[Transoral videoendoscopic resection of head-and-neck Tumors in 4-hand technique]. / Transorale videoendoskopische Resektion von Kopf-Hals-Tumoren in 4-Hand-Technik.

INTRODUCTION: Videoendoscopic surgery in 4-hand technique is a standard procedure in laparoscopic and also in transsphenoidal pituitary operations. In recent years transoral videoendoscopic resection of head and neck tumours in 4-hand technique (TOVR) gained more and more importance. MATERIALS AND METHODS: From March 2013 28 transoral videoendoscopic resections of oropharyngeal (n = 5)-, hypopharyngeal (n = 12) and laryngeal (n = 11) carcinomas in 4-hand technique werde successfully performed. RESULTS: In all 28 cases a R0-resection without extension to a transcervical surgical approach was achieved transorally. Even in patients with minor mobility of the cervical vertebral column (n = 9) and reduced adjustment facilities of the Kleinsasser laryngoscope or Weerda distending laryngoscope transoral tumor resection could be successfully performed with the use of rigid angular optics. CONCLUSION: TOVR is an effective, cheap and minimally invasive surgical procedure featuring numerous advantages compared to CO2 laser resection and can be considered as real alternative for traditional resection methods of head and neck tumours.

[Laryngopharyngeal reflux disease (LPRD) in children]. / Laryngopharyngeale Refluxerkrankung (LPRD) bei Kindern.

LPRD in children is characterized by symptoms, clinical findings, and sequelae caused by the reflux of gastric acid, bile acid or refluxate containing pepsin beyond the esophagus. For diagnostic procedures and therapy of gastroesophageal reflux disease (GERD) in children and adults widely accepted guidelines have been established. However, diagnosis and therapy of LPRD in children remains a continuous issue of inter- and intradisciplinary discussions. Although both GERD and LPRD in children are reflux-induced diseases, these two entities are different in symptoms, cause, diagnostic procedures, and therapy. Thus, the terms GERD and LPRD are not eligible to be used as synonyms.Otorhinolaryngologists are becoming more and more involved in the management of children with suspicious LPRD. With flexible transnasal laryngopharyngoscopy being one of the most important diagnostic tools for LPRD detection, otorhinolaryngologists play an important role in the interdisciplinary diagnostic network of physicians treating children with suspected LPRD. The present article highlights age-dependent clinical symptoms, diagnostic tools, differential diagnoses, and adequate therapy for pediatric LPRD.

Versatile tabletop setup for picosecond time-resolved resonant soft-x-ray scattering and spectroscopy.

We present a laser-driven, bright, and broadband (50 to 1500 eV) soft-x-ray plasma source with <10 ps pulse duration. This source is employed in two complementary, laboratory-scale beamlines for time-resolved, magnetic resonant scattering and spectroscopy, as well as near-edge x-ray absorption fine-structure (NEXAFS) spectroscopy. In both beamlines, dedicated reflection zone plates (RZPs) are used as single optical elements to capture, disperse, and focus the soft x rays, reaching resolving powers up to E/ΔE > 1000, with hybrid RZPs at the NEXAFS beamline retaining a consistent E/ΔE > 500 throughout the full spectral range, allowing for time-efficient data acquisition. We demonstrate the versatility and performance of our setup by a selection of soft-x-ray spectroscopy and scattering experiments, which so far have not been possible on a laboratory scale. Excellent data quality, combined with experimental flexibility, renders our approach a true alternative to large-scale facilities, such as synchrotron-radiation sources and free-electron lasers.

Does laryngopharyngeal reflux cause intraoral burning sensations? A preliminary study.

Intraoral burning sensations are a common problem in the otolaryngological practice. The aim of this study was to evaluate if laryngopharyngeal reflux can cause intraoral burning sensations by measuring oropharyngeal acid reflux. Patients with recurring intraoral burning sensations underwent oropharyngeal pH monitoring in our outpatient clinic. The pH catheter was placed at the level of the uvula. The catheter contained an externally worn transmitter, which wirelessly sent the data to a monitor. In addition, patients were instructed to indicate meals or the occurrence of burning sensations by pressing provided buttons on the monitor. Corresponding events of burning sensations and a significant decrease in oropharyngeal pH values should be visualized. Twenty two patients suffering from recurring intraoral burning sensations underwent oropharyngeal pH measurement for 21-25 h. We could find oropharyngeal reflux episodes in 11 patients. However, we could not detect any episodes of burning sensations in the mouth corresponding with a decrease in oropharyngeal pH values. Our results suggest that there is no causal connection between LPR episodes and the occurrence of intraoral burning sensations in the examined patients. Although further studies with more patients are necessary in the future, we conclude from our findings that recurring intraoral burning sensations are not an indication for proton pump inhibitor therapy.

