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The anatomical variations of the nose and the nasopharynx concerning the possible complications in placement of transnasal tubes are discussed, such as problems with septal deviations, retropharyngeal or even intracranial aberration. In order to avoid complications attributable to these techniques the use of instruments designed for anterior rhinoscopy is recommended. No convenient and practicable instrument for routine use by an anaesthesiologist has been developed to date.

Five rare tumours of the base of the tongue are reported. Diagnosis and therapy of a tuberculoma, an amyloid tumour, a mucoepidermoid carcinoma, a pleomorphic adenoma, and an angioleiomyoma are illustrated. The frequency and other possible sites of these tumours are discussed based on a review of the literature. The standard surgical approaches to the base of the tongue are described, favouring lateral pharyngotomy. The need for careful planning of the operation is stressed including difficulty in intubation and control of bleeding after operation.

The relation between malignant neoplasms and zoster oticus as a paraneoplastic syndrome is discussed based on a bibliographic review and catamnestic evaluations of own patients. 19 patients who had suffered from zoster oticus were included in a follow-up study covering a period up to 13 years after the affection. The symptoms of zoster oticus as described in the literature are reviewed and compared with the findings in our patients. Although there were no indications of neoplasms in our patients a general check-up is recommended in all cases of zoster oticus in accordance with the rules established in internal medicine and dermatology.

Regarding the high carcinogenic potential of asbestos fibres and the mostly inhalative exposition, the question is investigated whether tumors of the inner nose and the paranasal sinuses can be induced by asbestos. Literature contains no communications on this subject. Three cases of tumors of the inner nose and the paranasal sinuses are presented which are connected with an exposition to asbestos. These cases cannot be recognized according to jurisdiction and the valid Ordinance on Occupational Diseases, because the correlations are not scientifically proved in a sufficient manner. Attention shall be drawn on this problem in order to realize possible further cases.

Although there are some pointers towards dependence of pathogenesis of laryngeal cancer on hormone metabolism, proof for this assumption is still missing. We studied hormone metabolism of 43 patients with laryngeal disease (testosterone, oestradiol, FSH, LH, prolactin). We subdivided the patients into two groups: 20 patients with squamous cell carcinoma and 23 patients with non-malignant diseases. No differences were seen between the two groups on statistical evaluation of the data. We could not prove any hormonal dependence, which might have had a therapeutical impact on the administration of antiandrogen drugs.

This is a report on five cases of histiocytosis x with manifestations in ENT. Based on our own experience and reports in the literature the recommendation is given to search for further foci of the disease even in the case of an eosinophilic granuloma, which is generally presumed to be unilocular. Therapeutic steps should be taken only after having established thorough staging.

Currently, the method of choice for evaluation of head and neck cancers is CT, because in many respects it is superior to the other imaging modalities except for MR. For parotid tumors, however, histological grading is of major importance. The staging of tumors of the hypopharynx and larynx can be done just as reliably by CT and microlaryngoscopy; the latter has the advantage of including biopsy. Ultrasound is of primary value in providing information on metastases to the cervical lymph nodes. If CT is used for staging of the primary tumor or planning radiation therapy, then it also can be utilized for the detection of lymphatic spread.

It is well known from in vitro studies that the functional state of the ciliary epithelium is temperature-dependent. The ciliary beat is irreversibly arrested above about 40-45 degrees C. We exposed 30 volunteers to inhalation therapy with hot moist vapour of about 50 degrees C. The functional state of the nasal mucosa was assessed by counting ciliary beat frequency and the percentage of dead and vital ciliated cells from a vital cytological sampling of the nose before and after treatment. The percentage of vital cells was the same whereas the ciliary beat frequency rose significantly. It is discussed that in the mucosal layer temperatures are not as high as in the inhaled vapour due to the air-conditioning capacity of the nose.

Results of chemotherapy in head and neck cancers are reported with a regimen of cisplatinum, bleomycin and methotrexate. In 63 previously untreated patients, the overall response rate was 73%, including 13/63 CR and 33/63 PR. The response rate in 20 previously treated tumors was 20%. The chemotherapy protocol was well tolerated without severe complications. Initial chemotherapy as a third modality in addition to radiotherapy and/or surgery is discussed.

