[Topical application of tranexamic acid to prevent post-tonsillectomy haemorrhage]. / Topische Anwendung von Tranexamsäure zur Prophylaxe von Nachblutungen nach Tonsillektomie.

BACKGROUND: Haemorrhage after tonsillectomy (TE) is a frequent and possibly major complication. The aim of the present study was to examine, if the rate of haemorrhage after tonsillectomy could be reduced by the topical application of Tranexamic acid (TXA) postoperatively. MATERIAL AND METHODS: Between November 2011 and April 2013, all patients (n=246) received TXA postoperatively to prevent haemorrhage after TE. The patients were instructed to dilute 1 ampulla of TXA in 300 ml of tap water (concentration 0.2%) from postoperative day 5-10 and to gargle or spray the tonsillar fossae 5-6 times daily. The study group was compared retrospectively with a control group of patients undergoing TE with-out postoperative application of TXA from December 2010 to November 2011 (n=248). RESULTS: The overall rate of postoperative haemorrhage was 19% and 22% in the study and control group, respectively. The rate of postoperative bleeding that needed surgical intervention was at 8.9% and 11.3% in the study and control group, respectively. Topical application of TXA did not significantly reduce the rate of postoperative haemorrhage after TE. CONCLUSION: Topically applied TXA did not reduce postoperative haemorrhage after TE. However, a slight tendency to less bleeding which needed surgical intervention was found in pa-tients older than ≥ 12 years.

Silicone stents in the management of inoperable tracheobronchial stenoses. Indications and limitations.

BACKGROUND: Various stent models have been developed for the treatment of inoperable stenoses of the central airways caused by external compression. Increasing use is made of the silicone stents designed by Dumon. We tested their technical feasibility, tolerance, and long-term efficacy in relieving respiratory symptoms in patients referred for endoscopic palliation of malignant disease. METHODS: All procedures were performed under general anesthesia with the use of the rigid bronchoscope. We inserted 38 stents in 31 patients (median age, 67 years; 25 men and 6 women) whose airways showed residual obstruction of > 50 percent of the lumen after laser resection of endobronchial tumor and/or mechanical dilatation of extrinsic compressions. RESULTS: Stent placement and removal--where necessary--were easy in all patients, but five stents inserted in three patients with short (< or = 2.5 cm) and conical stenoses migrated, necessitating emergency removal. In 27 of the remaining 28 patients, stent tolerance was excellent; 1 proximal tracheal stent (< 1 cm below the vocal cords) had to be removed because of otalgia and dysphagia. One lethal hemoptysis occurred within hours after a repeated laser therapy and removal of an indwelling stent. No other serious complications occurred. Immediate and lasting relief of dyspnea and improvement in performance status (Karnofsky scale, activity index) was achieved in 90 percent (28/31) of patients (p < 0.01). The influence of adjuvant radiotherapy on local tumor recurrence and survival was analyzed in a subgroup of ten patients with stage IIIB squamous cell carcinoma with comparable performance status. Five did not undergo adjuvant radiotherapy (group A) and five did (group B). In group A, four of five stents were occluded by tumor recurrence above or below the stent after a median follow-up of 2 months; in group B, zero of five were occluded (p < 0.05) after 4 months. Median survival was 4 months in group A and 6 months in group B; the difference did not reach significance. CONCLUSIONS: The silicone stents designed by Dumon are easily inserted and removed; they are also well tolerated and very efficacious in relieving respiratory symptoms caused by extrinsic airway compression. Short and conical stenoses present limitations for their use due to increased risk of migration. Combined treatment with laser resection, stent insertion, and subsequent radiotherapy is necessary to prevent local tumor recurrence and may improve survival.

Tonotopic organization of the human auditory cortex as detected by BOLD-FMRI.

Functional magnetic resonance imaging is a noninvasive and nonradioactive method for the detection of focal brain activity. In the present study the auditory cortex was investigated in nine normal subjects who were binaurally stimulated using pulsed sine tones of 500 Hz and 4000 Hz. The BOLD (blood oxygenation level dependent) signal change coincided with the stimulation paradigm and was detected in the plane of the superior temporal gyrus. The comparison of the spatial distribution of activated areas revealed a different behavior for the two frequencies. The present findings underline the existence of a frequency specific organization in the medio-lateral, fronto-occipital and cranio-caudal extension in both hemispheres of the auditory cortex in human. The activated areas for the high tone were found more frontally and medially orientated than the low tone stimulated areas. Furthermore, a slight cranio-caudal shift was observed for the higher frequency, more pronounced in the right than in the left temporal lobe. Finally, for most of the subjects investigated the BOLD activation area of the 500 Hz sine tone was larger than that of the 4000 Hz stimulation. Both frequencies showed a lateralization of signal response to the left temporal lobe.

