Efficacy of microsurgery in Reinke's oedema evaluated by traditional voice assessment integrated with the Vocal Extent Measure (VEM).

SUMMARY: There are few data analysing to what specific extent phonomicrosurgery improves vocal function in patients suffering from Reinke's oedema (RE). The recently introduced parameter vocal extent measure (VEM) seems to be suitable to objectively quantify vocal performance. The purpose of this clinical prospective study was to investigate the outcomes of phonomicrosurgery in 60 RE patients (6 male, 54 female; 56 ± 8 years ([mean ± SD]) by analysing its effect on subjective and objective vocal parameters with particular regard to VEM. Treatment efficacy was evaluated at three months after surgery by comparing pre- and postoperative videolaryngostroboscopy (VLS), auditory-perceptual assessment (RBH-status), voice range profile (VRP), acoustic-aerodynamic analysis and patient's self-assessment using the voice handicap index (VHI-9i). Phonomicrosurgically, all RE were carefully ablated. VLS revealed removal or substantial reduction of oedema with restored periodic vocal fold vibration. All subjective and most objective acoustic and aerodynamic parameters significantly improved. The VEM increased on average from 64 ± 37 to 88 ± 25 (p #x003C; 0.001) and the dysphonia severity index (DSI) from 0.5 ± 3.4 to 2.9 ± 1.9. Both parameters correlated significantly with each other (rs = 0.70). RBH-status revealed less roughness, breathiness and overall grade of hoarseness (2.0 ± 0.7 vs 1.3 ± 0.7). The VHI-9i-score decreased from 18 ± 8 to 12 ± 9 points. The average total vocal range enlarged by 4 ± 7 semitones, and the mean speaking pitch rose by 2 ± 4 semitones. These results confirm that: (1) the use of VEM in RE patients objectifies and quantifies their vocal capacity as documented in the VRP, and (2) phonomicrosurgery is an effective, objectively and subjectively satisfactory therapy to improve voice in RE patients.

[Microlaryngoscopy and phonomicrosurgery]. / Mikrolaryngoskopie und Phonomikrochirurgie.

Microlaryngoscopy is a reliable technique and the most frequently applied method in laryngeal surgery. The design of new laryngoscopes and the application of video endoscopes may permit further improvements in laryngeal exposure, whilst minimizing the damage caused by their insertion. In contrast to this, the principle microsurgical procedures for improvement, restoration and preservation of the vocal function have remained almost unchanged. These techniques are oriented towards minimal excision of pathological tissue with maximal conservation of normal tissue, in particular the epithelium of the vocal folds and the lamina propria-the basic structures for vocal fold vibration. Phonomicrosurgy can only be justified on the basis of a proven improvement as evidenced by vocal function analysis.

[Who heals, is right!--A forgotten genius? In memory of Wilhelm Fliess on the occasion of his 150th birthday and 80th anniversary of death]. / Wer heilt, hat recht!--Ein vergessenes Genie? Zum 150. Geburtstag und 80. Todestag von Wilhelm Fliess.

INTRODUCTION: Interdisciplinary contacts between otorhinolaryngology and gynecology are rare. We commemorate a special example of such dialogue in remembrance of the rhinolaryngologist Wilhelm Fliess on the occasion of his 150 (th) birthday and 80 (th) anniversary of death in October 2008. CURRICULUM VITAE AND MERITS: Born in Arnswalde (Western Pomerania, today Poland) in 1858, after secondary school medical studies at Friedrich-Wilhelm-University in Berlin (Germany), graduated with Doctor of Medicine degree, in 1883 start of his own medical practice as a general practitioner in Berlin, in 1887 specialization as rhinolaryngologist. Close friendship with Sigmund Freud, considered as "midwife of psychoanalysis" and originator of biorhythm concepts. Main scientific research: nasogenital reflex theory, vital periodicity and idea of innate bisexuality. NASOGENITAL REFLEX THEORY: The basis was Fliess' hypothesis of "nasal reflex neurosis", a "shifting of conflicts" from the genitals to the nose. He defined endonasal "genital spots" at the anterior ends of the inferior turbinates and at the tubercula septi, which were treated by cocainization, chemical etching or cauterization to eliminate dysmenorrhea, other abdominal pain and sexual disorders. DISCUSSION: The presented rise and fall of Fliess' therapeutic nasogenital concept demonstrates that even in established theories which have been confirmed by thousand-fold successful treatment results a critical examination should be consistently performed to question the nature of our "clinical success".

