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Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der Schleimhäute von Nase und Nasennebenhöhlen. Eine eosinophile Entzündung wird als häufiger Endotyp beschrieben. Der Anti-IL-5-Antikörper Mepolizumab ist seit November 2021 als Zusatztherapie zu intranasalen Glukokortikosteroiden für die Behandlung Erwachsener mit schwerer chronischer Rhinosinusitis mit Nasenpolypen zugelassen, wenn systemische Glukokortikosteroide oder eine Operation keine ausreichende Krankheitskontrolle bewirken. Während nationale und internationale Empfehlungen für den Einsatz von Mepolizumab bei CRSwNP existieren, ist bislang nicht hinreichend festgelegt worden, wie diese Therapie überwacht wird, welche Folgedokumentation notwendig ist und wann sie ggf. beendet werden sollte. Methoden In einer Literatursuche wurden die bisherigen Daten zur Behandlung der CRSwNP mit Mepolizumab analysiert und die vorhandene Evidenz durch Recherchen in MEDLINE, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library ermittelt. Es wurden Humanstudien berücksichtigt, die im Zeitraum bis einschließlich 10/2022 publiziert wurden. Ergebnis Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen und eventuelle Therapiepausen sowie eine Beendigung der Therapie bei Anwendung von Mepolizumab für die Indikation CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue, nichtoperative Therapieansätze mit Biologika für Patient*innen mit schweren, unkontrollierten Verlaufsformen. Hier geben wir Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen, eventuelle Therapiepausen oder eine Beendigung der Therapie bei einer Mepolizumab-Behandlung als Zusatztherapie mit intranasalen Glukokortikosteroiden zur Behandlung von erwachsenen Patient*innen mit schwerer CRSwNP, die mit systemischen Glukokortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden kann.

Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der Schleimhäute von Nase und Nasennebenhöhlen. Eine Typ-2-Inflammation als immunologischer Mechanismus wird als häufigster Endotyp beschrieben. Der Anti-IL-4-/-IL-13-Antikörper Dupilumab ist seit Oktober 2019 als Zusatztherapie zu intranasalen Glukokortikosteroiden für die Behandlung Erwachsener mit schwerer chronischer Rhinosinusitis mit Nasenpolypen zugelassen, wenn systemische Glukokortikosteroide oder eine Operation keine ausreichende Krankheitskontrolle bewirken. Während nationale und internationale Empfehlungen für den Einsatz von Dupilumab bei CRSwNP existieren, ist bislang nicht hinreichend festgelegt worden, wie diese Therapie überwacht und wann sie ggf. beendet werden sollte. Methoden In einer Literatursuche wurden die bisherigen Daten zur Behandlung der CRSwNP mit Dupilumab analysiert und die vorhandene Evidenz durch Recherchen in MEDLINE, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library ermittelt. Es wurden Humanstudien berücksichtigt, die im Zeitraum bis einschließlich 05/2022 publiziert wurden. Ergebnis Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen und eventuelle Therapiepausen sowie eine Beendigung der Therapie bei Anwendung von Dupilumab für die Indikation CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue nichtoperative Therapieansätze mit Biologika für Patienten mit schweren, unkontrollierten Verlaufsformen. Wir geben hier Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen, eventuelle Therapiepausen oder eine Beendigung der Therapie bei einer Dupilumab-Behandlung als Zusatztherapie mit intranasalen Glukokortikosteroiden zur Behandlung von erwachsenen Patienten mit schwerer CRSwNP, die mit systemischen Glukokortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden können.

Einleitung: In der klinischen Praxis wird der Endoskopiker immer wieder mit Fremdkorpern im Gastrointestinaltrakt konfrontiert. Der Versuch einer endoskopischen Bergung sollte bei potenziell penetrierenden Fremdkorpern erfolgen. Hierzu existieren verschiedene endoskopische Techniken. Im Gegensatz zu Fremdkorperbergungen aus dem oberen Gastrointestinaltrakt werden Entfernungen aus dem mittleren und tiefen Dunndarm nur sehr selten berichtet. Fallbericht: Wir stellen den Fall einer Patientin vor, die eine geoffnete Sicherheitsnadel verschluckt hatte, welche mittels Doppelballonenteroskopie (DBE) unter Anwendung eines dunnen Enteroskops mit dickem Ubertubus aus dem Jejunum entfernt werden konnte. Schlussfolgerung: Unser Fallbericht beschreibt eine sichere Moglichkeit, potenziell penetrierende Fremdkorper aus dem tiefen Dunndarm durch Einziehen in den Ubertubus eines DBE zu bergen. Es erscheint ratsam, bei radiologischem Nachweis eines potenziell penetrierenden Fremdkorpers im Dunndarm primar ein Ballonenteroskopiesystem zum Bergungsversuch einzusetzen.

