[Megadolichobasilar anomaly causing acute deafness with vertigo]. / Megadolichobasilaris als Ursache einer akuten Taubheit mit Schwindel.

Megadolichobasilar anomaly, a dilatant arteriopathy of the basilar artery attributable to chronic arterial hypertension, can cause cranial nerve compression syndromes of the cerebellopontine angle or infarcts of the vertebrobasilar circulation. In this paper, we report on a patient with known megadolichobasilar anomaly and a partially thrombosed fusiform aneurysm of the basilar artery, who presented with acute-onset vertigo and subsequent deafness due to thromboembolic occlusion of the labyrinthine artery. Because of the vascular origin of the patient's symptoms, his vertigo disappeared over time while the deafness persisted.

[Quality management: reduced waiting time and enhanced efficiency in a university ear, nose, and throat outpatient department]. / Qualitätsmanagement: Verkürzung von Wartezeiten und Effizienzsteigerung bei der Versorgung ambulanter Patienten an einer HNO-Universitätsklinik.

BACKGROUND: The introduction of Diagnosis-Related Groups, which standardize payment for each clinical service, entails keeping the inpatient treatment as short as possible. Thus outpatient treatment is gaining in importance. To cope with this change, organizational and structural modifications of clinic routine are necessary. METHODS: In the ear, nose, and throat outpatient clinic of Johann Wolfgang Goethe University in Frankfurt, Germany, a hotline was established that allows patients to make appointments and get advice based on quality management guidelines according to DIN EN ISO 9001:2000. The development of this project is described here step by step, from planning to inclusion in the daily clinic routine. RESULTS: Patient visits became more effective despite increasing demand. This resulted in high satisfaction of patients and clinic personnel alike. CONCLUSION: This model may contribute considerably to coping with the increasing demand for clinic appointments and to optimal use of a clinic's human resources.

[Quality assessment according to DIN EN ISO 9001:2000: certification in a university ENT department]. / Qualitätsmanagement nach DIN EN ISO 9001:2000: Zertifizierung einer HNO-Universitätsklinik.

BACKGROUND: In 2003, our department inaugurated a quality management system. The certification according to DIN EN ISO 9001:2000 as required by the hospital management was achieved in August 2005. The aims were optimization of internal operating schedules and standardization of procedures according to logistic interfaces with external structures. METHODS: Since 2000, the implementation of an internal quality management system is required by German law and threatened by penalty in case of non-implementation. Beside a basic audit and optimization of all organizational procedures, all core processes were determined and the approvals checked. These aims involve both the quality of operational procedures, in and outpatient treatment, research, study and teaching and aspects of service such as quickness of scheduling and forwarding of reports as well as economic aspects and efficiency. The department of "quality management", whose main tasks are the professional guidance and the training of the quality management representatives, plays an important role. RESULTS: Realization of the new regulations and restructuring resulted in an increase in effectiveness and an improvement in operational procedures. In particular, patients and staff have benefited from the reorganized and modified sequence of operations. CONCLUSION: Implementation of a quality management system in different hospital departments is recommended.

Diagnostic and therapeutic approaches to carotid body tumors. Review of 24 patients.

OBJECTIVE: To determine the clinical characteristics of carotid body tumors to define better a standardized proceeding in the management of carotid body tumors. DESIGN: Retrospective survey. Duration of postoperative follow-up was 4 months to 16 years (median, 57 months). SETTING: Institutional, tertiary care medical center. PATIENTS: Consecutive sample of 24 patients (10 men and 14 women) with 28 carotid body tumors treated in the University of Vienna (Austria) General Hospital in 35 years. INTERVENTIONS: Surgical resection, preoperative embolization. MAIN OUTCOME MEASURES: Initial signs, duration of symptoms, extension of the tumors, methods of investigations, and treatment modality, with special respect to the operative technique. RESULTS: Doppler color flow imaging and angiography provided essential mainstays for definite diagnosis. Computed tomography and magnetic resonance imaging contributed additional information about tumor extension. Nineteen patients (79%) underwent surgical resection of 22 tumors, 8 (42%) after preoperative embolization. There were no perioperative deaths. Hemiplegia occurred in 1 patient, and cranial nerve palsy occurred in 5 patients. Tumor recurrence was observed in 3 patients. Five patients refused surgery or tumors were unresectable. CONCLUSIONS: Our standard diagnostic procedure consists of establishing diagnosis by Doppler color flow sonography, angiography for detailing the vascularization of the tumor, and selective embolization to enable safer surgery with less bleeding. Early surgery is recommended to minimize major risks.

