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Systemic steroids are widely used worldwide as a standard of care for primary therapy of idiopathic sudden sensorineural hearing loss (ISSHL). The German ISSHL guideline recommends high-dose steroids for primary therapy of ISSHL, without evidence from randomized controlled trials (RCTs). The rationale for the treatment of ISSHL using high dose steroids is only based on retrospective cohort studies.This article describes the planning and initiation of a multicenter, national, randomized, controlled clinical trial entitled Efficacy and safety of high dose glucocorticosteroid treatment for idiopathic sudden sensorineural hearing loss - a three-armed, randomized, triple-blind, multicenter trial (HODOKORT). This clinical trial aims to compare standard dose with two types of high-dose steroids for primary systemic therapy with respect to their efficacy in improving hearing, and thus communication ability, in patients with idiopathic sudden sensorineural hearing loss.This study is funded by the "Clinical Trials with High Patient Relevance" research program in the health research framework of the German Federal Ministry of Education and Research. It is one of two studies by the German Study Center of Clinical Trials of the German Society of Otorhinolaryngology, Head and Neck Surgery (DSZ-HNO). Planning and initiation was done in cooperation with the DSZ-HNO, the Coordination Center of Clinical Trials of the Martin-Luther-University Halle-Wittenberg, and the Study Center of the University Hospital Freiburg.

Lymphatic malformations are congenital malformations of the lymphatic system. They are mainly located in the head and neck area, and grow proportional to the patients' body growth. Depending on the morphology, it can be distinguished between macrocystic, microcystic and mixed lymphatic malformations. Due to their infiltrative growth, microcystic lymphatic malformations are particularly difficult to treat. Therapeutic approaches include conventional surgical resection, laser therapy, sclerotherapy and systemic drug therapies.

The number of elderly patients with head and neck cancer is increasing. However, there are few valid data on postoperative course after head and neck cancer surgery in elderly patients. The aim of this study was to evaluate the oncological outcome of elderly patients after surgical treatment for oro- and hypopharyngeal cancer.The clinical data of 81 patients, separated into two age groups (62 65 years vs. 19 ≥ 65 years), were retrospectively analysed. The cohort comprised T1 and T2 oro- and hypopharyngeal cancer patients, who had undergone primary treatment with transoral laser surgery and neck dissection. Overall and disease-free survival times of the patients were analysed. Additionally, comorbidities and perioperative complications were compared between the two age groups. Median follow-up time was 5.9 years.Comparison of different clinical and histopathological data revealed no significant differences between the age groups. The Kaplan-Meier method revealed no significant difference in disease-free survival between the age groups (p = 0.52). Age had no effect on disease-free survival in uni- or multivariate analysis (p = 0.53 vs. 0.94). Surgery-related complications were observed in 13 patients (16 %), 11 cases of which concerned the younger group of patients.Transoral laser surgery and neck dissection can lead to satisfactory oncological and surgical outcomes in elderly patients with oro- and hypopharyngeal cancer.

Lymphatic malformations are congenital abnormalities of the lymphatic system which occur predominantly in the head and neck region. According to their dominant clinical and morphological characteristics, these are classified into micro- and macrocystic forms. Established therapies for lymphatic malformations include conventional surgery, sclerotherapy and laser treatment. Despite the significant improvements in therapeutic options seen in recent years, treatment of extensive lymphatic malformations remains an interdisciplinary challenge. Close-knit interdisciplinary cooperation is necessary to provide optimized care for affected individuals.

Venous malformations are the prototype low-flow malformations in the head and neck region. Arteriovenous malformations (AVM) represent the main high-flow malformations. In recent years it has been possible to significantly optimize the therapeutic options for venous malformations. In addition to conventional surgery, laser treatment and sclerotherapy have become established techniques and the importance of embolization with new alcohol-based materials is increasing. AVM are progressive and destructive diseases. Therapy of choice is usually a combined treatment comprising embolization and surgical removal of the arteriovenous nidus. This curative approach is usually possible if diagnosis is made at an early stage. Incomplete embolization or sole ligation of the arterial supply causes progression. There is a clear need for improved therapeutic methods and pharmacotherapeutic approaches.