Correction of complex facial scars frequently requires individualized, multimodal strategies, which are composed of various therapeutic measures. This report provides information on techniques for correction of contractures, atrophic scars, scars within hair-bearing regions of the face and auricular keloids. Additionally, we present adjuvant procedures in a subject-related manner.

Ein 14-jahriger Junge berichtete uber eine plotzliche Visusminderung, Flimmerskotome und Blendungsempfindlichkeit. Die korperliche Untersuchung ergab eine Fazialisparese rechts, Parotisschwellung beidseits, hohes Fieber sowie eine Verschlechterung des Allgemeinzustandes. Neben einer milden Uveitis anterior bestanden ein Makulaodem, ausgepragte chorioretinale Infiltrate sowie in der Angiographie multiple Hyperfluoreszenzen beidseitig. Es ergab sich die Diagnose eines Heerfordt-Syndroms. Unter systemischer Prednisolon-Therapie kam es zu einer deutlichen Besserung der Symptomatik einschlieslich einem Visusanstieg.

Spindelzellige Lipome des Mundbodens bzw. des Pharynx sind ein seltener Phanotyp unter den Tumoren des Weichgewebes. Sie mussen bei der differenzialdiagnostischen Abklarung von Schwellungen im Nasen-Rachen-Raum berucksichtigt werden. Wir berichten uber ein spindelzelliges Lipom im Bereich des Mundbodens bei einem 69-jahrigen Mann. Aufgrund der typischen makroskopischen und histologischen Merkmale sowie der Bewertung der bildgebenden Verfahren lasst sich das spindelzellige Lipom von den in diesem Beitrag aufgefuhrten Differenzialdiagnosen abgrenzen.

The ingestion of foreign bodies is a frequently observed problem in daily clinical practice. In order to avoid complications such as perforation, endoscopic removal of potentially penetrating foreign bodies should be attempted quickly. The use of various endoscopic techniques has been reported for this purpose. However, extraction of foreign bodies from the mid gastrointestinal tract has rarely been reported.We present the case of a patient who had swallowed a safety needle which could safely be removed from the jejunum by means of double-balloon enteroscopy (DBE). The combination of a thin p-type enteroscope with a thick t-type overtube was used in order to improve the manoeuvrability of the endoscope. The needle was pulled into the overtube which served as a protective shield during the retrieval of the endoscope.Our case report describes the potential of removing foreign bodies from the deep small bowel by pulling them into the overtube of a double-balloon enteroscope. If the suspicion of foreign body impaction in the small bowel is made, it may be advisable to primarily choose a balloon enteroscopy system. Through this, quick and deep insertion can be combined with a safe removal of the foreign body.

Chronic rhinosinusitis (CRS) appears to be of increasing relevance epidemiologically. Despite progress in elucidating the role of eosinophilia as well as aspirin intolerance and eicosanoid mediators, the pathophysiology remains obscure. Endonasal sinus surgery has become the treatment of the choice for CRS patients with and without nasal polyposis, particularly if conservative treatment fails. Long-term studies indicate that a minimally invasive approach with microscopic and endoscopic procedures is preferable to radical surgery. Powered instrumentation or computer-aided surgery are still controversially discussed, but certainly can be very helpful in the hands of an experienced surgeon, especially to minimize surgical trauma and save surgical time. The complex therapeutic concept needs to be individually tailored to the disease of the patients and to the heterogeneous etiologic aspects.