Acute acoustic trauma. A retrospective study of influencing factors and different therapies in 268 patients.

The files of 268 patients with acute acoustic trauma acquired during military service were analysed in a retrospective study. The following factors were examined: age, profession, degree of hearing loss, audiometric contour, and drug treatment. No influence of age or profession on recovery of hearing loss could be detected. The absolute hearing gain, defined as the difference between the hearing loss at onset and, on average, 7 days later, was dependent on the degree of initial hearing loss. The relative hearing gain, defined as absolute hearing gain divided by initial hearing loss, was independent of the degree of initial injury. The audiometric contour after the acoustic trauma had no prognostic relevance. Nine different types of drug treatment were compared in a subgroup of patients (n=199), in all of whom treatment was started within 2 days of the acoustic trauma. There were no significant differences in relative hearing gain between the nine types of treatment. Patients receiving early treatment had significantly better hearing one week after the acoustic trauma, as compared with the group of patients (n=69) not receiving treatment during the first 7 days. However, it was not possible to determine retrospectively whether this difference was due to treatment effects, or whether it was due to the exclusion of spontaneous remissions among those who were neither examined nor treated within the first 7 days.

A randomized, double-blind, placebo-controlled study of dextran/pentoxifylline medication in acute acoustic trauma and sudden hearing loss.

The effectiveness of any therapy in acute acoustic trauma or sudden hearing loss of unknown origin has not been demonstrated convincingly. The assessment is difficult because of a relatively high rate of spontaneous recovery. Nevertheless, many different forms of treatment are recommended. We tested one form, treatment with rheoactive substances, in a prospective, randomized, double-blind trial and compared treatment with (a) infusions of dextran-40 with pentoxifylline, (b) saline infusions with pentoxifylline, and (c) saline infusions with placebo medication. Pure-tone hearing thresholds served as control parameters and were taken before treatment and at 1 and 4 weeks after the onset of therapy. Three hundred eighty-two patients were included in the trial, 331 (87%) could be analyzed, 184 patients were treated because of sudden hearing loss, 147 because of acute acoustic trauma. The three treatment groups were comparable in their basic characteristics including the amount of initial hearing loss. In patients with sudden hearing loss, no significant differences of hearing recovery were detected between the three treatment groups. Hearing recovery was also similar in patients with acute acoustic trauma. A power analysis of the study revealed that possible true treatment differences of a hearing recovery of 10 dB would have lead to significance with a probability of over 90%. It is concluded that there were, in fact, no clinically relevant differences in hearing gains of sudden hearing loss or acute acoustic trauma between treatments with saline infusions together with placebo medication and treatment with dextran-40 and/or pentoxifylline.

Choanal atresia in premature dizygotic twins--a transnasal approach with Holmium:YAG-laser.

Twins born prematurely presented with choanal atresia and were successfully treated using a transnasal, endoscopically and microscopically controlled Ho:YAG-Laser assisted technique. One twin, who had bilateral choanal atresia was operated immediately, the other one, with unilateral choanal atresia, received surgery 8 months after birth. The rare feature of twins both suffering from choanal atresia and a technique for definitive treatment of this disease in premature neonates are presented and discussed. This report of dizygotic twins with nonsyndromal choanal atresia suggests the possibility of an autosomal recessive inheritance with various penetration or an undefined teratogenic etiologic factor.

Evaluation of persistent torticollis following adenoidectomy.

Post-operative neck complaints are not an uncommon finding following adenotonsillectomy. However, non-traumatic subluxation of the atlantoaxial joint (Grisel's syndrome) should be considered in cases of persistent neck pain and stiffness. An early diagnosis and adequate treatment of this rare condition is mandatory to prevent potentially serious complications. We describe three cases with persistent torticollis in the post-operative period, discuss the pathogenesis and evaluate the clinical management of these patients.

[Hearing disorders in childhood]. / Hörstörungen im Kindesalter.

Hearing impairment in children may severely affect language acquisition. Therefore, early identification and expedient auditory rehabilitation is important. Hearing impairment should be diagnosed within the first year of life. Unfortunately, hearing handicap is still recognized at an average age of two years. In 70% of the cases, the hearing impairment is first suspected by the parents. The hearing of children at risk should be assessed using systematic screening programs. Parents who suspect that their child is hearing impaired must be taken seriously, and a thorough pedaudiologic evaluation is necessary. The principles of auditory rehabilitation are outlined.

[Temporomandibular myoarthropathy syndrome--a frequent cause of facial pain]. / Das temporo-mandibuläre Myoarthropathiesyndrome--eine häufige Ursache für Gesichtsschmerzen.