Five human larynges, obtained by surgery, were examined by light and electron microscopy and with an operating microscope, searching for signs of ciliary activity. In two larynges the mucociliary waves could be seen in the subglottic space, whereas a mucociliary transport could not be proved. Via light microscopy, fully ciliated epithelium was found in some cases, in other cases ciliated epithelium was seen only occasionally, whereas in some cases it was absent, substituted by squamous epithelium. The ciliary ultrastructure was normal. The author discusses whether the ciliated structure survives radiotherapy, or whether a regeneration occurs from untreated areas.

It is known from in-vitro-studies, that temperatures exceeding 45 degrees C can damage the function and structure of the nasal cilia irreversibly. We tested 30 healthy volunteers by inhalation therapy, exposed to moist vapor over a 10 min period. The ciliary function was assessed by vital cytological sampling, and included measurement of ciliary beat frequency. The beat frequency increased during inhalation therapy, but the number of viable ciliated cells did not change significantly. Thus warm air inhalation therapy does not damage the nasal ciliated epithelium, probably due to the air conditioning capacity of the nose.

The synovial sarcoma is a mesenchymal tumour that is very rare in the head and neck region. This is a report on two cases. In a 30-year old patient the tumour arose near the thyroid gland and the hypopharynx. He died in spite of surgical removal, radiotherapy and chemotherapy, one year after the first symptoms. An 8-year old boy was affected by a synovial sarcoma near the hyoid bone and is without recurrence after surgical removal, radiotherapy and chemotherapy. Subsequently, the main diagnostic characteristics of these tumours are discussed. A better prognosis of the tumours associated with the hyoid bone is a remarkable fact.

Clinical findings and age distribution of 71 female patients with laryngeal cancer seen in the ENT department of the University of Münster between 1961 and 1981 are reported. Of these patients, 26 could be questioned with regard to their habit of smoking and relevant gynaecological biographical data. They were compared with an equal number of patients of the same age not suffering from hormone-dependent diseases. With regard to histology, localisation or TNM staging, no signs of laryngeal cancer in women could be found compared to male patients reported in the literature. From the data gathered by questioning, it is possible to conclude that certain trends are represented, suggesting two pathogenetic types of laryngeal cancer in women: 1. Cancer of a young, non-smoking woman, showing signs of virilism. 2. Cancer of an older, smoking woman without signs of virilism.

During insufflation anaesthesia the ciliary beat frequency of the ciliated cells of the trachea and the nasal cavity was assessed via vital cytological sampling from these sites before and after anaesthesia. The percentage of vital and dead ciliated cells as well as the percentage of squamous cells was counted in a chamber.-It was found that the ciliary beat frequency did not change significantly, whereas the number of vital ciliated cells in the tracheal samples was significantly reduced and the vitality of the epithelia in the nose showed a minor change. It must be presumed that the observed noxious effects on the tracheal epithelium are due to inhaled gases, since the temperature and humidity in the ventilation circuit are within a range known not to violate the ciliary epithelium. Apart from that, the intubation itself might produce reflexes in the mucosal layer.

A method for sampling cytological brushings of human nasal mucosa using phase-contrast microscopy is detailed and the modes for counting the ciliary beat frequency (CBF) are reviewed. To test the reproducibility of our method, we performed two sampling procedures on subsequent days on each of 19 volunteers and patients. The total volume of harvested cells, the number of beating ciliated cells, and the CBF were assessed. Since there are some differences present in subsequent cell samples, our findings indicate that it may be better to critically evaluate a single sampling procedure in order to establish a correct clinical diagnosis, especially if the number of harvested cells is small. The need to standardize methods for counting the CBF to achieve comparable results is stressed.

This is a report on the preoperative and postoperative findings of 120 patients with frontobasal fractures. The majority of 62 defects of the dura were treated with lyophilised dura and fibrin glue. The course was controlled by means of a questionnaire. Thus the technique of repairing the lesions as well as the often performed osteosynthesis of the frontal sinus with wire or plates proved to be effective.

This is a report on induction chemotherapy of 20 oropharyngeal and 20 hypopharyngeal squamous cell carcinomas with cis-platinum, bleomycin, and methotrexate. The response rate, defined as a tumour regression of at least 50%, was 70% for the hypopharynx and 80% for the oropharynx. The lymph nodes responded in 50% of the cases. The toxicity was low. Induction chemotherapy is considered to be significant, but it must be stressed that surgery and/or radiation therapy must follow to sustain the initial success.

A usual rhinomanometer was used to construct an apparatus to measure the aerodynamic resistance of a tracheostomy speaking tube lying in the trachea. This resistance, evoked by the sieve or the hole in the tube, is considerable. A model of a trachea was made from a silicone tube to assess the resistance of several types of tracheostomy speaking tubes.