[MRI of the regions of the inner ear and cerebellopontine angle using a 3D T2-weighted turbo spin-echo sequence. Comparison with conventional 2D T2-weighted turbo spin-echo sequences and T1-weighted spin-echo sequences]. / MRT der Innenohr- und Kleinhirnbrückenwinkelregion mit einer 3D T2-gewichteten Turbo-Spin-Echo-Sequenz. Vergleich mit konventionellen 2D T2-gewichteten Turbo-Spin-Echo-Sequenzen und T1-gewichteten Spin-Echo-Sequenzen.

PURPOSE: To assess the value of a three-dimensional (3D) T2-weighted turbo spin-echo sequence (3D T2-TSE) in comparison to conventional two-dimensional (2D) T2-weighted TSE and unenhanced and enhanced T1-weighted spin-echo sequences (SE) in imaging anatomic structures and pathologic changes of the inner ear and cerebellopontine angle. PATIENTS AND METHODS: The inner ear and cerebellopontine angle were investigated by MRI in three healthy volunteers and 18 patients performing a 2D T2-weighted turbo spin-echo sequence and a 3D T2-TSE in the axial plane. In the patient study, 2D T1-weighted SE sequences both before and after the i.v. injection of gadopentetate dimeglumine in both the axial and coronal plane were performed in addition. RESULTS: Only the 3D T2-TSE enabled an accurate imaging of the anatomic structures. In cases of pathology, the 3D T2-TSE provided additional information to the performed 2D sequences. The combination of the 3D T2-TSE with unenhanced and enhanced 2D T1-weighted SE enabled the most accurate diagnosis in cases of pathology. CONCLUSIONS: Accurate depiction of anatomic structures of the inner ear and cerebellopontine angle could be obtained by 3D T2-TSE only. The most accurate diagnosis in cases of pathology was provided by the combination of the 3D T2-TSE with unenhanced and enhanced 2D T1-weighted spin-echo sequences.

[Interdisciplinary surgical treatment of anterior skull base tumors]. / Interdisziplinäre chirurgische Behandlung von Tumoren der vorderen Schädelgrube.

OBJECTIVES: We present our clinical experiences regarding interdisciplinary surgical treatment of anterior skull base tumours and evaluate postoperative results. METHODS: Fifty-seven patients (25 male, 32 female) with benign and malignant neoplasms involving the anterior skull base were retrospectively reviewed. In all cases tumour resection was carried out by an interdisciplinary rhino-neuro-surgical skull base operating team. Forty-three of 57 patients (75.4%) underwent common transbasal tumour resection and 11 (19.3%) were operated on from an extended transbasal approach. An extensive transbasal approach for tumour resection was used in 3 patients (5.3%). Postoperative mortality and morbidity were evaluated over a period of 6 months. RESULTS: In all 57 patients a good access to the frontal fossa and the sinuses was achieved. By means of the transbasal approaches, one-step tumour removal was possible in all cases. Tumor diameter ranged fom 12 mm to 114 mm. Even tumours extending as far as the hard palate required no additional transfacial procedures. Surgical mortality was 3.5%. Permanent postoperative complications were noted in 4 cases (7.02%) and transient postoperative complications in 7 (12.28%). CONCLUSION: In dealing with anterior skull base tumours, interdisciplinary surgical procedures using transbasal approaches provide a satisfactory outcome at a low rate of postoperative complications. When transbasal approaches are applied, no additional transfacial skull base exposure using midfacial incisions is required.

[Glomus caroticum chemodectoma. Review on current diagnosis and therapy]. / Glomus caroticum--Chemodectom. Ubersicht über die aktuelle Diagnostik und Therapie.