The temporo-mandibular joint syndrome (syn.: myofascial pain syndrome) is a frequent cause of facial pain. Originally, occlusal disturbances were thought to be of primary etiopathogenetic importance. However, the significance of psychological factors has been recognized during the past few years. Therefore, the treatment of patients with myofascial pain syndrome not only concerns dentists, but also general practitioners. In this report, the clinical examination, differential diagnosis and the therapeutic concept are described in order to increase interdisciplinary understanding of the temporo-mandibular joint syndrome. Additionally, the authors present their own experiences using local anesthesia therapeutically in 34 patients with myofascial pain syndrome. The symptoms remained unchanged in eight patients (24%), clinical improvement was seen in 17 patients (50%) and nine patients (26%) were free of disease after treatment.

Modification of the Hörmann technique of hyoid suspension in obstructive sleep apnoea.

Hyoid suspension is a procedure to stabilise the retrolingual space in obstructive sleep apnoea. Using the Hörmann technique, a steel wire is slung around the body of the hyoid and fixed to the upper rim of the thyroid cartilage. It was observed, however, that the steel wire may lie very superficially to the pharyngeal mucosa. Evaluation of computed tomography (CT) scans showed a mean distance between the hyoid and the pharynx of only 3 mm. A modification is presented by threading a steel wire through a hole that is drilled through the hyoid bone. Thus pharyngeal exposure of the steel ligature and possible perforation of the mucosa is avoided.

[Does CT-navigation improve the outcome of functional endonasal sinus surgery?]. / Verbessert die CT-Navigation bei Nasennebenhöhleneingriffen das Operationsergebnis?

INTRODUCTION: Computer-assisted surgery (CAS) has found widespread use in functional endonasal sinus surgery (FESS) over the past few years. The present study investigates if CAS leads to a better outcome in FESS. MATERIAL AND METHODS: All patients who underwent endonasal sphenoethmoidectomy were enrolled in a prospective, non-randomized study. The procedures were done without CAS (group A) in 2003 and in 2004 with CAS (group B), using a Stryker navigation unit. 62 patients (113 sphenoidectomies) were included in group A and 61 patients (109 sphenoidectomies) in group B. The underlying disease was recurrent chronic sinusitis or polyposis nasi in all patients except for inverted papilloma in one patient of group A and in two patients of group B. The follow-up period was 6 months. Preoperatively and at 6 months postoperatively, a CT-scan was obtained and symptom scores were assessed using a questionnaire. RESULTS: No significant difference was found between group A and B with respect to symptom scores, and CT-scans preoperatively and at 6 months postoperatively. The operation strategy did not change by the introduction of CAS. The frontal sinus was entered in group A and B in 59% and 64%, respectively. All parameters significantly improved postoperatively, compared to the preoperative values. As far as complications are concerned, two anterior orbital injuries and one retrobulbar haematoma occurred in group A and one postoperative lacrimal stenosis in group B. CONCLUSIONS: CAS does not lead to a better clinical outcome in FESS. Our data suggest that the rate of complications may be reduced using CAS. However, studies with a much larger number of patients would be necessary for a definite answer to this issue.

[Experiences with the treatment of vascular malformations using the Nd-YAG laser]. / Erfahrungen in der Behandlung von vaskulären Malformationen mit dem Nd-YAG-Laser.

Lasers have been used for about 15 years in the treatment of vascular malformations and haemangiomas in the head and neck area. The physical properties of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser system make it particularly suitable for this purpose. We review our first experience with the treatment of vascular malformations using the Nd-YAG-laser. 9 Patients with 10 vascular malformations were treated. A complete remission was achieved with 9 of the 10 vascular malformations and a partial remission with the remaining case. No complications were observed. The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser therapy has proven itself as simple to use, being highly effective and having a low complication rate.

[A recommendation for calibration and choice of masking noises used in speech audiometry]. / Ein Vorschlag zur Eichung und Wahl von Störgeräuschen für die Sprachaudiometrie.

Tests to evaluate speech recognition ability against background noise have still not been adequately standardized. This is due in part to the lack of a calibration procedure for the various noises used in testing. In the present study, a psychoacoustic method for the calibration of fluctuating background noises was evaluated. Three types of noise were used: babble noise, stationary noise and fluctuating speech simulating noise in accordance with (CCITT Rec. G 227). Following calibration, the masking effect of each type of noise was evaluated. Results indicated that stationary and fluctuating speech simulating noise had similar effect on speech understanding ability. The steepness of the intensity-intelligibility function was significantly greater using babble noise as compared with stationary or fluctuating speech simulating noise. Babble noise was well accepted by our subjects. However, since its measurement can be calibrated, stationary speech simulating noise may also be used in speech audiometry.

Resection of endobronchial tumors using a tracheoscope and neodymium:YAG laser.

A modified technique for palliative resections of malignant endobronchial tumors with the Nd:YAG laser is described. A special tracheoscope was used in conjunction with the instrument guide of a laser bronchoscope. The main advantage of this technique is easy and simultaneous access to both lungs for ventilation and surgical procedures. The method helps to separate surgical from anesthetic manipulations. The experience of over 70 operations using this technique provides evidence that the use of a tracheoscope is a safe and efficient method of endoscopic resections of larger intrabronchial tumors.

A comparison between the electrically reproduced loudness and the original loudness of speech at high levels.

Four words lists of a German Speech Intelligibility Test (DIN 45621) were recorded at 60 and 75 dB SPL. Both recordings were presented to 20 normally hearing subjects at 75 dB SPL via free-field equalized earphones. Discrimination in noise was significantly better in the original recording at 60 dB SPL. The better understanding may be explained by a more favourable consonant-vowel intensity ratio. Moreover, a significant increase in fundamental frequency could be demonstrated at the higher recording level. The implications for speech audiometry and hearing aids are discussed. Furthermore, it was found from loudness comparisons that both recordings were equally loud at a level of 75 dB SPL. However, significantly increased loudness was indicated in the 75 dB SPL recording by the loudness calculation procedure ISO 532 B.

[New aspects in surgery of the thyroid gland with intraoperative monitoring of the recurrent laryngeal nerve]. / Neue Aspekte in der Schilddrüsenchirurgie mit dem intraoperativen monitoring des N. laryngeus recurrens.

A method for electrophysiological monitoring of the recurrent laryngeal nerve during thyroid surgery is described. An electromyographic record from the muscles of the vocal folds is obtained using two fine needle electrodes. The electrodes are placed endoscopically. The nerve is identified by electrical stimulation, and the electromyographic activity is registered using a Nerve Integrity Monitor NIM-2 (Xomed-Treace). Our experience with this method in 43 patients is described. The safety of the integrity of the recurrent laryngeal nerve is increased using intraoperative monitoring. This has led to a modification of the operative concept in thyroid surgery. Electrophysiological monitoring is mandatory in surgery of large goitres, retrotracheal and substernal extension, for re-operations and malignant diseases of the thyroid gland.

Influence of context on speech understanding ability using German sentence test materials.

The use of contextual information for the recognition of subsequent words may be considered as a central auditory process. In the present study, preliminary test forms of a German version of the American SPIN test were evaluated. The test materials consisted of short sentences with a contextual part and a final word that was always a monosyllabic noun. The contribution of context to the recognition of "high predictable" (HP) and "low predictable" (LP) final words of these sentences was investigated. Testing was performed in noise. However, the masking noise was time-weighted such that the masking level was higher for the final word than for the preceding contextual portion of the sentence. At scores of 29.3%, 50% and 70.7% correct, the mean difference in S/N ratio between HP and LP items was approximately 5, 5 and 2.5 dB, respectively. Equal performance for HP and LP items would indicate central auditory dysfunction. Possible diagnostic applications are discussed.

Performance of normally hearing and hearing-impaired listeners using a German version of the SPIN test.

Various stages in the development of a German version of the English SPIN (Speech Performance in Noise) test have been reported previously by the authors (Züst & Tschopp, 1993). The test forms consist of 15 sentences each with a length of five to nine syllables. The forms have been constructed with either low predictable (LP) final words or high predictable (HP) final words, based upon the amount of contextual information available in the sentence. The test is performed with a background noise and uses adaptive testing strategies. The proportion of HP to LP responses is compared. Normally, scores of the HP segment are higher than those of the LP segment of the test, because the increased contextual information contributes to a better understanding of the HP final words. The SPIN test results in young normally hearing listeners (n = 12), elderly normally hearing listeners (n = 13), young hearing-impaired subjects (n = 14) and elderly hearing-impaired subjects (n = 19) are reported. The most important findings were that the LP-HP difference was not dependent on the degree of peripheral hearing loss, and that no age-related effects could be demonstrated. The SPIN test results were compared with conventional speech audiometric parameters, hearing threshold levels for pure tones and self-reported hearing handicap. Low to moderate correlations were present but were not consistent across comparisons.

[The context effect in speech recognition of sentences]. / Der Kontexteffekt bei der Spracherkennung von Sätzen.

Context plays an important role in speech recognition. The goal of the present study was to quantify context effects in speech recognition using the Basel Sentence Understanding Test. This test consists of two types of sentences according to the amount of contextual information: sentences with high predictable (HP) final words and sentences with low predictable (LP) final words. The effect of different contextual situations on speech recognition was investigated in this study using the Basel Sentence Understanding Test. The speech recognition threshold of HP sentences was found to be 6 dB lower than that of LP sentences. However, contextual effects can only be demonstrated if the context is clearly understandable. In the Basel Sentence Understanding Test, this is achieved by special masking techniques. The significance of the contextual part of the sentence with respect to the recognition of the whole sentence is different in HP and LP sentences.