively, these tests have to be considered complementary and are valuable in both diagnostics and therapeutic decisions.

The ex utero intrapartum treatment (EXIT) procedure is used for unborn fetuses in cases of predictable complications of postpartum airway obstruction. Indications for the EXIT procedure are fetal neck tumors, obstruction of the trachea, hiatus hernia of the diaphragm and congenital high airway obstruction syndrome (CHAOS). Large cervical tumors prevent normal delivery of a fetus due to reclination of the head with airway obstruction. Therefore, a primary caesarean section or the EXIT procedure has to be considered. The EXIT procedure has time limitations as the blood supply by the placenta only lasts for 30-60 min. Airway protection has to be ensured during parturition.This article reports the case of an unborn fetus with a large cervical teratoma where an obstruction of the cervical airway was detected and monitored by ultrasound and magnetic resonance imaging (MRI) during pregnancy. The EXIT procedure was therefore used and successfully accomplished. The features of the interdisciplinary aspects of the EXIT procedure are described with the special aspects of each medical discipline.

Background: Side-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades., Materials and Methods: As clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome., Results: A total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders., Conclusions: By means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.

Today, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.

Intratympanic gentamicin treatment (IGT) is an evidence-based therapeutic option for recurrent vertigo attacks in Ménière's disease (MD). Today, in MD it is possible to monitor changes of vestibular receptor function, induced by IGT, with objective test methods such as the video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP) in a dynamic, time-and frequency-dependent manner. We report on a 65-year-old female patient with recurrent vertigo attacks in a right-sided MD, where receptor function was followed up before and up to 4 weeks after IGT (time dynamic). Quantitative changes of vestibular function (frequency dynamic) were detected with bithermal calorics and vHIT, with air-conducted sound (ACS) cVEMP and bone-conducted vibration (BCV) oVEMP at 500 Hz. The horizontal vestibuloocular reflex (hVOR) gain in vHIT decreased successively until the 4th week with the appearance of catch-up covert and catch-up overt refixation saccades, and side asymmetry increased in caloric testing. Saccular function was extinguished within 4 weeks, whereas utricular function was diminished after 4 weeks. Monitoring vestibular receptor function with objective test methods provides a quantitative insight into the dynamic activity of vestibular function and is therefore applicable in order to adjust IGT regimen at different therapeutic stages.

Perturbation of semicircular canal function may result in a pathological angular vestibulo-ocular reflex (aVOR). The resulting impairment in gaze stabilization is perceived as "vertigo" or "dizziness" and may occur following receptor function impairment of all three semicircular canals. The head impulse test reveals hidden (covert-catchup) or visible (overt-catchup) saccades in disturbances of semicircular function. Most peripheral vestibular disorders can be treated conservatively. There are surgical treatment options for some diseases, such as intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence. Vestibular training promotes central reorganization of the VOR. Impaired semicircular receptor function, in particular bilateral vestibulopathy, may affect spatial orientation and cognitive processes. Balance prostheses could serve as a replacement for receptors in the future.

The perception and conversion of motion stimuli by the vestibular receptors, unimpaired postural control and intact visual acuity are essential for spatial orientation. Disturbances in these three sensory systems can manifest as "vertigo", "dizziness" or "imbalance". The integrity of peripheral receptor function, especially of the three semicircular canals, plays a superficial role. They are sensitive to acceleration stimuli, which they transmit via reflexes to the eye muscles. The stabilization of a visual target is via vestibulo-ocular reflexes, which have a very short latency and thus ensure a permanently stable image on the retina. Modern lateral-specific testing procedures are available to diagnose the receptor function of the peripheral vestibular system. The function of the semicircular canals can be analyzed using a head impulse test (HIT) and, more recently, by means of video-HIT as well as on the basis of a caloric test. Using these techniques, all three semicircular canals can be assessed in a side- and receptor-specific manner.