Carotid body tumors are rare neoplasms arising from the small chemoreceptor organ in the adventitia of the common carotid bifurcation. Patients with carotid body tumours usually present with a gradually enlarging non-tender anterolateral neck mass. Differential diagnosis includes metastatic lymph nodes, carotid artery aneurysm, salivary gland tumour, branchial cleft cyst, and neurogenic or thyroid tumours. When such a lesion is suspected, a non-invasive Doppler colour flow ultrasonography enables the clinician to arrive at a definite diagnosis. Subsequent arteriography is mandatory, because the finding of an intensely blushing hypervascular mass spreading into the carotid bifurcation further supports the diagnosis and provides accurate preoperative information concerning arterial blood supply. Computed tomography scanning is appropriate to delineate the relation of the tumour to adherent structures, while magnetic resonance tomography demonstrates the relation of the tumour to the adjacent internal jugular vein and the carotid artery. Selective embolization should be performed for safe surgical removal with less bleeding. Early surgery is the treatment of choice and is recommended in order to minimize major risks. Subadventitial resection is the most established technique. Radical resection prevents local recurrence and has the best long-term results. Removal of the internal or common carotid arteries can become mandatory in selected cases of extensive disease. Surgical treatment by an experienced team is associated with considerably low mortality and morbidity.

[Tumors of the anterior skull base. Effects of perioperative imaging on adjuvant radiotherapy planning]. / Tumoren der vorderen Schädelbasis--Einfluss der perioperativen Bildgebung auf die adjuvante Radiotherapie--Planung.

OBJECTIVES: Treatment of anterior skull base tumours is still considered being a major challenge for all involved disciplines. Surgical management, complications, as well as the role of imaging for multimodality treatment options should be evaluated critically. PATIENTS AND METHODS: 57 patients underwent interdisciplinary one step trans-basal approaches for resection of benign and malignant anterior fossa tumours. Beside assessment of surgical results and perioperative morbidity, in 13 patients with malignant tumours perioperative imaging was evaluated with regard to further possible radio-oncological treatment options. RESULTS: Applying trans-basal approaches radical tumour resection could be achieved in all cases independent of tumor-size (diameter 12-114 mm). Permanent postoperative complications (until 6 months postoperatively) were found in 4 cases (7%), transient complications in 7 cases (12.3%). Evaluation of perioperative imaging showed a heterogen use of different imaging modalities and revealed lack of standardization, hampering further planning of radiation therapy. CONCLUSION: Treatment of anterior skull base tumours requires a maximum level of standardization of perioperative imaging, to grant a successful surgical and radio-oncological interdisciplinary patient management.

Open-set speech perception in adult cochlear implant users with ossified cochleae.

This study describes open-set speech recognition in cochlear implant subjects with ossified cochleae and compares it to a control group with open cochleae. Twenty-one postlingually deafened adults with a Med-El Combi 40/40+GB split- electrode implant were matched to patients using a Med-El cochlear implant with a standard electrode. Speech recognition was assessed over an 18-month period. Split- electrode patients improved significantly over time, but their scores were significantly lower and increased significantly slower than those of controls. Of 14 patients with a duration of deafness less than 20 years, average sentence test scores were 50%, and average monosyllabic word test scores were 31%. This study provides evidence that cochlear implantation is beneficial to patients with ossified cochleae, but early implantation is advisable.

[Benign and malignant lesions in the region of the inner ear and cerebellopontine angle]. / Benigne und maligne Veränderungen der Innenohr- und Kleinhirnbrückenwinkelregion.

Tumorous lesions in the region of the inner ear and cerebellopontine angle are very rare and can be classified into benign and malignant disease forms. This contribution presents and explains the CT and MRI characteristics of these tumors.High-resolution computed tomography (HRCT) in the axial projection is applied for evaluation in the high-resolution bone window. The coronary slices can be reconstructed from the axial datasets or in individual cases examined in the coronary plane.HRCT excellently demonstrates osseous lesions and in individual cases - e.g., exostoses - it can simply suffice to perform HRCT of the temporal bone, while HRCT is also excellent for detecting osseous lesions to determine whether the tumor is benign or malignant.MRI, on the other hand, excellently shows the extent of tumor spread because of its superb soft tissue contrast. Consequently, HRCT and MRI images of the inner ear and cerebellopontine angle provide meaningful information for visualization and classification of tumorous lesions. The two methods should not be considered as competing but rather as complementary and among other aspects exert considerable influence on the therapeutic approach.