Due to the increasing number of cochlear implantations (CI), postoperative radiological verification of the electrode position, e.g., with respect to quality control, plays a central role. The aim of this study was to evaluate the intracochlear position of deep inserted electrodes by cone beam computed tomography (CBCT).CBCT data sets (Accu-I-tomo, Morita, Kyoto, Japan) of 22 patients (28 ears operated between 2008 and 2011) were retrospectively analyzed. All patients underwent a CI (round window approach) with deep insertion of the electrode (Flex soft or standard electrode from MedEl©). CBCT data were analyzed for intracochlear position of the electrode (scala vestibuli, scala tympani, malposition between the scalae) and the certainty of this evaluation.All ears could be evaluated with the status certain or relatively certain in the basal turn of the cochlea. Thereby, the electrode array was inserted into the scala tympani in 93% (n = 26). Primary insertion into the scala vestibuli and the scala media was observed in 3.5% of the ears, respectively. In the apical part of the cochlea, only 32% (n = 9 ears) could be evaluated with relative certainty. The remaining 68% of cases could not be evaluated. Of the 32% interpretable cases in the apical part of the cochlea, 25% (n = 7) were inserted into the scala tympani, 3.5% (n = 1) into the scala vestibuli, and 3.5% (n = 1) were malpositioned between the scalae.The exact evaluation of the intracochlear position of the electrode by CBCT is only possible in the basal turn of the cochlea. In deep insertion, determination of the position in the medial and apical parts of the cochlea by CBCT is still not possible. Furthermore, the round window approach allows reliable implantation into the scala tympani.

Image-Adapted brachytherapy (IABT) is a modern interdisciplinary development of classic radiation therapy, which allows the application of a high radiation dose while avoiding severe adverse events, thereby improving the prognosis of our patients. Indications in head and neck squamous cell carcinoma (HNSCC) include tumours of the floor of mouth, the face, the paranasal sinuses, the naso- and oropharynx, recurrent cancer and incomplete resections due to close vicinity of the tumor to important structures. The application type can be classified as curative, adjuvant, perioperative as a boost with or without external beam radiation (EBRT) or as a palliative treatment. The published results encourage the integration of IABT as part of the therapy of HNSCC, thereby improving the prognosis and quality of life of our patients.

Digital volume tomography (DVT) is an advancement of panoramic tomography used in dentistry. DVT enables precise display of fine osseous structures without any disturbing artefacts. This makes its application interesting in the field of the lateral, anterior skull base and paranasal sinuses, as well as for the diagnosis of nasal bone fractures. The tomograms can be completed according to need by volume rendering or panoramic slices within a short time. Assuming they have the appropriate technical qualifications in radiation protection, ENT specialists are even able to perform tomography independently using DVT.

Diseases of the superior laryngeal nerve occur more often than thought. Paresis of the superior laryngeal nerve is one of the most frequent causes of dysfunction of this nerve, mainly occurring in the context of thyroid surgery.To avoid iatrogenic damage of the superior laryngeal nerve, knowledge of the exact topography of the course of this nerve is necessary. A lesion of the superior laryngeal nerve may be associated with changes in the voice as well as with swallowing disorders with aspiration. Diagnosis of this disease is clinically challenging because the clinical symptoms are frequently not pronounced. Besides laryngoscopy, stroboscopy and electromyography are required for exact diagnosis.

The surgical management of enlarged inferior turbinates has been actively debated for more than a century. The second part of this review describes the following techniques: laterofracture, submucous turbinectomy, concho-antropexy, partial turbinectomy, anterior turbinectomy, inferior turbinoplasty, total turbinectomy, and vidian neurectomy. Indications, advantages, disadvantages, complications, and controversies of each treatment modality are reviewed and discussed. Partial or submucosal resection should be preferred, because there are moderate side effects and the amount of turbinate excised can be altered according the degree of symptomatology. Total turbinectomy or vidian neurectomy are indicated if all other treatment attempts do not succeed.