Aneurysmal bone cyst is a benign osteolytic lesion in childhood and adolescence which primarily arises in metaphyseal long bones. Its presence in bones of the skull base is very rare. In a 3-year old girl presenting with proptosis, MRI demonstrated a well-defined displacing growing mass in the ethmoid sinus, orbita and anterior fossa. The histopathologic examination of biopsy specimens confirmed an aneurysmal bone cyst. Despite radical surgery the child suffered from two recurrences of the lesion in the first year after initial diagnosis. There has been no subsequent recurrence during the last 3 years. Since this lesion is rarely seen at the skull base, is difficult to differentiate clinically and by histopathology and may take an abnormal course, it is described in this case report to emphasize that it should be included in the differential diagnosis of ENT tumors at this location.

Background: Tumours and metastases of the lateral skull base are rare findings. Clinically, the progressive involvement of ipsilateral cranial nerves is important., Case Report: A 69-year-old man presented with headache and palsies of the facial nerve and nerve VI. Furthermore, he had hearing loss and hypaesthesia of the trigeminal nerve (V3). Four months previously, laser therapy for carcinoma of the trachea (cT4 cN3 cM0) had been done. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an intrapetrosal mass with destruction of the lateral skull base. The findings suggested a metastasis of the tracheal carcinoma. We performed a mastoidectomy with specimen collection, and the pathological analysis revealed infiltration of a squamous cell carcinoma. The patient died within 3 weeks after radiotherapy with palliative intention despite malignant progression., Conclusion: The diagnosis and therapy of metastases to the lateral skull base is an interdisciplinary challenge. CT and MRI scans are essential for planning further procedures. In cases of headache and cranial nerve palsies, a metastasis to the lateral skull base must be considered in the differential diagnosis.

Thyroglossal duct cysts are the most common anomaly in thyroid development. The occurrence of carcinoma in a cyst is reported to be about 1% of cases. Histopathological examinations reveal a papillary thyroid carcinoma in about 94% of these. We report the case of 38-year-old female having a massive, cervical cystic mass over a period of 18 months. An ectopic papillary thyroid carcinoma was diagnosed. A total thyoidectomy and bilateral neck dissection were performed. This revealed a small thyroid carcinoma and three positive lymphatic nodes. Whether the cystic carcinoma is the primary or a metastasis of the thyroid carcinomais discussed.

The nasolacrimal system lies in direct proximity to the nasal cavity and the paranasal sinuses. Consequently, different nasal pathologies may influence the lacrimal drainage system. Hence, a standardized rhinological examination using endoscopy and, when indicated, modern imaging is mandatory to clarify malfunctions of lacrimal drainage. This paper describes the different possible causes and the necessary diagnostic tools from an ENT physician's point of view. Furthermore, the results of a series of 48 patients with endoscopic dacryocystorhinostomy performed between 2005 and 2008 were entered into the study. Follow-up examination of these patients showed satisfactory results in 91% and complete reduction of symptoms in 82%. Accompanying surgical procedures were done in 14 patients (septoplasty, infundibulotomy, or reduction of the middle turbinate).

Nanotechnology is an "emerging industry" and becomes more widely used. As a result human exposure to nanoparticles is inevitable. Exposure to nanoparticles can affect the upper aerodigestive tract, before particles reach lung, stomach and intestine. The effects of this passage depend on particle size, particle concentration, the kind of the particle and the duration of contact. Only few in-vitro-investigations about effects of the exposition of nanoparticles on the mucous cells of oral cavity, nose and nasal sinuses exist. In-vitro-analysis with cells of nasal mucous membrane exposed to nanoparticles showed a release of mediators involved in inflammation and allergy development. Cytotoxic and genotoxic effects could be found for several nanoparticles (e.g. carbon nanotubes) in vitro. Due to different size, structure, chemical and physical properties nanoparticles can not be summarized in a homogenous group; quite the contrary risk evaluation of nanoparticles must be carried out case-related. Today toxicological risks can not be evaluated sufficiently. Biological interactions and tissue permeability of manufactured nanoparticles is a major issue for further investigations. In this report the use and health effects of nanoparticles are overviewed.