[Cochlear implantation with preservation of residual deep frequency hearing]. / Kochleaimplantat mit Tieftonrestgehörerhalt.

BACKGROUND: The aim of the present paper is to evaluate the clinical parameters in patients implanted for combined, ipsilateral electric-acoustic stimulation of the auditory system. METHODS: A total of 18 patients with residual deep frequency hearing were implanted with a Combi 40+cochlear implant (MED-EL, Austria). Insertion depths ranged from 18 to 22 mm (360 degrees ). A modified surgical technique should contribute to hearing preservation in low frequency regions of the cochlea. Pure-tone audiometric thresholds were measured pre- and postoperatively. A speech audiometric evaluation was performed on two subjects. RESULTS: Utilizing adapted surgical procedures, the preservation of low frequency hearing was accomplished in 16 of 18 subjects (88.9%). Seven (38.9%) patients had complete and nine (50.0%) partial preservation of residual hearing. The speech discrimination scores of two patients documented an increase in sentence intelligibility when compared with only the cochlear implant. CONCLUSIONS: Hearing preservation in cochlear implant surgery is possible. Insertions of 360 degrees provide a full functioning cochlear implant to stimulate sufficient neural structures for above average discrimination scores with the implant alone. A synergistic effect of the electric and the acoustic stimulation modes leads to high discrimination scores in background noise.

[Adonco. A clinical-scientific database system for the acquisition and analysis of oncologic data in head and neck regions]. / AdOnco. Ein klinisch-wissenschaftliches Datenbanksystem zur Erfassung und Auswertung onkologischer Daten im Kopf-Hals Bereich.

BACKGROUND: Our aim was to design and develop a computer database system for head and neck cancer patients for clinical and scientific use. METHODS: A relational database based on Filemaker Pro 6.0 was developed and integrated into our local network. Its precise and easy to handle interface should allow a quick overview of the patient's oncological data. An automatically generated letter was integrated to enhance patient care. For evaluation purposes, statistical analysis functions were incorporated. RESULTS: Over a 7 month period, about 300 patient records were available through the local network. The automated letter function and the well organized display resulted in more efficient patient care. Additionally, the quality of the information presented to referring physicians increased. Statistical analysis provided by the database was reliable and easy to export. CONCLUSIONS: We developed an oncology database for clinical and scientific use and integrated it into our patient documentation system. The combination of clinical and scientific features proved to be very effective in daily patient care routine and research.

[Vestibulocochlear anastomosis in the brain stem of the guinea pig. Preliminary report]. / Vestibulo-cochleäre Anastomose im Hirnstamm des Meerschweinchens. Vorläufiger Bericht.

A conspicuous fibre bundle running through the vestibular nuclear complex into the cochlear nucleus could be detected after tracing the superior vestibular nerve branch and the macula sacculi of the guinea pig with HRP (horseradish peroxidase). Considering certain electrophysiological findings, it is quite reasonable to believe that these fibres are indeed primary vestibular afferent fibres in synaptic contact with secondary cochlear neurons.

[Computed tomography and magnetic resonance imaging of congenital abnormalities of the temporal bone]. / Computertomographie und Magnetresonanztomographie kongenitaler Veränderungen des äusseren Ohrs,Mittel- und Innenohrs sowie des inneren Gehörgangs.