Background The full clinical picture of aspirin intolerance, Sampter's triad, is associated with nasal polyposis, clinical sensitivity to most non steroidal antiinflammatory drugs (NSAID) and intrinsic bronchial asthma. But the triad can be incomplete and nasal polyposis can be the first clinical symptom of aspirin sensitivity. Although the exact mechanisms of aspirin intolerance as well as those of desensitization remain obscure, an in vitro assay on eicosanoid metabolism has been proven to be helpful in diagnosis and treatment as it correlates well to the individual severity of clinical symptoms. Methods For this investigation 30 patients, who were undergoing adaptive desensitization for aspirin intolerance, were followed-up between 1 and 3 years. They received a maintenance dose of oral aspirin of only 100 mg a day after an initial application of higher doses. Their clinical course as well as their in vitro parameters of eicosanoid release were monitored throughout the individual observation period. Results Desensitization was successful in 25 of the 30 patients regarding the recurrence rate of nasal polyps, severity of bronchial asthma and sense of smell. There was a clear positive correlation between clinical and in vitro parameters. Discontinuing of aspirin therapy lead to worsening of clinical symptoms, regardless of the prior duration of treatment. Conclusions This article reviews the role of the in vitro assay and presents a desensitization protocol that can be maintained as a long term treatment without adverse side effects. Results suggest that the recurrence rate of nasal polyps after surgical therapy can be reduced using this protocol, however, only long term treatment can secure a beneficial outcome over time.

BACKGROUND The development of nasal polyps might be influenced by different factors such as mucosal inflammation. Infiltration with eosinophils is a common finding, although in largely different quantitis. PATIENTS AND METHODS We investigated 58 patients suffering from nasal polyps who were assigned for endonasal sinus surgery based on endoscopic and CT findings. Out of these patients, 52% have already had sinus surgery and had recurrent polyps. All patients were subjected to both, allergy testing and a functional in vitro test for aspirin intolerance. During surgery, tissue samples were gained and send for histological examination with special respect to eosinophil infiltration. RESULTS Eosinophil infiltration was observed in 66% of all patients. 37 patients (64%) exhibited aspirin intolerance only, four (7%) had a positive allergy test only, in 9 patients (15%) both, allergy and aspirin intolerance were diagnosed. Allergy and aspirin intolerance were accompanied by eosinophil tissue infiltration. Eosinophil infiltration was more common and more severe if allergy and aspirin intolerance were found together compared with the tissue eosinophilia in patients with either one entity. CONCLUSION This study confirms the importance of eosinophil infiltration in the pathogenesis of severe or recurrent nasal polyps based on allergy and aspirin intolerance. A coincidance of allergy and aspirin intolerance was found in an unexpected high number of patients.

BACKGROUND Paragangliomas (glomus tumors) of the head and neck are rare tumors, arising from the paragangliomatous tissue either of the carotid region or the jugular or the tympanic region. This study was conducted to investigate the possible differences in the tumor biology of these lesions depending on their site of origin. METHODS Nineteen specimens (10 jugulotympanic and 9 carotid glomus tumors) were investigated by quantitative DNA measurements and immunohistochemical assessment of proliferation markers (PCNA, Ki67), oncogenes (p53, nm23), different cell surface antigenes (CD44 4/5 and 6, CD54, CD106), and bcl 2 as a marker for apoptosis. RESULTS Depending on the location of the tumors these measurements revealed significant differences in tumor biology with higher proliferation scores and a higher number of aneuploid tumors in those of the carotid region, suggesting a more aggressive behavior compared to those of the jugulotympanic region. CONCLUSIONS The results also indicate a difference between the two groups in the risk of developing metastases or recurrent disease. They generally help to enhance our understanding of the biology of paragangliomas of the head and neck.

In der vorliegenden Studie wird ein Kollektiv von 15 Patienten vorgestellt, die alle bei Diagnosestellung eines T3- oder T4-Nasennebenhohlenkarzinoms eine Beteiligung der Orbita aufwiesen. Bei allen Patienten wurde sowohl aus funktionellen als auch aus kosmetischen Grunden im Rahmen der operativen Therapie auf eine Enukleation des Bulbus verzichtet. Neben der Uberlebenszeit wurde der Zeitpunkt und die Lokalisation von Rezidiven untersucht. Die Ergebnisse lassen den Schlus zu, das eine Verschlechterung der Prognose durch eine konservative Strategie gegenuber dem Orbitainhalt nicht zu beobachten ist und das zum Erhalt von Funktion und Kosmetik eine systematische Radikalitat gegenuber dem Orbitainhalt uberdacht werden mus.

Correction of complex facial scars frequently requires individualized, multimodal strategies, which are composed of various therapeutic measures. This report provides information on techniques for correction of contractures, atrophic scars, scars within hair-bearing regions of the face and auricular keloids. Additionally, we present adjuvant procedures in a subject-related manner.