The objective fitting of hearing aids and cochlear implants remains a challenge. In particular, the determination of whether sound is perceived as too loud or comfortable represents an unsolved problem in noncooperative patients. In a first step of an ongoing study, we assess the feasibility of habituation correlates in late auditory evoked potentials (LAEPs) to discriminate between a soft sound (SS) of 50 dB SPL and a loud sound (LS) of 100 dB SPL. We applied a new sweep-to-sweep time-scale coherence measure to analyse the habituation in LAEPs, i.e., relative changes within sweep sequences. From the comparison between both stimulation levels, a total discrimination of responses to SS and LS in the individual normal hearing subject was possible. As just relative changes in SS and LS sweep sequences were considered, purely exogenously driven morphological alternations in the responses such as intensity related amplitude and latency changes were excluded from the analysis. It is concluded that the proposed method allows for the reliable detection of auditory habituation and differentiation of SS from LS. The proposed scheme might provide an electrophysiological measurement and signal processing framework for the objective detection of the most comfortable loudness level and can be used in further, more clinically oriented studies.

Purpose: To report the use of a new platelike system (Titanium Epiplating System, Medicon, Tuttlingen, Germany) for rehabilitation of patients after total rhinectomy., Materials and Methods: This retrospective study was conducted on all patients treated between August 2001 and July 2006 with total or subtotal rhinectomy. The clinical outcomes and satisfaction of patients receiving nasal prostheses were evaluated, and the success rate of the subperiosteal implants was determined. Quality of life (QOL) was evaluated with a standardized questionnaire. Patients who had experience with different retention methods responded to a five-point scale evaluating their current satisfaction., Results: Eleven patients (four women and seven men) received nasal prostheses. The mean age was 63 +/- 12 years (range, 43 to 84 years). Nine patients were fitted with subperiosteal microplates and followed for a mean of 35 months. Two patients had subtotal rhinectomy and did not receive implants. In four patients immediate implant placement (concurrent with tumor resection) was performed; the other five patients received implants later. The implant success rate was 82%. There was no early implant loss, although one patient lost his implants after 3 years and another patient lost one implant after 1.5 years. QOL scores demonstrated high acceptance of implant fixed retention in comparison with other retention methods (P = .001)., Conclusions: Implantation of anatomically prefabricated titanium plates has a high success rate in the nasal area, although late implant loss may occur. Patient perceptions of QOL show improvement when prostheses are retained by subperiosteal implants.

After implantation of resorbable materials for internal fixation, foreign body reactions are described in 0-47% of cases. Copolymers of poly-l-lactic acid (PLLA) and polyglycolic acid (PGA) seem to offer better biocompatibility than other materials. One of our patients had a midfacial fracture, which we fixed using a resorbable system based on PLLA-PGA (82%-18%); a foreign body reaction developed after 22 months. When resorbable materials are used it is essential to be aware specifically of the risk of foreign body reactions, especially when the facial area is involved. This risk must be discussed with the patient in some detail during the preoperative period.

The different tumours of the parotid gland can be divided in benign or malignant tumours, regional inflammations and enlarged lymph nodes. We report on a 26-year-old male from Uganda with a slowly growing tumour of the right parotid gland for several months. The CT scan showed a poorly defined intraparotideal tumour. Ultrasonography revealed multiple enlarged cervical lymph nodes. Suspecting a neoplasm of the parotid gland we decided to perform a superficial parotidectomy for histological examination. The pathological analysis revealed a caseous necrosis and epitheloid granulomata containing Langhans giant cells. The polymerase chain reaction could not confirm our suspicion of tuberculosis. The Ziehl-Neelsen staining did not show any acid-proof rods. Only the breeding of the suspicious probes generated Mycobacterium tuberculosis. Initially denying any infections the patient admitted to having had tuberculosis that had been treated with antibiotics 2 years previously. Tuberculosis is a rare finding in parotid tumours. It must be considered as a differential diagnosis of parotid enlargements.

Abnormal wound healing processes can result in hypertrophic scars and keloids. Transforming growth factor-beta1 (TGF-beta1) and hepatocyte growth factor/scatter factor (HGF/SF) are biphasic growth factor cytokines in physiologic and pathophysiologic conditions. Findings have shown TGF-beta1 to be pivotal in the formation of keloid tissue. Therefore, neutralizing antibodies may allow wound healing without keloid formation. As reported, TGF-beta1 is antagonized by HGF/SF. Some authors have reported that exogenous administration of HGF/SF prevented scar formation. Hence, this study targeted TGF-beta1 and determined the levels of HGF/SF in fibroblast cell culture. Keloid tissue was taken from seven patients. Another seven patients with mature nonhypertrophic scar served as controls. All tissues were cultured, and fibroblast cultures were used for further experiments. The TGF-beta1 antisense was administered at 3 and 6 micromol/ml, and HGF/SF levels were determined after 16, 24, and 48 h of incubation. The levels of HGF/SF showed significant differences after incubation with antisense oligonucleotides. The increasing antisense levels resulted in increased HGF/SF levels (up to 87.66 pg/ml after 48 h of incubation). In conclusion, targeting TGF-beta1 resulted in significantly increased levels of HGF/SF. The clinical relevance could include the use of locally administered HGF/SF in protein or gene form to minimize formation of keloids. Nevertheless, wound healing is the result of many interacting cytokines, so neutralizing or targeting one protein could result in no significant effect.

Carcinogenesis of squamous cell carcinomas in the upper aero-digestive tract (UADT) is a multi-stage process. Since 1937, micronuclei (MN) have been considered a marker for genome damage in the initiation stage. By help of the micronucleus test, carcinogenic exposure can be proven in the mucosa area of the UADT. The hypothesis to be tested was that individual oral hygiene and the dental status, respectively - just like alcohol and tobacco abuse - are associated with the micronucleus rate in cytological preparations of the buccal mucosa. In a prospective clinical observation study, we determined in 100 probands the micronucleus frequency per 1000 mucosa epithelial cells. Study participants with a high number of missing teeth (M/T index, p=0.037), a below-average papillary bleeding index (PBI, p=0.032) and periodontal status, respectively (PSI, p=0.042) possessed a higher micronucleus number in comparison with restored dental conditions. Probands with composite restorations displayed a higher MN rate (p=0.006) compared to those with amalgam. However, we could not detect any significant relation with the prosthetic status (p> or =0.075). An adjustment was made according to alcohol and tobacco. We therefore conclude that subgingival plaque and synthetic dental materials in addition to chronic alcohol and tobacco consumption might have genotoxic relevance in the oral cavity.

We have recently shown that click evoked auditory brainstem responses (ABRs) single sweeps can efficiently be processed by a hybrid novelty detection system. This approach allowed for the objective detection of hearing thresholds in a fraction of time of conventional schemes, making it appropriate for the efficient implementation of newborn hearing screening procedures. It is the objective of this study to evaluate whether this approach might further be improved by different stimulation paradigms and electrode settings. In particular, we evaluate chirp stimulations which compensate the basilar-membrane dispersion and active electrodes which are less sensitive to movements. This is the first study which is directed to a single sweep processing of chirp evoked ABRs. By concentrating on transparent features and a minimum number of adjustable parameters, we present an objective comparison of click vs.chirp stimulations and active vs. passive electrodes in the ultrafast ABR detection. We show that chirp evoked brainstem responses and active electrodes might improve the single sweeps analysis of ABRs.Consequently, we conclude that a single sweep processing of ABRs for the objective determination of hearing thresholds can further be improved by the use of optimized chirp stimulations and active electrodes.

Background: Eosinophilic chronic rhinosinusitis (ECRS) is one of the most common diseases worldwide. To date the underlying cause remains unclear and no drug has been accredited for first-line therapy. VCAM-1 has been reported to play a pivotal role in establishing ECRS. Other authors have reported that inflammatory cytokines may mediate changes in the underlying epithelium in the sinuses through hepatocyte growth factor HGF. In our study, the effect of VCAM-1 on HGF levels was investigated., Materials and Methods: ECRS cell cultures were incubated with VCAM-1 and HGF levels were determined after 16, 24, 48 and 72 hours. RT-PCR was enrolled to depict the HGF-RNA levels., Results: Sixteen hours of incubation showed 28.5 pg/ml HGF, whereas in the control 16.3 pg/ml was detectable. After 24 and 36 hours, 37 pg/ml and 43.5 pg/ml HGF were measured in the incubated cell cultures, respectively; 72 hours of incubation with VCAM-1 resulted in 50.6 pg/ml HGF, whereas 23.5 pg/ml was determined in the controls. The RT-PCR for HGF also showed increased concentration in the incubated cells after 72 hours., Conclusion: VCAM-1 induced an increase in levels of HGF in the ECRS cell cultures. The rising transcriptional activity was demonstrated by means of RT-PCR. The levels of HGF were within physiological ranges, suggesting that a misbalance between HGF and VCAM-1 resulted in the establishment of ECRS. Further experiments are necessary to reveal the role of HGF in the development of ECRS. This is the first report about the effect of VCAM-1 on growth factors in ECRS cell culture.