Congenital abnormalities of the temporal bone are mostly accompanied by conductive or sensori-neural hearing loss. Before any therapeutic procedures are done high resolution CT (HRCT) and magnetic resonance imaging (MRI) should be performed to establish the correct diagnosis and to plan the potentially surgical intervention. HRCT best depicts osseous changes especially those of the external auditory canal and the middle ear containing the ossicles and the osseous structures of the temporal bone and the petrous bone containing the inner ear. MRI excellently shows soft tissue changes of the inner ear especially on the high resolution 3DT2-weighted sequences which give a superb contrast between the nerves and the cerebro-spinal fluid. Malformations of the external auditory canal consists of aplasia or hypoplasia and those of the middle ear range form extreme hypoplasia or aplasia to very mild deformations of the ossicles. Malformations of the inner ear also range form complete aplasia to very mild hypoplasia of the organs of the inner ear as well as malformations concerning the nerves in the internal auditory canal range from aplasia to hypoplasia. Malformations of the temporal bone can either occur isolated or in combination in which malformations of the external and middle ear may be accompanied by those of the inner ear. Furthermore, malformations of the temporal bone may also occur in otofacial, otocervical or otoskeletal syndromes. These syndromes may be accompanied by certain malformations of the temporal bone. HRCT and MRI are both excellent methods to depict congenital abnormalities of the temporal bone and of the inner ear and should be used as complementary methods because HRCT best depicts osseous changes and MRI superbly depicts soft tissue changes. Both methods are important to establish the correct diagnosis to plan the therapeutic procedures.

Optimizing of electroneuronography of the facial nerve.

The amplitude ratio between the paretic and the normal side as determined by electroneuronography is used as a basis for estimating the prognosis of facial palsy. Several methods have been described of placing the surface electrodes and of finding the supramaximal impulse strength. We investigated 16 normal test persons with the aim (1) of optimizing the procedure of neuronography with regard to the possible variations of electrode placement and stimulus intensity and (2) of finding out the right/left difference in normal test subjects. Following our results, the best positions of the recording electrodes are the nasal alae. Even under these most favorable test conditions we found an average side difference of the bilaterally recorded electroneurograms of normal test persons of 22%.

[Function preserving surgical therapy of head-neck tumors with the CO2 laser]. / Die funktionserhaltende chirurgische Therapie von Kopf-Hals-Tumoren mit dem CO2-Laser.

The use of microscopically controlled laser surgery to treat tumors of the upper aerodigestive tract has as a function maintaining form of treatment gained significance. It is an alternative to conventional surgery, which often makes organ removal necessary. We report on our experience with 85 patients who underwent a laser surgical resection of malignomas of the upper aerodigestive tract. The aim of transoral laser surgery is a histologically confirmed radical tumor resection. Tumor resection can be individually adapted according to the tumor extent. An unnecessary resection of cartilage and muscles can be avoided. Provided the appropriate indication is given, laser surgery yields good oncologic and excellent functional results.

Transpalatine excision of a cavernous hemangioma of the infratemporal fossa.

Hemangiomas of the head and neck region can represent a therapeutic challenge depending on their size, location and symptoms. We report a case of a 40-year-old woman who presented with a 2-cm encapsulated cavernous hemangioma in the infratemporal fossa (ITF). Extensive workup included CT, MRI and angiography. A transoral/transpalatine approach avoiding osteotomy was used for surgical excision. After an unremarkable postoperative course the patient has remained disease-free after a 2-year follow-up period. We suggest this surgical approach as an alternative in carefully selected cases of circumscribed small, benign lesions of the ITF.

[Tissue microarrays. Value of immunohistochemical proliferation markers for serial investigations of head and neck cancer]. / Tissue-Microarrays. Wertigkeit bei immunhistochemischen proliferationsassoziierten Reihenuntersuchungen von Kopf-Hals-Karzinomen.

BACKGROUND: Tissue microarrays (TMAs) are still seldom used in oncological research, especially that involving otorhinolaryngology, although the benefit of this method has often been reported. METHODS: We prepared ten different tumor probes from patients with head and neck cancer for immunohistochemistry and performed ki67 and proliferating cell nuclear antigen (PCNA) staining on the usual paraffin sections as well as on TMAs consisting of the same tissue. RESULTS AND CONCLUSIONS: We conclude that investigation by means of TMA makes oncological research, and especially the screening of tumor probes, much more efficient since a high correlation ( r>0.7, P<0.0001) between both methods was found.

[The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas]. / CT und MRT des erworbenen Cholesteatoms: Prä- und postoperative Bildgebung.

The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI.HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma,bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination.