[Principles of hygiene in ENT endoscopy]. / Grundsätze der Hygiene bei der HNO-Endoskopie.

This article gives a report on principles of reprocessing of rigid and flexible endoscopes used in ENT units including structural and spatial requirements based on the general and also ENT-specific risks of infection associated with diagnostic and therapeutic endoscopy. The underlying legal principles as well as recommendations from scientific societies will be exemplified in order to give the otorhinolaryngologist a practical guidance.Preliminary results of a nation-wide survey on infection control standards based on data of 29 ENT practices in Germany reveal actual deficits of varying degree concerning infection control management including reprocessing of endoscopes. The presented review aims to give support to the establishment of a structured infection control management program including the evaluation of results by means of a prospective surveillance.

Chemotherapy of advanced and relapsed squamous cell cancer of the head and neck with split-dose cisplatinum (DDP), 5-fluorouracil (Fura) and leucovorin (CF).

58 patients with locally advanced or relapsed squamous cell head and neck cancer were treated on 5 consecutive days with DDP 20 mg/m2/d IV-push, followed by CF 100 mg/m2/d IV-bolus and Fura 400 mg/m2/d IV-push 60 minutes later. Treatment was recycled on day 22(-29), according to toxicity. CF was added to the widely used DDP/Fura combination, because recent studies showed enhancement of Fura-activity by CF. 45/58 patients had no prior therapy and 13/58 pts were relapsed after chemotherapy and/or radiation therapy. All patients were evaluable for toxicity and response. After 3 courses of induction chemotherapy 23/45 pts in the previously untreated group had a complete response (CR); 20/45 a partial response (PR), 2/45 were restaged as no change (CR + PR: 95%). Induction chemotherapy was followed by radical surgery and postoperative radiation therapy. In the pretreated group 4/13 pts had a complete response; 6/13 a partial response; no change in 3/13 pts. Median duration of remission (MDR) has not been reached in the primarily untreated group, whereas in pretreated patients the MDR was 3.8 months (range 2.3 - 11.7 months). Hematologic and gastrointestinal toxicity was substantial but manageable and therapy was performed on an outpatient basis. The combination of DDP, CF and Fura has high activity in untreated and pretreated head and neck cancer patients. The obtained results are comparable to the widely used DDP/Fura continuous infusion regimen.

Fetor from ulcerated head and neck tumors: causation and therapy.

Almost all extensive tumors of the head or neck generate a fetor very unpleasant for the patient, his family, and the nursing staff. Thirty-one patients suspected of having a microbial superinfection of the tumor masses caused by anaerobes or an aerobe-anaerobe mixed infection were examined, and tumor samples from the oral cavity, throat, and larynx were obtained. Anaerobes could be demonstrated in every case, especially Bacteroides melaninogenicus. In the antibiotic treatment, clindamycin (Cleocin) proved to be superior to metronidazole (Clont). Within 12 to 24 hours after initiation of treatment, at the most 36 hours, the fetor almost always disappeared. The odor was stopped as long as antibiotic therapy continued.

Massive epistaxis after rupture of intracavernous carotid artery aneurysm. Case report.

We present a case of massive epistaxis caused by an internal carotid artery aneurysm. The initial treatment with endovascular balloon embolization failed as a result of balloon displacement. After rebleeding, the intracavernous aneurysm was treated with an endovascular detachable balloon embolization technique, which resulted in cessation of epistaxis. The different treatment options for interventional radiology and management of ruptured carotid artery aneurysms are discussed.

[Current antibiotic treatment of ENT infections in the child]. / Aktuelle antibiotische Behandlung der HNO-Infektionen des Kindes.

Most acute infections of the upper respiratory tract are primary viral infections. Bacterial infections and superinfections in the head and neck in children require appropriate antibiotic therapy to prevent complications. No essential change of the bacterial spectrum of ENT infections of children has been seen in recent years. Penicillins and macrolides are important antimicrobial agents in current therapy. Beta-lactams are an important therapeutic advance.