The objective fitting of hearing aids and cochlear implants in uncooperative patients still remains a challenge. Especially in determining the threshold of uncomfortable loudness which cannot be predicted from the auditory threshold. In this study, we propose a single sweeps processing method which employs a hybrid approach of adaptive frame decomposition adaptation by a tight wavelet frame and the gaussian novelty detection for the detection of large-scale electroencephalographic responses correlates of habituation in late auditory evoked potentials. For this, habituation is discerns as a novel event. It is concluded that the new approach provides a fast and reliable method in the discrimination of uncomfortable loudness level from comfortable loudness level. It can be further use in more clinically oriented studies related to an objective frequency specific fitting of hearing aids or cochlear implants.

Cystic fibrosis (CF) is an inherited multisystemic disorder that results in a generalized dysfunction of exocrine glands. Besides chronic obstructive pulmonary diseases, chronic sinusitis, nasal polyposis and hypertrophy of the inferior turbinates with nasal airway obstruction are typical signs. Tissue samples of the inferior turbinates and nasal polyps were taken during nasal surgery from 21 children, ranging from 3 to 16 years of age. Light- and electron microscopical examination were carried out. Furthermore, specimens of nasal mucosa of patients without chronic inflammation as controls and specimens of duodenal mucosa of patients with CF were investigated. Under a thick layer of respiratory epithelium with a high proportion of goblet cells, the seromucous glands display abnormal morphological structures with wide mucous cells and cystic dilatation. The glandular cells show inhomogeneous glandular droplets in the supranuclear cell portion. The nucleus contains dispersed chromatin as a sign of increased activity and the structures of the Golgi apparatus are clearly detectable. Apart from investigations concerning nasal polyps in CF, studies on the different morphological changes of nasal mucosa at the electron microscopic level are rare. This histological study focuses on various morphological changes of nasal glands at the ultrastructural level in correlation with typical symptoms in CF. In addition, a comparison with electron microscopic findings of CF-enteropathies is proposed. These findings could help to bring information concerning new morphological aspects in the pathophysiology of patients with CF.

Invasive aspergillosis (IA) originating from the paranasal sinuses can cause an intracranial growth mainly along the skull base and larger vessels. This study reports our experience in the diagnosis and treatment of a series of patients with IA. A retrospective chart review of four patients with chronic invasive intracranial aspergillosis was performed. Clinical signs, physical examinations, radiographs, histological samples, and outcome were demonstrated. The patients demonstrated different symptoms like exophthalmus, ophthalmoplegia, loss of vision, and hypaesthesia of the ophthalmic and maxillary nerve. Computed tomography and MRI revealed extensive sino-orbital and skull base lesions. The patients were treated with aggressive endonasal debridement, intravenous antifungal agents and daily irrigations with antimycotic suspensions. Furthermore, we applied hyperbaric oxygenation. Two patients died from complications due to subarachnoidal hemorrhage and accompanied complications respectively. Despite the high mortality rate patients with an invasive aspergillosis can be effectively treated in some cases by an early and rigorous treatment schedule using all surgical and conservative therapeutic options.

Squamous cell carcinomas of the upper aerodigestive tract are a global health-political challenge. Accordingly, current research efforts are aimed towards the opportunities for early recognition of risk patients, and at the recognition of risk factors related to carcinogenesis. We determined the revertant number of the variety Salmonella typhimurium TA 98 and TA 100 after incubation, with saliva samples from 100 probands as a measure of a genotoxic environment within the oral cavity, depending on the dental status as measure of oral health. Beside chronic alcohol (p=0.032) and tobacco consumption (p<0.001), the dental status displayed in partial aspects (high plaque index, high number of decayed teeth, prosthetically not rehabilitated status, p or= 0.104). Therefore, it can be concluded that the polymicrobial supragingival plaque, as a possible independent factor, possesses a relevant mutagenic interaction with saliva, and that individual oral health is a co-factor in the development of carcinomas in the oral cavity.

Patients who have had a cancer-related total laryngectomy (N = 217) were studied in order to investigate possible associations between perceived stigmatisation and such physical and social factors as: type and intelligibility of the replacement alaryngeal voice, mental health, and gender. The laryngectomees participated in structured interviews. The German questionnaire "Fragebogen zur pyschosozialen Anpassung nach Laryngectomie" (Questionnaire for Psychosocial Adjustment after Laryngectomy, FPAL) was used to measure patients' perceived stigmatisation. Speech intelligibility was measured both by using the Post-laryngectomy Telephone Intelligibility Test (PLTT) and by taking into account patients' own evaluation of how well they are able to speak. Patients' mental health was measured with the Hospital Anxiety and Depression Scale (HADS). Multi-factorial analysis of variance and covariance was used to test the effects of the parameters. Results show that stigmatisation is associated with anxiety (F = 5.992, p < 0.05 and F = 12.895, p < 0.001) but not with speech intelligibility, alaryngeal voice type, gender, or depression. There is a correspondence between the degree to which patients feel stigmatised because of their voice or tracheostomy and their sense of loneliness (F = 4.917, p < 0.05 and F = 6.271, p < 0.05). We can conclude that perceived stigmatisation is frequently accompanied by anxiety and loneliness. Men are apparently as often concerned as women. Stigmatisation is not increased when patients do use electronic devices for communication, and it is not lower in patients whose operation dates back several years.

Inner ear extension caused by schwannomas, which can cause hearing loss, tinnitus and vertigo, is an extremely rare finding. We report a male patient who presented with progressive hearing loss as well as tinnitus in the right ear. Despite rheologic infusion therapy with glucocorticosteroids at another hospital, the patient showed an explicit hearing loss and vertigo related to the right ear. In the pure tone audiogram, we found complete deafness of the right ear, the equilibriometry with caloric testing showed complete loss of the labyrinth. In the HR-MRI, a structure appeared in ranges of the basal and middle cochlea with enhancement of the contrast medium. From the MRI aspect, this appeared to be a small intracochlear schwannoma. As a differential diagnosis, a chronic granulation is also possible. In agreement with the patient, we decided to control the structure clinically every 6 months using MRI; no further growth of the structure appeared. A precise imaging via HR-MRI is required to detect intracochlear schwannomas. Observation is an appropriate option for patients who have serviceable hearing. Surgical exploration can be recommended in cases of progressive diseases and growth into the inner ear with recurrent vertigo attacks. The option of radiotherapy for the treatment of intrameatal acoustic neurinomas should be considered.

Background: [corrected] Aspergillosis of the paranasal sinuses is subdivided into noninvasive and invasive types, depending on invasion of the tissue. The invasive form often occurs in immunodeficient patients and can be divided further into granulomatous, chronic invasive, and acute fulminating forms., Case Report: We report the clinical course of an immunosuppressed 64-year-old male with invasive aspergillosis originating from the sphenoid sinus with infiltration of the orbit and intracranial extension into the cavernous sinus. The patient was referred to our hospital with loss of vision, ptosis, and ophthalmoplegia of 3-month duration. Additionally he suffered from diabetes mellitus II and kidney failure after kidney transplantation. After CT scanning, endonasal sinus debridement and decompression of the orbit were carried out immediately. Histology revealed invasive aspergillosis. Postoperatively, both systemic and local antimycotic therapy and antibiotic treatment were performed. According to recommendations of the Undersea and Hyperbaric Medicine Society, cerebral abscess is a certain indication of hyperbaric oxygenation. We decided to attempt therapy for that as well. The patient died 3 weeks after surgical intervention due to carotid dissection., Conclusion: Invasive aspergillosis of the paranasal sinuses and the skull base of immunsuppressed patients is usually lethal because of intracranial complications. Therefore, fast diagnosis using CT and MRI and surgical and antimycotic therapy are necessary.