Chronic nasal obstruction is a common disorder, mostly caused by hypertrophied inferior turbinates. If there is inadequate response to conservative medical management, the inferior turbinates should be reduced. The choice of treatment is mainly influenced by whether the nasal airway obstruction is due to hypertrophic mucosa or to an enlarged turbinate bone. The first part of this review describes the various surgical modalities for treatment of swelling of the turbinal mucosa. The indications, advantages, disadvantages, complications, and controversies of each modality (submucous diathermy, cryosurgery, infra-red coagulation, argon-plasma coagulation, radiofrequency, laser surgical techniques) are reviewed and discussed.

Rendu-Osler-Weber disease is an autosomally dominant inherited disease which affects the connective tissue of blood vessels. The major symptom is recurrent epistaxis for which still exists no generally recommended treatment. Treatment modalities discussed in the literature include bilateral closure of the nostrils, brachytherapy, vessel embolization, hormone therapy, dermoplasties, as well as different kinds of laser therapies. Advantages and disadvantages of single treatment modalities are discussed. Dermoplasty and laser therapy seem to be the most suitable treatment procedures currently available for recurrent epistaxis in affected patients. Treatment carried out with the argon, KTP or ND:YAG laser has proven to be suitable as initial therapy. In most cases the additional use of long-term applications of a soft nasal ointment allows a lasting successful treatment. Our experiences show that dermoplasty should be reserved for cases with continued bleeding despite laser treatment but only rarely offers a long-term cure in the sense of a total recovery from epistaxis.

Since 1984 at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, 34 patients with hypopharyngeal diverticular have been operated microendoscopically using the CO2 laser. Results and complications of this technique were compared to a group of patients in whom standard (non-laser) diverticulotomy was carried out from 1976 to 1993. Ninety per cent of the patients treated endoscopically with laser surgery have not had complaints and the rate of postoperative complications has been low. Three patients developed pharyngeal stenoses while one case incurred a mediastinitis. Intraoperative bleeding was not observed. In comparison to the microendoscopic procedure serious complications were more frequently observed in patients treated with the standard diverticulotomy. In eight of these cases paralysis of the recurrent laryngeal nerve occurred. A mediastinotomy was performed in another three patients because of mediastinitis. In two cases stenosis occurred after surgery and one patient developed a fistula. Endoscopic diverticulotomy utilizing a CO2 laser was found to be an excellent treatment for Zenker's diverticulum because of the good functional results achieved and low complication rate. The procedure was easy to perform because of the short duration and could be repeated frequently without significant additional risks.

Spherulocytosis (myospherulosis is a disease resulting from the physical emulsion phenomenon between lipid-containing materials and blood. It can be caused by the application of lipid-based ointments with or without antibiotics to wounds. This "foreign-body" reaction appears as a granulation tissue that will cause symptomatic when developing under closed wounds or in such cavities as the middle ear or paranasal sinuses. Poor healing after paranasal sinus surgery may be due to spherulocytosis. This occurred in several cases managed at the University Hospital in Kiel as the result of postoperative nasal packs sensitizing sinus mucosa. These experiences led the authors to conclude the nasal ointment packs should be avoided in paranasal sinus surgery.

Sera containing media are frequently used for cultivation of epithelial cells, but the influence of serum on analytic methods can be significant. For this reason the development of serum-free media is of great significance. We investigated the influence of serum-free medium on growth characteristics of human squamous cell carcinoma (SCC) cells of the upper aerodigestive tract and compared these in serum-containing media, using cloned SCC cell lines HLaC-78 and HCFMK-1. Three serum-containing culture media were used: MEM-Instamed, RPMI-1640 and MCDB-153, each containing 10% fetal calf serum. Serum-free culture medium was MCDB-153 supplemented with bovine hypophysis extract, insulin and ethanolamine. Results showed that supplement-enriched, serum-free medium was suitable for culturing SCC cells. When compared to serum-containing media, cell growth of the SCC cell lines was significantly higher in the serum-free medium.

Laryngeal carcinomas have different metastatic characteristics depending on their locations. Although these changes could be explained by differences in density of the lymphatic system, studies of the laryngeal lymphatic system have been controversial. To clarify these differences the lymphatic systems of 184 organ specimens were investigated with light and electron microscopy, histochemistry and injection techniques. Three types of lymphatic vessels were found in the larynx: lymph sinuses, precollectors and collectors. The highest density of lymphatics was found in the supraglottic larynx. From this region, lymph drained via 3-6 collectors to a hypopharyngeal collector. The subglottic lymph mainly drained via 2-4 collectors to paratracheal and mediastinal lymph nodes. The lymph system of the vocal folds was sparse but drained mainly to the supraglottic larynx. No lymph collector was found in the mucosa of the vocal fold. According to these results, the incidence of lymphatic spread correlated first with the density of the initial lymphatics in the various laryngeal regions and secondly (and probably of greater significance) with nearness of tumor to the laryngeal collectors.

We report a rare case of an adult rhabdomyoma of the floor of the mouth in a 52-year-old woman. To date only 25 cases of such tumors have been described in the oral cavity. In spite of its large size (approximately 10 x 8 x 6 cm), the tumor could be completely removed. Up to now, 20 months after the removal of tumor, no recurrences, have occurred.

The Nd:YAG laser is suitable for the treatment of various otorhinolaryngological clinical disorders. These include the palliative reduction of tumor size in sites with difficult access, treatment of hemangiomas and reduction of hyperplastic turbinates. Within certain limits, other indications are treatment of recurrent epistaxis and recurrent polyposis. Palliative reduction of malignancies in the nasopharynx, esophagus, and bronchial system (laser power density: 1500-8000 W/cm2) must sometimes be carried out in several sessions in order to avoid complications due to the laser (i.e., perforation of the bronchial or esophageal wall, lesions of adjacent vessels or nerves). Nd:YAG laser treatment of hemangiomas (500-3000 W/cm2) can lead to excellent results. To avoid excessive thermal lesions, vascular tissue is cooled with ice cubes or with an ice-cold Ringer's solution. The laser process is continued until the onset of tissue blanching. Carbonizations of the tissue are to be avoided. In Nd:YAG laser therapy of hyperplastic lower nasal conchae (approx. 1000 W/cm2), results are based on submucous scarring in which the covering epithelium is maintained. The objective of Nd:YAG laser treatment of recurrent epistaxis in patients with Osler's disease (500 W/cm2) is to reduce the incidence of hemorrhage. Use of the laser in recurrent polyposis is best confined to patients who refuse conventional surgical revision operations. Laser light (500-3500 W/cm2) should only be applied for a short period of time (0.5 s) to avoid creating a rarefying osteitis.

Laser surgery can be performed using either endotracheal intubation, apnoea or jet ventilation. For operations performed under endotracheal intubation the same technical rules apply as for any other type of anaesthesia. To facilitate intubation a special laser tube is required. The Mallinckrodt Laser-Flex Tracheal Tube has the best physical qualities of all endotracheal catheters available commercially. Aspiration prophylaxis using ranitidin and metoclopramide is recommended for procedures under apnoea or using jet ventilation. For monitoring purposes during jet ventilation or procedures under apnoea, transcutaneous oximetry, ECG recording as well as non-invasive blood pressure measurements at short intervals is mandatory. In addition video monitoring is desirable to allow visual anaesthesiological surveillance of the larynx. The jet ventilator must meet established standards; the option must be available to survey inspiratory peak pressure and end-exspiratory pressure as well as the setting of appropriate alarm limits.

A total of 111 cases of laryngeal plasmacytoma have now been reported. The disease may present either as a primary extramedullary plasmacytoma (n = 90) or as a metastasis of a multiple myeloma (n = 21). The distinction between these two types is very important in therapy and prognosis. We report a subglottic plasmacytoma in a 48-year-old woman. Investigations showed bone marrow infiltration, osteolysis and light chain expression in serum, indicating generalized disease. Therefore polychemotherapy was given, during which complete macroscopic and microscopic regression of the laryngeal plasmacytoma was observed. However, 14 months later, the patient died of renal failure due to systemic progression of the multiple myeloma.

We report two patients, a 3-year-old child and a 75-year-old woman, with a foreign body of the trachea, and of the entire tracheobronchial system respectively. We emphasise the importance of rigid endoscopes for foreign body extraction and for respiration. Also, we describe the differentiation of endogenous from exogenous foreign bodies of the tracheobronchial system.