Highly efficient soft x-ray spectrometer for transient absorption spectroscopy with broadband table-top high harmonic sources.

We present a novel soft x-ray spectrometer for ultrafast absorption spectroscopy utilizing table-top femtosecond high-order harmonic sources. Where most commercially available spectrometers rely on spherical variable line space gratings with a typical efficiency on the order of 3% in the first diffractive order, this spectrometer, based on a Hettrick-Underwood design, includes a reflective zone plate as a dispersive element. An improved efficiency of 12% at the N K-edge is achieved, accompanied by a resolving power of 890. The high performance of the soft x-ray spectrometer is further demonstrated by comparing nitrogen K-edge absorption spectra from calcium nitrate in aqueous solution obtained with our high-order harmonic source to previous measurements performed at the electron storage ring facility BESSY II.

Content validation of the Comprehensive ICF Core Set for Head and Neck Cancer (HNC): the perspective of psychologists.

OBJECTIVE: The 'Comprehensive ICF Core Set for Head and Neck Cancer (HNC)' is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with HNC. The objective of this study was to explore the content validity of this Core Set from the perspective of psychologists. METHODS: Psychologists experienced in HNC treatment were asked about the patients' problems, resources and aspects of environment they treat in HNC patients in a three-round Delphi survey. First round responses were linked to the ICF. In round two a list of all identified ICF categories was sent to the participants and they were asked whether the listed ICF categories represent the patients' problems, resources and the aspects of the environment psychologists treat in HNC patients. In round three the participants were requested to reconsider their decisions based on the group response. Kappa statistics was used to describe the agreement between the two health care professionals who performed the linking. RESULTS: 34 psychologists from 15 countries named 728 concepts covering all ICF components. 98 ICF categories were linked to these answers. 27 concepts were linked to the not yet developed ICF component 'personal factors'. Kappa coefficient reached 0.71 (95% bootstrapped CI 0.64-0.77). CONCLUSION: The validity of the Comprehensive ICF Core Set for HNC was largely supported by the perspective of psychologists. However, some categories considered relevant for psychologists but currently not covered by the Comprehensive ICF Core Set for HNC require further investigation.

Double-blind, placebo-controlled trial with esomeprazole for symptoms and signs associated with laryngopharyngeal reflux.

OBJECTIVE: To determine the efficacy of proton pump inhibitor (PPI) therapy with esomeprazole on symptoms and signs associated with laryngopharyngeal reflux (LPR). STUDY DESIGN AND METHODS: Prospective, double-blind, randomized, placebo-controlled study. Sixty-two patients with a reflux finding score (RFS)>7 and a reflux symptom index (RSI)>13 were enrolled and received either esomeprazole 20 mg twice daily or placebo for three months. RSI and RFS were assessed at baseline, after six weeks, and after three months. RESULTS: Reductions of total RSI and RFS as well as of several subscores were significantly higher in the treatment group compared to placebo after three months (P<0.05 each). The difference between study groups was most pronounced for posterior commissure hypertrophy (P<0.01). CONCLUSION: In the treatment of LPR-related symptoms a high placebo effect can be observed. However, compared to control, twice-daily PPI treatment for three months demonstrated a significantly greater improvement in laryngeal appearance and LPR symptoms.

Tonsillotomy in the treatment of obstructive sleep apnea syndrome in children: polysomnographic results.

INTRODUCTION: The therapy of choice in the treatment of pediatric obstructive sleep apnea syndrome (OSAS) consists of tonsillectomy or tonsillotomy combined with adenoidectomy. While tonsillectomy unfortunately has a notable risk of secondary hemorrhage and postoperative pain, tonsillotomy is safer and less painful for children. The effect of both surgical methods on symptoms of OSAS seems to be equal, but up to now postoperative polysomnographic data for children treated by tonsillotomy are missing. MATERIALS AND METHODS: Twenty children aged 2-9 years (mean age: 4.1+/-2.0 years) with OSAS diagnosed by full-night polysomnography were included in the study. OSAS was defined as an apnea-hypopnea index (AHI) of 5 or more with minimum oxygen saturation (SaO(2) min) of less than 90%. Exclusion criteria were obesity, craniofacial abnormalities or other pulmonary, cardiac or metabolic diseases as well as a history of recurrent tonsillitis. All children were treated by CO(2) laser tonsillotomy and adenoidectomy. Three to 12 months (mean: 7.7 months) after the procedure a control-polysomnography was performed in all children. RESULTS: No statistically significant changes were seen in the pre- and postoperative distribution of sleep stages, sleep efficacy and total sleep time. The AHI decreased from 14.9+/-8.7 to 1.1+/-1.6 (p<0.001), SaO(2) min increased from 71.1+/-11.1% to 91.2+/-3.5% (p<0.001). Thus, all children were cured by the operation. DISCUSSION: These polysomnographic data show that CO(2) laser tonsillotomy in combination with adenoidectomy is highly effective in the treatment of pediatric OSAS and should be preferred over tonsillectomy because of less postoperative pain and a lower risk of postoperative bleeding.

Subcutaneous Emphysema as a Complication of Tonsillectomy: A Systematic Literature Review and Case Report.

INTRODUCTION: Subcutaneous and mediastinal emphysema is a rare complication after tonsillectomy. This case presentation and literature review summarizes the existing literature on this unusual complication. MATERIALS AND METHODS: This study presents a case of a 21-year-old man who developed a cervical subcutaneous emphysema 6 days after tonsillectomy, whereby conservative treatment produced spontaneous resolution. A proper analysis of this case also required undertaking a systematic search in MEDLINE/PubMed and SCOPUS electronic databases concerning this rare complication, without language restrictions. RESULTS: Based on our criteria, we identified 41 reports including 43 individual cases, in which patients were mostly young and equally distributed between the genders (18 males and 23 females, two unknown). The treatment was mainly conservative and consisted of observation and/or antibiotic therapy. CONCLUSION: Subcutaneous or mediastinal emphysema is an uncommon complication after tonsillectomy. It is important that clinicians become aware of this rare complication, which requires a close monitoring of the patient.

Efficacy of once-daily esomeprazole treatment in patients with laryngopharyngeal reflux evaluated by 24-hour pH monitoring.

OBJECTIVE: Laryngopharyngeal reflux (LPR) is generally treated with twice-daily proton-pump inhibitor (PPI) therapy. In this study, the efficacy of esomeprazole 40 mg once-daily together with lifestyle modifications was determined by repeated 24-hour pH monitoring. STUDY DESIGN AND SETTING: A prospective study. Forty-nine patients with suspected LPR underwent 24-hour pH monitoring. Twenty-seven of 49 patients with measurable abnormal proximal reflux reflected by a reflux area index (RAI)>6.3 were treated with esomeprazole 40 mg every day, and a second pH study was performed. RESULTS: In 22 of 27 patients, everyday PPI treatment reduced the RAI. Four of 5 patients with no RAI reduction reported on symptomatic relief. CONCLUSION: In a considerable number of patients with suspected LPR, pH monitoring reveals no abnormal proximal reflux. Esomeprazole 40 mg every day together with lifestyle modifications could reach adequate acid suppression in a large number of patients. Symptom improvement is also reported by patients without measurable effects of therapy.

Anterior Cervical Disc Fusion Does not Affect the Presence of Cervical Vestibular-Evoked Myogenic Potential.

OBJECTIVE: Cervical spondylosis and cervical disk herniation are the most frequent forms of degenerative disease in the cervical spine. Surgical treatment mainly includes anterior cervical disk fusion. However, information concerning vestibular-evoked myogenic potential (VEMP) recording in patients undergoing cervical spine surgery is limited. The present prospective study aimed to investigate the effect of anterior disk fusion surgery on cervical VEMP (cVEMP) parameters. MATERIALS AND METHODS: Twenty-five patients were enrolled in this study, and 20 patients (10 men and 10 women) completed cVEMP testing. Patient ages ranged from 29 to 76 y (mean, 52 y). Patients with conductive hearing loss or vestibular dysfunction were excluded. The cVEMP test was recorded preoperatively and 1 and 4 months postoperatively. Air-conducted tone-bursts of 500 Hz were used. RESULTS: We found no statistically significant difference between the preoperative and postoperative cVEMP values. CONCLUSION: Cervical spine surgery (anterior cervical disk fusion) for treating cervical spondylosis does not appear to affect the presence of cVEMP or the parameters of cVEMP, when using air-conducted tone-bursts of 500 Hz. Moreover, cVEMP testing can be used in the postoperative phase for evaluating vertigo in patients who have undergone anterior cervical disk fusion.

Hyperfibrinogenemia as a risk factor for sudden hearing loss.