We report a 68-year-old male who had orbital trauma from a bicycle accident. His vision was initially normal but deteriorated over 8 days to complete blindness. After 13 days, when he first consulted a physician, clinical investigation revealed total ophthalmoplegia, ptosis, and chemosis. Computed tomographic scan showed fractures of the medial orbital wall, orbital floor, and posterior ethmoid with dislocation into the orbital apex near the optic nerve. The patient was sent to our department for optic nerve decompression. Clinical examination showed induration and an already healed infraorbital entry wound suggesting an orbital foreign body, which was confirmed by ultrasound. Renewed analysis of CT scans in different window settings could clearly demonstrate a wooden foreign body in the lower eyelid. Additionally, a diffuse inflammation in the orbital apex was diagnosed. The foreign body was removed and decompression of the orbita and optic nerve was performed. Antibiotics and corticosteroids were administered i.v. Unfortunately, no visual improvement could be achieved.

The effectiveness of intralesional sclerotherapy of lymphangiomas and ranulas with OK-432 (Picibanil) has been proved in several clinical studies. The aim of our study was to review the effectiveness of sclerotherapy of benign cervical cysts with Picibanil as an alternative method to surgical excision. Between March 2002 and March 2006, a prospective observational study was carried out to assess the effects of Picibanil on cervical cysts. Between 2002 and 2006 we treated 14 patients having cervical cysts through intralesional application of Picibanil with a dose of 0.01 mg/ml. So far we used Picibanil with 13 patients achieving a high success rate. In eight cases we observed, both clinically and ultrasonographically, a nearly complete regression, and a complete regression of the cysts in three cases. In two cases the cysts atrophied. In these cases only residual findings could be observed. In one case we extirpated the remaining cyst. If there is no clear reaction of the cyst to the treatment, an excision is indicated 6 weeks after the injections to gain meaningful histological examination. No significant complication after sclerotherapy with Picibanil was observed. According to our results the application of OK-432 (Picibanil) is a safe and effective primary method for sclerotherapy of benign cervical cysts which can replace surgical extirpation in special cases. However, the risk of malign diseases has to be excluded before the commencement of the Picibanil treatment.

Background: Nasal NK/T-cell lymphomas are rare malignancies in Europe or North America. Histological diagnosis is difficult, because tumors imbedded in large necrotic areas and neoplastic infiltrates may be admixed with small lymphocytes, plasma cells, eosinophils, and histiocytes, and thus the process could be misdiagnosed as chronic inflammation. Progression of the disease leads to septal perforation and may also result in destruction of the hard palate, and if left untreated it ends fatally. This introduced the term "lethal midline granuloma", a term which should not be used any more., Material and Methods: Clinical features, pathohistology, and current classification of primary nasal NK/T-cell lymphomas are described against the background of the recent literature and a case report., Results: Immunophenotyping is essential for the diagnosis. Tumor cells are uniformly infected by Epstein-Barr virus, which could be verified by EBER in situ hybridization. Immunohistochemically, tumor cells are positive for CD56, cytoplasmic CD3epsilon, and CD2 and they express cytotoxic molecules like granzyme B, TIA-1, GMP17, and perforin. Therapeutic options are radio- or radiochemotherapy. On average, 2- and 5-year survival rates of 50% are obtained in stages I and II. The prognosis of advanced tumor stages is very poor., Conclusions: Immunohistochemical and molecular genetic early diagnosis is of crucial prognostic relevance.

The translaryngeal tracheotomy (TLT) according to Fantoni with rigid endoscopy is well known and easy to execute. In our department we have used this method since 2002. In 17 patients suffering from carcinomas of the upper aerodigestive tract, we performed a TLT. Peri- and postoperative complications were examined. In 17 patients there were no intraoperative complications. As an early complication we found in one case a dislocation of the tracheostomy tube postoperatively. In one patient we observed metastases in the prior TLT stoma as a major late complication. Another patient also probably suffered from metastases in the prior TLT stoma. We did not find tracheoesophageal fistulas or stenosis of the trachea. Iatrogenic neoplastic seeding of squamous cell carcinomas of the upper aerodigestive tract is a serious complication. Our experience with these two cases and a review of the literature indicates that in patients with head and neck cancer, pull procedures for placement of TLT tubes may induce metastases by direct implantation of tumor cells because of contact between the TLT tube and the primary tumor cells. TLT according to Fantoni cannot be recommended for the treatment of cancer of the upper aerodigestive tract. Methods of tube insertion that avoid such contact, e.g., Ciaglia, surgical tracheostomy, should be preferred.