[Topical immunomodulation. A milestone for the treatment of therapy-resistant noninfectious chronic external otitis?]. / Topische Immunmodulation. Ein Meilenstein in der Behandlung der therapieresistenten nichtinfektiösen chronischen Otitis externa?

BACKGROUND: Recurrent exacerbation of chronic external otitis represents a special challenge for the attending physician. The goal of our study was to evaluate the effectiveness of novel topical immunomodulators acting through an anti-inflammatory, nonsteroidal mechanism. PATIENTS AND METHODS: In a prospective study, in 33 patients an ear wick containing tacrolimus ointment (Protopic 0.1%) was inserted every 2-3 days. Altogether, the wick was changed three times. Therapeutic outcomes were assessed by reexaminations, video-otoscopy, and a standardized findings sheet. RESULTS: Twenty-eight patients showed significant improvement of clinical symptoms, with 13 of them showing complete healing (follow-up 10-22 months). Relapses (15 cases) were associated with significantly extended symptom-free intervals and reduced numbers of further recurrent episodes. CONCLUSIONS: Because of the safe and successful anti-inflammatory effects, topical immunomodulators represent a new alternative in chronic inflammatory stages of otherwise therapy-resistant external otitis.

Snoring noise pollution--the need for objective quantification of annoyance, regulatory guidelines and mandatory therapy for snoring.

Habitual snoring without episodes of apnea or hypoventilation and without respiratory related arousals is considered to be annoying and without any need for treatment. However, studies seem to suggest an enormous psychosocial impact of annoyance for the bed partner. Apart from subjective questionnaires there still exists no generally accepted mode of measurement that can describe snoring objectively. We therefore adapted methods developed for environmental medicine and established a new snore score using psycho-acoustic parameters. For quantification of snoring noise we conducted nocturnal measurements in 19 habitual snorers. Free-field snore sounds were acquired with two low-cost non-contact microphones and transferred to a PC (sampling frequency 11 kHz). The data were recorded, analysed and stored automatically using a MATLAB script. Following the analysis of sound characteristics and levels, the score was computed from relevant parameters containing the rating level (L(R)), maximum level, two percentile levels for frequent maxima (L(5)S; L(1)) and snoring time. The determined values substantially exceeded the prescribed limits defined by WHO noise guidelines, and mainly affected the equivalent continuous sound exposure level, rating level and the immission standard values of brief noise peaks, whose maximum was exceeded by up to 32 dB(A). The Berlin snore score illustrated the objective acoustic annoyance on a scale from 0 to 100. It allows inter-individual comparison and objectifies the need for therapy. The clinical applicability of evaluating the reduction of snoring after surgical therapy is discussed exemplarily. The presented measuring method was found to be suitable for quantifying snoring noise and can be easily integrated into existing polysomnographic applications. In the case of habitual snoring with objective evidence of psychosocially disturbing acoustic annoyance, health fund providers should assume the costs of mandatory medical therapy.

[Increasing incidence of wasp stings in otorhinolaryngological practice]. / Zunahme der Inzidenz von Wespenstichen im HNO-Bereich.

BACKGROUND: Wasp sting injuries can be lethal due to generalized reactions and edematous obstruction of the upper respiratory system. Due to media reports and our own observations, the consequences of the 2004 "plague of wasps" should be examined for the ear, nose, and throat (ENT) region. PATIENTS AND METHODS: Wasp sting injuries treated during the years 2002 to 2004 were evaluated in a retrospective study with respect to frequency, localization, therapy, occurrence of allergic reactions, and other complications. RESULTS: In 2002 to 2004, the number of patients with wasp sting injuries tripled. The occurrence of stings in the ENT region increased from 20% to more than 40%, with a strong rise in enoral and endolaryngeal stings after accidental swallowing or inhalation of wasps. The medical treatments employed proved the existence of sufficient therapeutic strategies. CONCLUSIONS: The treatments demonstrate a clear increase in wasp sting injuries in the year 2004. The main climatic cause was the European record summer of 2003, in which wasps multiplied.