[What can the additional diagnosis contribute in sudden deafness?]. / Was leistet die Umfelddiagnostik beim Hörsturz?

100 patients suffering from sudden hearing loss were examined with regard to cardiovascular risk factors and compared with a control group without ear diseases. Hypercholesterinaemia and hypertriglyceridaemia were significantly more often seen in patients with sudden hearing loss. No accumulation of pathological findings in neurological, orthopaedic or ophthalmological examinations was observed in patients with sudden hearing loss.

[Pain therapy in patients with incurable tumors of the head and neck]. / Schmerztherapie bei Patienten mit inkurablen Kopf-Hals-Tumoren.

The treatment of pain in patients with terminal cancer of the head and neck is discussed. The treatment must be tailored to the individual patient and should use oral agents if possible. The basic medication consists of peripherally acting analgesics; if the results are inadequate, these must be combined with centrally acting agents. Neuroleptics are important adjuvant analgesics, which have proved to be particularly valuable for more severe pain in head and neck cancer. This treatment can be carried out either in hospital or in domiciliary practice.

[History of intubation]. / Zur Geschichte der Intubation.

The Arabian doctor Avicenna (980-1037) described the first orotracheal intubation in dyspnoea. The history of peroral endotracheal intubation actually begins in the 18th century. At that time obstetricians and lifesavers used breathing tubes. In 1880 Macewen preoperatively intubated a patient to prevent the aspiration of blood during extirpation of a tumour from the base of the tongue. Regular peroral intubation to keep the respiratory tract clear during narcosis was first applied by Franz Kuhn in 1900; unfortunately, the pioneer himself did not live to see his method become a routine procedure. It was only as late as 1945, that endotracheal intubation became part of hospital practice at our clinic.

[The history of tracheotomy]. / Zur Geschichte der Tracheotomie.

Tracheotomy is one of the oldest operations in medicine. The development of tracheotomy from antiquity to our time is reported. After the beginnings of the operation in Greek and Roman medicine, the operation was called laryngotomy or bronchotomy. It was Heister who coined the name "tracheotomy". Tracheotomy is still an important operation even after more than 2000 years. In recent years there has been a change from simple tracheotomy to plastic tracheostomy.

[Antibiotics and blood coagulation--current references for the ENT physician]. / Antibiotika und Blutgerinnung--aktuelle Hinweise für den HNO-Arzt.

A rare but important side effect of antibiotics is their inhibitory effect on haemostasis and blood coagulation. Modern antibiotics with a wide spectrum like cephalosporins of the 2nd and 3rd generation, as well as semisynthetic penicillins, can imitate warfarin in its effect on the blood clotting system. Other antibiotics can enhance the effect of warfarin derivatives when given simultaneously. The mechanism by which penicillin and its derivatives inhibit platelet aggregation is not yet clear. Other antibiotics can induce thrombo-cytopenia. Before antibiotic treatment is started the doctor should consider liver and kidney function, a possible malnutrition, interaction with other drugs (especially inhibitors of platelet aggregation and warfarin derivatives), and other diseases of the patient that also prolong bleeding time.

[Anaerobic infections in ulcerating tumors of the head and neck. A contribution to the problem of odors]. / Anaerobierinfektionen bei exulzerierten Tumoren im Kopf-Hals-Bereich. Ein Beitrag zum Foetorproblem.

Incurable exulcerated head and neck tumours frequently produce a foul odour which is a great problem for patients, nurses and family of patients. This odour is a sign of anaerobic infection in necrotic tumours. Bacteriological examinations in fifteen patients with tumours of the oral cavity, the oropharynx and with recurrent tumours of the hypopharynx and larynx showed anaerobic bacteria. Bacteroides melaninogenicus, B. oralis, B. bivius, Peptococcus and Fusobacterium were most frequently represented. Five cases showed mixed aerobic-anaerobic infections. Foul odour disappeared regularly after a short time by antianaerobic chemotherapy (clindamycin or metronidazole). Foetor is evidently caused by microbial activity of anaerobic bacteria in secondary infected tumours. Antibiotic treatment directed strictly against anaerobes helps to improve quality of life of patients with advanced head and neck cancer with regard to foetor.