The effects of high-frequency ventilation (HFV) on the rheological properties of tracheobronchial secretions were investigated in vitro. The mucus was obtained by suction from 16 patients after major surgery of the larynx or hypopharynx. After short centrifugation, the mucus was treated with high-frequency vibrations of 3 or 30 Hz for 10 min in a chamber saturated with water vapor. The mucus was separated by a nonpermeable membrane from the ventilator's gas stream. Maximal, minimal, and mean viscosity were determined by a modified capillary viscosimeter. Under high-frequency vibrations, maximal, minimal, and mean viscosity slightly increased (p less than or equal to .001). Conversely, the mean viscosity of control samples did not change significantly. These findings indicate that high-frequency vibrations do not improve mucous rheology. Observed beneficial effects of HFV on mucociliary clearance may be caused by changes in the mucous subphase during HFV.

A case report on a locally advanced inoperable esthesioneuroblastoma in a patient of 65 years of age is presented. Chemotherapy (CYVADIC) resulted in a slight reduction of tumour mass and was followed by rapid tumour regrowth. By megavoltage radiotherapy (65 Gy) with shrinking field technique a clinically complete remission was achieved. The role of radiotherapy in long-term local tumour control in combination with surgery is discussed, taking into account the few date reported in literature. Depending on the tumour stage at diagnosis, a graduated strategy combining surgery and radiotherapy is recommended as the treatment of choice. The value of adjuvant chemotherapy has not yet been clearly established, not even in locally progressing or advanced stages of tumours or in metastasizing tumours.

18 patients with inflammatory or neoplastic diseases of the skull underwent bone scintigraphy; the scintigraphic and radiologic findings were compared with the extent of the lesion found at surgery. Possible errors and the diagnostic value of this method are discussed.

The influence of nasal obstruction on mucociliary transport is tested by the saccharin test (Andersen). Twenty normal subjects were tested with open nose and subsequently with the nose closed by a clamp. The transport times were significantly longer, when the nose was clamped. It is diScussed that nasal obstruction and missing ventilation leads to changes in the mucus layers by superfluent humidity. This causes a decoupling of the mucociliary transport. Thus a new aspect in pathogenesis of nasal and sinus disease is given.

After a short historical introduction, the current state of knowledge of the anatomy and physiology of the mucociliary system is reviewed. Description and discussion of the clinical and experimental methods of investigation and measurement of the mucociliary transport and of the ciliary activity then follow. Light and electron microscopy are also considered. Next, the pathology, pathophysiology and pharmacology of the mucociliary system are reported. The introduction ends with the consideration of specific diseases related to the mucociliary system, such as the immotile cilia syndrome. The main interest of this investigation is directed to changes in the ciliary epithelium in laryngeal malignancies. Therefore the literature relevant to physiology is critically evaluated. Pilot studies of the method used for investigating the physiology of the ciliary epithelium were mainly undertaken on the more accessible nasal mucosa as a model for ciliary epithelium. The use of the saccharin test for demonstration of nasal mucociliary transport is thoroughly assessed and the suitability of a new, improved, marking substance was tested. The quantification of cell types for cytological assessment of nasal smears under the phase contrast microscope was appraised. The method of determination of ciliary frequency by microphotometry was evaluated critically by a series of experiments. The author's electron microscopic findings on ciliary epithelium taken from human larynges affected with cancer are also discussed. After these pilot studies the method of the saccharin test and the cytological smear appeared to be unsuitable for oncological investigations. Therefore, mucociliary transport in the subglottic space of 75 human larynges excised for malignancy was investigated by the development of a suitable method. This method demonstrated abnormal mucociliary transport pathways. Investigations of the normal pathway of mucociliary transport in the larynx were obtained in animal experiments and by endoscopic investigations in man.

The saccharine test for assessing mucociliary clearance in the nose is the most practicable method. As the used sodium salt of saccharine is well water soluble, there is suspicion of interference with the very delicate two-layer-system of mucus or transport merely in the periciliary fluid, thus bringing about methodical errors. This is avoided by using inert tracers such as radioactively tagged ion exchange resin particles, which on the other hand must be observed with expensive equipment. A synthesis of both methods is demonstrated by using saccharine loaden ion exchange resin particles. The validity of the test is proven in vitro and in vivo.