[Quality in the appraisal of head and neck sonography results in university hospitals-a random sample]. / Qualität in der Befundung von Kopf- und Halssonographien an Universitätskliniken ­ eine Stichprobe.

BACKGROUND: Ultrasound diagnostics are widely used and are standard for radiologists, otolaryngologists, and oral and maxillofacial surgeons in the diagnostic work-up of various pathologies. There is agreement that digital documentation is urgently needed at present to improve and standardize the quality of sonographic documentation. There are more and more publications on the implementation of standardized documentation of findings in imaging diagnostics, including head and neck sonography. OBJECTIVE: The present work aims to determine the quality of routine head and neck sonography findings on a random basis, according to the criteria of the Bavarian Association of Statutory Health Insurance Physicians (KVB) at a selection of German university otolaryngology departments (ENT). MATERIALS AND METHODS: A total of 70 randomly selected anonymized written findings including image documentation from seven ENT departments were retrospectively analyzed by an experienced KVB examiner concerning fulfilment of KVB criteria. The data were evaluated descriptively. RESULTS: Of the 70 reports, 69 were eligible for evaluation. The average documentation completeness was 80.6%. A total of 9 findings were correctly documented in full (13%). The documentation completeness of the individual departments was sorted in ascending order from 68.1% to 93%. With 88.5% vs. 75%, the hospitals with a structured report showed a higher level of completeness. In 75% of the cases the hospitals with structured reports also had digital solutions for reporting and image archiving. CONCLUSION: In general, there is potential for optimization regarding the completeness and quality of routinely prepared head and neck sonography findings at the selected university ENT departments. The implementation of structured reporting masks and the conversion of analogue documentation into digital solutions as well as digital networking with the hospital information systems, picture archiving and communication systems should be promoted. Supervision by senior doctors is required to ensure the quality of findings of inexperienced colleagues and to help to achieve standards in reporting.

Semicircular canal dehiscence in HR multislice computed tomography: distribution, frequency, and clinical relevance.

The literature about bony defects in the semicircular canal system is highly inconsistent. Therefore, we analyzed a series of 700 high-resolution multislice CT examinations of the temporal bone for semicircular canal dehiscencies. An unselected group of ENT patients with different clinical symptoms and variable age was chosen. We found semicircular canal dehiscence in 9.6% of temporal bones, superior semicircular canal was affected mostly (8%), less common posterior semicircular canal (1.2%); only in 3 cases (0.4%), lateral semicircular canal showed dehiscence. In 60% of SSC dehiscence, we registered bilateral manifestation. The so-called "third mobile window" in semicircular canal dehiscence causes a great variety of clinical symptoms like vertigo, nystagmus, oscillopsies, hearing loss, tinnitus and autophonia. Comparison with anatomic studies shows that CT examination implies the risk of considerable overestimation; this fact emphasizes the important role of clinical and neurophysiological testing.

[Traffic medicine expert opinions in otorhinolaryngology: current aspects]. / Verkehrsmedizinische Begutachtung in der HNO-Heilkunde : Aktuelle Aspekte.

According to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the moment bilateral deafness and high-grade hearing loss (> or = 60% in pure tone audiometry) are not exclusion criteria for driving licenses grades A, B and C, while driving licenses grade D and licenses for public transport are generally excluded. In the forthcoming revised edition of the guidelines it has been suggested that the latter group will also not be excluded. The regulations concerning dizziness are wide-sweeping at the moment as no driving license will be granted if dizziness is present but will be more specific in the next issue. In particular a division will be made between single axle and two axle vehicles. An expert assessment about driving suitability can only be made by a certified specialist with qualifications in traffic medicine.

[Vestibular compensation : basic principles and clinical significance]. / Vestibuläre Kompensation : Grundlagen und klinische Bedeutung.

The vestibular system has the ability to repair deficits due to functional lesions, which is known as vestibular compensation. For successful function the performance of different receptors is less important than the bilateral balance of neuronal activity between the vestibular nuclei complexes. In this review based on data from animal experiments and clinical observations, the mechanisms of vestibular compensation, its time course and its clinical significance are described. Most of the clinical features can be explained by neuronal operations known from animal experiments. It must be emphasized that vestibular compensation is not a static phenomenon but a fluctuating process which can be influenced by therapeutic procedures. Vestibular compensation for static phenomena can be almost completely carried out, but for dynamic features only incompletely. These factors should be taken in account for diagnosis, therapy and assessment of vestibular disturbances.

[Special ginkgo extract in cases of vertigo: a systematic review of randomised, double-blind, placebo controlled clinical examinations]. / Ginkgo-Spezialextrakt bei Schwindel: Ein systematischer Review randomisierter, doppelblinder, placebokontrollierter klinischer Prüfungen.

BACKGROUND: The concept for the medical treatment of vertigo has changed over the last 30 years due to recognition of the dependence of the vertiginous sensation on vestibular compensation and the dependence of vestibular compensation on the state of vigilance. METHODS: In this systematic review, experimental studies of the influence of the special ginkgo extract EGb 761 on vestibular compensation in animals and randomized, double-blind clinical studies of EGb 761 in vestibular and non-vestibular vertigo are described and critically evaluated. RESULTS: The beneficial effect of EGb 761 on vestibular compensation has been demonstrated in preclinical and clinical studies. CONCLUSION: Evidence of the efficacy of EGb 761 for the treatment of vertiginous syndromes is presented in the available studies.

[Skull vibration induced nystagmus test]. / Le test vibratoire osseux vestibulaire.

OBJECTIVES: To establish during a consensus meeting the fundamental basis, the validity criteria, the main indications and results of the skull vibration induced nystagmus test (SVINT) which explores the vestibule high frequencies. MATERIAL AND METHODS: The SVINT is applied on the mastoid process (right and left sides) at 100 Hz during 10 seconds on a sitting upright subject. Total unilateral peripheral lesions (tUVL: operated vestibular shwannomas, vestibular neurectomies) and partial unilateral peripheral lesions (pUVL: preoperative neuromas, Meniere's disease, vestibular neuritis, chemical labyrinthectomies) were studied. Thirty-six patients had brainstem lesions and 173 normal subjects were used as controls. RESULTS: The SVINT is considered positive when the application of the vibrator produces a reproducible sustained nystagmus always beating in the same direction following several trials in various stimulation topographies (on the right and left mastoid). The skull vibratory nystagmus (SVN) begins and ends with the stimulation; the direction of the nystagmus has no secondary reversal. The slow phase velocity (SPV) is>2 degrees /second. In tUVL the SVINT always reveals a lesional nystagmus beating toward the safe side at all frequencies. The mean SVN SPV is 10.8 degrees /s+/-7.5 SD (N=45). The mastoid site was more efficient than the cervical or vertex sites. Mastoïd stimulation efficiency is not correlated with the side of stimulation. The SVN SPV is correlated with the total caloric efficiency on the healthy ear. In pUVL the SVINT is positive in 71 to 76% of cases; the mean SVN. SPV (6.7 degrees /s+/-4.7 SD)(N=30) is significantly lower than in tUVL (P=0.0004). SVINT is positive in 6 to 10% of the normal population, 31% of brain stem lesions and negative in total bilateral vestibular peripheral lesions. CONCLUSIONS: SVINT is an effective, rapid and non invasive test used to detect vestibular asymmetry between 20 to 150 Hz stimulation. This test used in important cohorts of patients during the ten last years has demonstrated no observable adverse effect. SVINT complements other tests which evaluate lower frequencies (caloric test: 0,003 Hz) and the medium frequencies (Head-Shaking-Test (HST): 2 Hz; the head impulse test (HIT): 6 Hz). SVINT is useful in the diagnosis of labyrinthine hydrops or detection of acoustic neuromas. It is useful when the caloric test can not be practised because of middle ear problems. SVINT has its limits: in pUVL, the nystagmus direction is not always specific of the pathologic side and can change with the stimulus frequency. This test does not precisely point out the level of the lesion on the vestibular pathway.

[Acute peripheral vestibular lesions. Monocular subjective visual vertical and cyclodeviation]. / Akute periphere vestibuläre Läsionen. Monokulare subjektive visuelle Vertikale und Zykloduktionsstellung.

BACKGROUND: A deviation of the subjective visual vertical (svv) is often found in patients with unilateral peripheral vestibular lesions and in most cases the deviation is transitory and easy to compensate. The purpose of the study was to find out if there is a correlation between deviation of the svv and objective cyclodeviation of the retina. PATIENTS AND METHODS: A total of 20 patients (10 females and 10 males aged between 16 and 78 years) with acute vestibular disease were enrolled. Only patients with a binocular deviation of the svv of more than 2 degrees and/or a difference between the monocular deviation of more than 1.5 degrees were included. The svv was examined monocular in a darkened room and after pupil dilatation, fundus photography was performed on each eye. The angle between papilla and macula was measured manually. RESULTS: We found a good qualitative correlation between svv (mean 7.9 degrees) and objective cyclodeviation (mean 10.6 degrees). CONCLUSION: In contrast to the binocular measurement of the svv, we found good correlation between the monocular svv and the objective cyclorotation measured with fundus photography. It is not yet clear which part of the vestibular system is responsible for cyclodeviation. Because of our results we recommend monocular measurement of the svv in clinical examinations.

[Bilateral acoustic neuromas, a report of eight cases (author's transl)]. / Neurinomes de l'acoustique bilatéraux. A propos de 8 observations.

The treatment of bilateral acoustic neuromas is extremely difficult. An earlier diagnosis would give better opportunities to preserve facial and hearing function. We study on eight cases, the initial symptoms and the evolution to stimulate the interest of the E.N.T. specialist of this unrecognized disease.

[Surgery of acoustic tumors by the retro-sigmoid route. A personal technique. Results on audition and the facial nerve (61 cases) (author's transl)]. / Chirurgie des tumeurs de l'acoustique par voie rétro-sigmoïde. Technique personnelle. Résultats sur l'audition et le facial (61 cas).

In the surgery of acoustic tumors it is possible to preserve audition and, indeed, imperative, if the neuroma is bilateral. In this work, we describe our technique by the retro-sigmoid route which allowed us to preserve hearing in 36% of cases and facial motor movements in 82% of cases (61 operations).

Effect of thirst challenge on ADH levels in patients with bilateral Menière's disease.

The aim of the study was to investigate plasma ADH levels and plasma/urine osmolality in patients suffering from bilateral Menière's disease since a disturbance in the water household after thirst challenge is a suspected pathogenic factor in the development of this disease. In this study the plasma ADH levels and plasma/urine osmolality of bilateral Menière's disease patients under thirst challenge were investigated to show whether the water balance is affected. 9 patients with bilateral Menière's disease and 9 healthy controls skipped water intake for 12 h. Plasma ADH, plasma/urine osmolality, and electrolytes were measured after this thirst period as well as 8 h later after food and fluid intake. During food and fluid intake the patients demonstrated a slightly higher plasma ADH level and plasma osmolality than controls, whereas at the end of the thirst period patients and the controls showed no significant change. Instead the urine osmolality differed significantly (p<0.001): showing a high urine osmolality in controls and an almost stable urine osmolality in patients after thirst challenge. This indicates that the water balance in patients is likely different from that of controls. These observations point to ADH and its target aquaporine 2 as keyplayers in the pathophysiological events leading to the development of Menière's disease.

[Vestibular evoked myogenic potentials]. / Vestibulär evozierte myogene Potenziale.

The recording of vestibular evoked myogenic potentials is a relatively new neuro-otologic method which gives specific information about the function of the sacculus and the inferior vestibular nerve on each side separately. The main indications for this method are vestibular schwannoma and fistula of the labyrinth, involvement of the sacculus or the inferior vestibular nerve in Menière's disease and vestibular neuritis, vertigo of unknown etiology, and forensic questions.

[Ultrasonics in the diagnosis and follow-up of tumors of the inner nose and paranasal sinuses]. / Ultraschall in der Diagnostik und Nachsorge von Tumoren der inneren Nase und der Nebenhöhlen.

Ultrasound diagnosis is not applicable in diagnostics and monitoring of tumors of the inner nose; the B-mode can be used only if the lumen of the nose is completely filled out by the tumor. In case of the paranasal sinuses the A-mode imaging furnishes a pattern containing back wall echoes and intermediate echoes which necessitates further diagnostic measures. Thanks to the B-mode imaging it is possible to determine the tumor extent and an eventual infiltration into the surrounding tissues. The pre- and posttherapeutic diagnosis of tumors of the inner nose and the paranasal sinuses contains also an investigation of the neck in order to detect possible metastases.

[Critical remarks on so-called cervicogenic vertigo]. / Kritische Anmerkungen zum sogenannten zervikogenen Schwindel.

A critical review of neurophysiological literature is given about the part played by the neck proprioceptors in the regulation of vestibular functions. In comparison with vestibular and optokinetic influences the neck proprioceptors are of secondary importance. A critical review of the publications by the supporters of a cervical genesis of vertigo leads to the conclusion that "cervical nystagmus" must be proven before the concept of neck-triggered vertigo can be accepted. In relation to all forms of vertigo, vertigo induced by cervical disorder represents a very low percentage only.

[Two cases of hepatic complication from halothane anesthesia following pediatric tonsillectomy (author's transl)]. / Zwei Fälle von hepatischen Komplikationen nach Kindertonsillektomie in Halothanenarkose

A report of two cases of hepatic complications (one of these with fatal consequence) after pediatric tonsillectomy using halothane anesthesia is given. Although in both cases it could not be proven that the halothane was the cause of the hepatic complication, an exacerbation of occult liver dystfunction by the anesthetic was considered possible.

[Therapy of isolated acute laryngitis with fusafungin. A phase IV study]. / Therapie der isolierten akuten Laryngitis mit Fusafungin. Eine Phase-IV-Studie.

Four-hundred and eighty-four patients with acute laryngitis were examined before and after treatment with fusafungin under phase IV conditions. After one week of therapy such complaints as hoarseness, sore throat and difficulties in swallowing were improved in about 90% of the patients, while the leading complaint of "hoarseness" had disappeared in 60%. Inflammatory findings, documented by a physician, showed comparable results. An analysis of subgroups (ineffectively treated patients and patients with long-lasting symptoms and complaints) shows that fusafungin was effective therapeutically for treating for acute laryngitis. This study also shows that the generally accepted high rate of spontaneous recovery does not exist.

[Possibilities for quantifying vestibular vertigo]. / Möglichkeiten der Quantifizierung des vestibulären Schwindels.

The problem of the quantification of vertigo is still unsolved. In this article, two methods in the field of visual orientation in which the vestibular system is involved, are proposed. The visual subjective vertical allows to determine the degree of deviations, which is augmented in acute vestibular lesions. - The degree of deviation correlates well with the subjective intensity of vertigo. Both methods seem to be useful in the quantification of subjective vestibular complaints.

[Rehabilitation of patients with vestibular disorders]. / Rehabilitation von Patienten mit vestibulären Störungen.

The connections between the two vestibular nuclei permit vestibular compensation after unilateral lesions. The interactions between the vestibular and the visual and proprioceptive system can support vestibular compensation. Our physical training program for the treatment of vertigo is based on these mechanisms. The training consists of fixation exercises, smooth pursuit and motor learning by proprioceptive cognition. The results are very convincing.

[Therapy of vestibular vertigo]. / Therapie des vestibulären Schwindels.

The non-surgical treatment of vestibular disorders must be based on current knowledge of vestibular pathophysiology. It is generally accepted that after vestibular lesions a self-repair mechanism exists that allows a more or less complete recovery. In cases of persisting vestibular complaints the physician's duty consists in stimulation of these pre-existing mechanisms. This can be done by physical exercises, as has been recommended since the work of Cawthorne and Cooksey in 1946. This concept is meanwhile supported by modern neurophysiological research. This article describes a short training program consisting of exercises for fixation during rotations, smooth pursuit, optokinetic nystagmus and motor learning mechanisms. Physical exercises can be reinforced by nootropic drugs.

[Visuovestibular interaction in the regulation of body posture]. / Uberlegungen zu visuovestibulären Interaktionen bei der Regulation der Körperhaltung.

Visual stimulation can provoke egocentric illusory movements or changes of posture. Therefore, vestibulo-spinal tests were usually performed with eyes closed. A more sensible method seems to be the "visual stabilization", which is obtained by means of a box fixed on the head and with eyes open. In this manner, body instability due to vestibular disorders becomes more apparent.