[History of esophagoscopy]. / Zur Geschichte der Oesophagoskopie.

Since the middle of the 19th century very many experts have endeavoured to develop the oesophagoscopy following two different principles of oesophagus examination. Some tried to transfer the technique of indirect laryngoscopy on the oesophagus by using a larynx speculum. In order to achieve an insight into the oesophagus they separated its closed upper end by means of special retracting instruments. Various instruments were developed for this purpose (by Voltolini, Semeleder, Stoerk, Bevan, Waldenburg, Mackenzie) which however not proved to be effective. Mostly angled or jointed tubes came into use which were stretched after insertion. More successful were those applying simple straight tubes. Except for Stoerk it was Kussmaul who had a sword-swallower swallow a tube instead of a sword. Today flexible fiberglass endoscopes are used as well as rigid tubes.

[Perforation of the ear drum. On the history of paracentesis and grommet insertion]. / Der Trommelfellstich. Zur Geschichte von Parazentese und Paukenröhrchen.

As early as 1649, Jean Riolan the Younger pierced an ear drum, after which the patient's hearing improved. This occurred as a result of an accidental ear drum injury while cleaning an ear canal with an ear-spoon. In 17th and 18th centuries, several pioneers in medicine (Thomas Willis, Antonio Mario Valsalva, William Cheselden) conducted experiments in an effort to ascertain the function of the ear drum in hearing. At the end of the 18th century, ear drum perforation, like perforation of a cataract, was indiscriminately performed by itinerent quacks and "physicians" in England, France, and Germany. Ear drum perforation was performed in many places even for the healing of deaf and dumb. Astlee Cooper reported about success with ear drum perforation in 1800 and listed strict indications. He recommended the operation only in the presence of obturation of the Eustachian tube. Because of the negative results of indiscriminate ear drum perforation, the operation soon acquired a bad reputation and was not performed for decades. It was only Herrmann Schwartze who reintroduced paracentesis into the daily practice of otorhinolaryngology. He was director of the royal ENT clinic in Halle and published a trailblazing treatise on the indications, value, and success of this operation. Since physicians had soon realized that spontaneous healing tendencies of the ear drum quickly lead to closure of an artificial perforation, many physicians tried different techniques to obtain a permanent opening. Gruber resected half of the ear drum--unsuccessfully. Others put foreign bodies into the ear drum apertures, such as catgut, whalebone rods, and lead wires. In his textbook of 1845, Martell Frank first described a grommet made of gold foil. Politzer experimented with a hard rubber ring but later abandoned his attempts because of lack of success. Voltolini manufactured an open hollow ring of gold foil or aluminium, which had to be fixed at the handle of the malleur. Armstrong described a "new" therapy for chronic secretory otitis media consisting of inserting a vinyl tube into the ear drum. While he was not the inventor of the grommet, he was the first to reintroduce grommets in the middle of the 20th century. Theromoparacentesis was performed as early as 1867 by Voltolini, who performed this operation using a galvanic cautery device. After more than 100 years, the Japanese physician Saito reintroduced thermoparacentesis into the therapy of tube ventilation disorders. Paracentesis, grommet insertion, and thermoparacentesis are among the most successful treatments currently available to the ENT specialist when used properly. They are treatments with a long history.

[Anaerobic infections in the head and neck area. Current status of knowledge]. / Anaerobierinfektionen im Kopf-/Halsbereich. Aktueller Wissensstand.

The classification of anaerobic infections and the most common organisms affecting the head and neck, pathogenesis diagnosis and current therapy are reported. Certain types of infections are particularly important for anaerobic bacteria and include actinomycosis, infectious complications of chronic otitis media or sinusitis, phlegmon of the floor of the mouth, peritonsillar abscess, retro-(para-)pharyngeal abscess, neck space infections, mediastinitis, wound infections following head and neck surgery and septic complications.