This article reports the case of a 14-year-old boy who was presented in the case conference with symptoms of decreased visual acuity, scintillating scotomas and photophobia. Physical examination revealed right facial paralysis, parotid gland swelling, high fever and poor general condition. Ophthalmoscopy revealed anterior and posterior uveitis including macular edema and chorioretinal infiltrates. Angiography revealed a dense pattern of hyperfluorescent lesions and these observations resulted in the diagnosis of Heerfordt syndrome. Under systemic prednisolone therapy, symptoms were reduced and visual acuity recovered.

Background: Only very limited data are available in the literature on the incidence of childhood cancer of the head and neck worldwide. Methods: Based on data obtained from the national German Childhood Cancer Registry, a total of 370 malignancies of the head and neck in children under the age of 15 (199 boys and 171 girls), which were reported to this institution between 1994 and 2003, were analysed in this study. Results: The overall incidence of malignancies of specific sites of the head and neck in Germany is 4.48 per 100000 children. The most frequently observed entities, representing primary tumours, are soft tissue sarcomas (0.39/100000), lymphomas (0.09/100000) and thyroid carcinoma (0.07/100000). The most commonly affected organs are the thyroid (1.21/100000), orbita (0.91/100000), nasopharynx (0.66/100000), tonsils (0.43/100000) and paranasal sinuses (0.14/100000). Overall, boys are more frequently affected than girls; however, incidence increases in girls with age and exceeds that of boys in the age group between 10 and 14 years. Conclusions: This is a first statistical evaluation detailing cumulative incidences of various histologic types of malignancies of the head and neck including age and gender distribution as well as organ-specific localization in children below the age of 15 in Germany.

Postoperative bleeding is the major complication in tonsillectomy, and pain the most common side effect. The use of bipolar scissors versus blunt dissection tonsillectomy were compared in this study in order to evaluate postoperative bleeding and pain, as well as operative time.In this case control study, 138 patients with the diagnosis of chronic tonsillitis, mononucleosis or a peritonsillar abscess were divided into two groups. A total of 78 patients were operated using bipolar scissors while 60 patients underwent tonsillectomy by blunt dissection. Operating time, frequency of postoperative bleeding and the postoperative pain score were compared between these two groups.The average operating time in the bipolar scissor group showed a tendency to be shorter than in the blunt dissection group (mean 4.1 min), although this did not reach a level of statistical significance. No differences were seen in pain scores or in the incidence of postoperative bleeding.The data documented in this study show that tonsillectomy with bipolar scissors might represent a surgical option to reduce surgical time in a larger patient group. Postoperative pain and the incidence of postoperative bleeding did not show any statistical difference between the two surgical techniques.

Chronic rhinosinusitis (CRS) appears to be of increasing relevance epidemiologically. Despite progress in elucidating the role of eosinophilia as well as aspirin intolerance and eicosanoid mediators, the pathophysiology remains obscure. Endonasal sinus surgery has become the treatment of the choice for CRS patients with and without nasal polyposis, particularly if conservative treatment fails. Long-term studies indicate that a minimally invasive approach with microscopic and endoscopic procedures is preferable to radical surgery. Powered instrumentation or computer-aided surgery are still controversially discussed, but certainly can be very helpful in the hands of an experienced surgeon, especially to minimize surgical trauma and save surgical time. The complex therapeutic concept needs to be individually tailored to the disease of the patients and to the heterogeneous etiologic aspects.

Cyclooxygenases 1 (Cox-1) and 2 (Cox-2) play a key role in arachidonic acid metabolism and in the regulation of eicosanoid production. The balance of prostaglandin and leukotrien release in respiratory mucosa is a crucial factor in the development of Sampter's triad in NSAID (aspirin-) intolerant patients and possibly also relevant in the pathophysiology and immunology of chronic rhinosinusitis (CRS) and nasal polyposis in NSAID tolerant patients.36 surgical specimens were immunohistochemically labeled for Cox-1 and Cox-2. Specimens were taken from chronically inflamed mucosa (n=13) and from nasal polyps (n=10) during endonasal sinus surgery. Controls were obtained from healthy nasal respiratory mucosa (n=13), harvested during turbinate surgery in patients with nasal obstruction without inflammatory disease.Analysis revealed that Cox-1 and Cox-2 were labeled in all 23 inflamed / polypoid tissue specimens and in all 13 controls. In chronically inflamed tissue the expression of Cox-1 and Cox-2 was strongly labeled in the respiratory epithelial lining and in mucosal glandular ducts. In nasal polyps the expression pattern of Cox-1 was similar, but Cox-2 was much less intensely labeled in the superficial epithelial cellular lining. Controls showed homogenious labeling of Cox-1 and Cox-2 in both tissues with little intensity.These data suggest that Cox-2 is downregulated in epithelial cells of nasal polyps. Cox-1 and 2 are present in high concentrations in ductal structures of mucosal glands. The significance of these findings has to be discussed with regard to the regulatory function of Cox-2 in eicosanoid release and the role of the latter in the immunology and pathophysiology of nasal polyps.

The full clinical picture of aspirin intolerance, Sampter's triad, is associated with nasal polyposis, clinical sensitivity to most non steroidal antiinflammatory drugs (NSAID) and intrinsic bronchial asthma. But the triad can be incomplete and nasal polyposis can be the first clinical symptom of aspirin sensitivity. Although the exact mechanisms of aspirin intolerance as well as those of desensitization remain obscure, an in vitro assay on eicosanoid metabolism has been proven to be helpful in diagnosis and treatment as it correlates well to the individual severity of clinical symptoms.For this investigation 30 patients, who were undergoing adaptive desensitization for aspirin intolerance, were followed-up between 1 and 3 years. They received a maintenance dose of oral aspirin of only 100 mg a day after an initial application of higher doses. Their clinical course as well as their in vitro parameters of eicosanoid release were monitored throughout the individual observation period.Desensitization was successful in 25 of the 30 patients regarding the recurrence rate of nasal polyps, severity of bronchial asthma and sense of smell. There was a clear positive correlation between clinical and in vitro parameters. Discontinuing of aspirin therapy lead to worsening of clinical symptoms, regardless of the prior duration of treatment.This article reviews the role of the in vitro assay and presents a desensitization protocol that can be maintained as a long term treatment without adverse side effects. Results suggest that the recurrence rate of nasal polyps after surgical therapy can be reduced using this protocol, however, only long term treatment can secure a beneficial outcome over time.

The development of nasal polyps might be influenced by different factors such as mucosal inflammation. Infiltration with eosinophils is a common finding, although in largely different quantitis.We investigated 58 patients suffering from nasal polyps who were assigned for endonasal sinus surgery based on endoscopic and CT findings. Out of these patients, 52% have already had sinus surgery and had recurrent polyps. All patients were subjected to both, allergy testing and a functional in vitro test for aspirin intolerance. During surgery, tissue samples were gained and send for histological examination with special respect to eosinophil infiltration.Eosinophil infiltration was observed in 66% of all patients. 37 patients (64%) exhibited aspirin intolerance only, four (7%) had a positive allergy test only, in 9 patients (15%) both, allergy and aspirin intolerance were diagnosed. Allergy and aspirin intolerance were accompanied by eosinophil tissue infiltration. Eosinophil infiltration was more common and more severe if allergy and aspirin intolerance were found together compared with the tissue eosinophilia in patients with either one entity.This study confirms the importance of eosinophil infiltration in the pathogenesis of severe or recurrent nasal polyps based on allergy and aspirin intolerance. A coincidance of allergy and aspirin intolerance was found in an unexpected high number of patients.

Paragangliomas (glomus tumors) of the head and neck are rare tumors, arising from the paragangliomatous tissue either of the carotid region or the jugular or the tympanic region. This study was conducted to investigate the possible differences in the tumor biology of these lesions depending on their site of origin.Nineteen specimens (10 jugulotympanic and 9 carotid glomus tumors) were investigated by quantitative DNA measurements and immunohistochemical assessment of proliferation markers (PCNA, Ki67), oncogenes (p53, nm23), different cell surface antigenes (CD44 4/5 and 6, CD54, CD106), and bcl 2 as a marker for apoptosis.Depending on the location of the tumors these measurements revealed significant differences in tumor biology with higher proliferation scores and a higher number of aneuploid tumors in those of the carotid region, suggesting a more aggressive behavior compared to those of the jugulotympanic region.The results also indicate a difference between the two groups in the risk of developing metastases or recurrent disease. They generally help to enhance our understanding of the biology of paragangliomas of the head and neck.

Fifteen patients at the University of Mainz were diagnosed as having T3 or T4 carcinomas of the paranasal sinuses that invaded the orbit. Treatment involved surgical resections of tumor with adjacent periorbita but without enucleation in an attempt to preserve vision and/or cosmesis. Survival rates and especially the rate, time and locations of recurrences were investigated. Analysis of the data revealed that preservation of the eye in these cases with advanced sinus carcinomas with orbital tumor involvement did not seem to worsen prognosis. The individual gain in terms of quality of life through the preservation of vision and cosmesis seems to justify the surgical approach used.

110 Patients were followed-up after supraglottic laryngectomy: The 3-year survival rate was 74%. The overall 5-year survival rate was 49%. For the cases of T3-tumours from these of the entrance of the larynx the 5-year survival rate was about 73%. For the T4-tumours the 5-year survival rate was only about 22%. Better results are not possible at the present even if other kinds of therapy are used.

The indications are exactly fixed and critically screened in 110 cases of supraglottic laryngectomy. Comparison with more radical surgical methods yields the same results with functional advantages of supraglottic laryngectomy. The limitations of resection are: the foramen coecum at the base of tongue, the arytenoids and the vocal cord at the entrance of the larynx, the piriform recessus in cases of extension to the hypopharynx.

Between 1972 and 1981 frontolateral laryngectomy was performed in 72 cases of vocal cord cancer. Regular follow-up examinations were performed over a period of at least five and up to 15 years after primary surgery. In 1987, 63 of these patients were still alive. In 68 out of 72 (94.3%), survival time was three years or more. In 34 out of 43 (79%), survival time was five years or more. Leroux-Robert's indication guidelines are confirmed and slightly extended. The functional results and the frequency of recurrence are reviewed.

The authors report a case of cystic dilatation of the terminal portion of the thoracic duct which clinically corresponded to a swelling in the root of the left side of the neck. Pathogeny and evolutive mode of this exceptional affection are ill known. Echography and scanography show the cystic nature of the mass. Diagnosis is made by direct puncture which can prove the chylous nature of the content and permits the opacification of the cyst. Lymphography shows the type of junction with the thoracic duct.

From 1972 to 1979 transtemporal neurectomy of the vestibular nerve was performed on 42 patients suffering from therapy-resistant symptoms of ménière's disease. Regular postoperative follow-up for 3 to 10 years after neurectomy showed that all 42 patients had no further attacks of vertigo. Tinnitus was diminished or disappeared in 25 patients; postoperative audiologic controls revealed no changes in 20 patients (48%), and a hearing gain in 3 cases (7%). 19 patients (45%) present with a slowly progredient hearing loss in continuation of the preoperative development. The sensation of pressure in the ear was observed by 19 patients and improved in all of them immediately after the operation, but reappeared in 12 of them (29%) within 6 months postoperatively.

Description of the possibilities of operations within the internal auditory canal and the cerebellopontine angle, especially of the removal of acoustic neuromas by transtemporal and translabyrinthine approach. Besides at the total removal of the tumor the operative technique aims at the conservation of the facial nerve and its function. The transtemporal approach is recommended only for the removal of small tumors limited to the internal auditory canal. If the tumor originates from the vestibular nerve, the facial and cochlear nerve can be preserved by this procedure. The translabyrinthine approach implicate the complete unilateral deafness but is available even for the removal of bigger tumors leaving the internal auditory canal in the direction of the cerebello-pontine angle. Sketches and operation slides illustrate details of the operative preparation. Special difficulties occuring in the cerebellopontine angle are demonstrated. Clinical and diagnostic problems in relation to the operation planning are discribed. The cooperation between otosurgeon and neurosurgeon is indispensable

A simple and safe method is described in detail for the closure of septal perforations of various sizes. Temporal fascia is used with full thickness or split thickness skin on both sides. Fixation of the transplanted tissue by suture or glue is usually not necessary.

The choice of special techniques and a certain flexibility of the surgeon in performing his personal methods, and also the preoperative and intraoperative evaluation of specific characteristics of the nasal structures, are important factors in the prevention of mistakes and complications in rhinoplasty. Typical mistakes in septoplasty and the surgical treatment of the turbinates and the dermal and soft tissue structures are discussed. Septal subluxation, deviations of the nasal tip or postoperative scar formation often result in difficult postoperative corrective problems. Lack of care in the removal of bony or cartilaginous humps can lead to very bad nasal deformations. Precise control of all structures at the end of the operation and eventual final correction or "finishing" will often help to avoid secondary septo-rhinoplasties.