[History of surgical interventions in the paranasal sinuses]. / Zur Geschichte operativer Eingriffe an den Nasennebenhöhlen.

Hippocratices was the first to describe lesions that obstruct the nasal passages. Andreas Vesalius described the maxillary, frontal, and sphenoid sinuses. Mikulicz, Lothrop and Claoué are considered to have been the first to perform inferior meatal antrostomy of the maxillary sinus. Siebenmann was apparently the first to recommend suprameatal antrostomy in the middle meatus, which is now fashionable again. Grünwald, Hajek, Killian, Halle and Uffenorde developed endonasal ethmoid surgery to an established procedure.

[Antibiotic therapy in patients with renal insufficiency]. / Antibiotische Therapie bei Patienten mit Niereninsuffizienz.

For the otolaryngologist (ENT specialist), too, antibiotics are among the most frequently prescribed drugs. This article gives the essential fundamentals for the antibiotic treatment of patients with restricted kidney functions, as well as advice for antibiotic therapy in clinics and in medical practice.

[Significance and problems of pseudomonas infection in ENT medicine]. / Bedeutung und Problematik der Pseudomonas-Infektion in der HNO-Heilkunde.

Pseudomonas aeruginosa is frequently cultured in chronic otitis media, in external otitis, and from infected radical mastoid cavities. Necrotizing external otitis is a typical infection caused by Pseudomonas aeruginosa. Perichondritis of the external ear is sometimes due to a Pseudomonas aeruginosa infection. Some cases of chronic sinusitis and wound infections in patients with tracheostomy are caused by this organism. Antiseptic agents or astringents should be used for local treatment of Pseudomonas infected ears. If these fail local treatment with azlocillin for several days is a good alternative. Systemic antibiotic therapy is also available for Pseudomonas aeruginosa infections.

Concentrations of ampicillin and sulbactam in serum and tissues of patients undergoing ENT surgery.

2 g ampicillin and 1 g sulbactam were given by infusion to 24 patients who were to be operated on in the ENT region. About 1 hour later during the operation samples of serum and of various tissues were taken and analysed for ampicillin and sulbactam. The mean serum concentrations of ampicillin and sulbactam were 59.2 mg/l and 31.6 mg/l, respectively. At the same time the concentrations of the two drugs were usually lower in the tissues than in serum. About 1 hour after the infusion the mean tissue concentration of ampicillin was 33.5 mg/kg and of sulbactam 19.5 mg/kg. The results show that ampicillin and sulbactam penetrate within an hour into the different tissues affected by the operation and maintain about the same ratio as in serum (2:1). The concentrations of ampicillin and sulbactam measured in the different compartments are capable of inhibiting the bacteria most frequently involved in ENT infections. These measurements unequivocally support the use of the ampicillin/sulbactam combination in the treatment and perioperative prophylaxis of bacterial infections of the ENT tract.

[Osteoma of the maxillary sinus]. / Osteom der Kieferhöhle.

BACKGROUND: Osteoma of the paranasal sinuses is a rare and benign entity that develops slowly. If they occur, locations within the frontal sinus and ethmoid cells are more frequent, whereas osteomas in the sphenoid or maxillary sinus are very rare. CASE: We report on a 25-year old female patient presenting with a bony mass in the right maxillary sinus. A standard external approach using a modified Caldwell-Luc procedure was successfully employed as endoscopic endonasal surgery was limited by the size of the bony lesion. CONCLUSIONS: Trauma or infection are often suggested as an etiologic factor in the pathogenesis of osteoma. In our case the development of maxillary osteoma was related to dental extraction and postoperative fistula. External standard procedures remain mandatory if endonasal endoscopic surgery fails in the removal of osteoma of the paranasal sinuses.