OBJECTIVE: To clarify predisposing conditions for vascular events. SETTING: Vascular events, immunologic processes, and viral infections have to be considered as pathomechanisms for most cases of sudden hearing loss. STUDY DESIGN: Hemorrheologic parameters were studied in 53 patients with sudden hearing loss within 5 days of the onset. PATIENTS: A control group of 53 normal-hearing people was matched pairwise according to age and gender. RESULTS: Fibrinogen levels were significantly higher in patients with sudden hearing loss (343 +/- 98 mg/dl) than in control subjects (303 +/- 69 mg/dl). Erythrocyte aggregation (27.3 +/- 5.6 a.u. versus 20.9 +/- 8.5 a.u.) and plasma viscosity (1.31 +/- 0.13 mPa/s versus 1.26 +/- 0.08 mPa/s) in patients with SHL were also significantly higher than in control subjects. No significant difference could be found in the parameters of clinical chemistry, hematology, and hemostasias investigated. CONCLUSION: Because elevated plasma fibrinogen plays a major role in cardiovascular diseases such as myocardial infarction and stroke, it is possible that this plasma protein is also involved in the pathogenesis of sudden hearing loss of vascular origin. More research is still required to determine the value of measuring plasma fibrinogen levels in clinical practice and identifying hyperfibrinogenemia in sudden hearing loss.

Round window application of D-methionine, sodium thiosulfate, brain-derived neurotrophic factor, and fibroblast growth factor-2 in cisplatin-induced ototoxicity.

HYPOTHESIS: In this study we tested the effect of local administration of D-methionine, sodium thiosulfate, brain-derived neurotrophic factor, and fibroblast growth factor-2 on cisplatin ototoxicity in guinea pigs to the round window membrane. BACKGROUND: Cisplatin is an important antineoplastic agent in the therapy of many malignancies. Its clinical utility is limited by severe side effects, including ototoxicity. Recent studies have shown protection against cisplatin ototoxicity in animal experiments by the systemic administration of D-methionine and sodium thiosulfate. Growth factors such as brain-derived neurotrophic factor and fibroblast growth factor-2 also have shown otoprotective effects in in vitro studies. METHODS: Osmotic pumps (Alzet) were implanted unilaterally in 30 guinea pigs. Five groups of six animals received either D-methionine, sodium thiosulfate, fibroblast growth factor-2, brain-derived neurotrophic factor, or saline 0.9%. Cisplatin was administered intraperitoneally for 5 consecutive days. Distortion product otoacoustic emissions were recorded every day. The animals were killed on day 6, and their cochleae were removed and analyzed by transmission electron microscopy. RESULTS: Compared with control animals, guinea pigs treated with D-methionine showed better otoacoustic emissions on days 3 and 4 (Mann-Whitney test, p < 0.05). The differences were not evident on days 5 and 6. Sodium thiosulfate, brain-derived neurotrophic factor, and fibroblast growth factor-2 showed no significant protective effect. CONCLUSION: Local application to the round window membrane can be used as an effective treatment in the prevention of cisplatin toxicity. Local application may avoid systemic side effects and reduce the antineoplastic effects of cisplatin.

Frequency of bilateral cervical metastases in oropharyngeal squamous cell carcinoma: a retrospective analysis of 352 cases after bilateral neck dissection.

BACKGROUND: The decision whether to perform an elective neck dissection in patients with head and neck squamous cell carcinoma (HNSCC) and clinically negative lymph nodes (cN0) is made based on the probability of micrometastases in the neck for the given subsite and size of the primary. To date there is limited information about contralateral and bilateral cervical lymph node metastases of oropharyngeal carcinoma. METHODS: A retrospective chart review was performed of 352 patients with oropharyngeal SCC who received a bilateral neck dissection. The frequency of histologically unveiled bilateral neck metastases was determined. RESULTS: Carcinomas of the tonsillar fossa starting with a T2 classification and carcinomas of the soft palate, base of tongue, and pharyngeal wall at any stage showed a high frequency of bilateral metastases. CONCLUSIONS: Bilateral neck dissection should be recommended for all but T1 and selected cases of T2 carcinomas of the tonsillar fossa.

E-cadherin but not beta-catenin expression is decreased in laryngeal biopsies from patients with laryngopharyngeal reflux.

Abnormal exposure of acid refluxate on the esophageal mucosa has been shown to decrease the epithelial barrier function through an alteration in the intercellular junctional complex. However, only few studies have examined the molecular effects caused by abnormal exposure of gastric refluxate on the laryngeal epithelium. E-cadherin and beta-catenin are cell membrane-associated proteins playing a major role in the maintenance of cell-cell adhesion in epithelial tissues. In this study we tried to analyse the molecular effect of laryngopharyngeal reflux (LPR) on the cellular expression of these proteins. Therefore, we compared the expression of E-caherin and beta-catenin in laryngeal biopsies from patients with and without pH-documented laryngopharyngeal reflux. Paraffin-embedded archival laryngeal biopsies taken from 21 patients, who had undergone rigid laryngoscopy under general anaesthesia and postoperative 24-h pH monitoring, were evaluated immunohistochemically with antibodies to E-cadherin and beta-catenin. The membrane expression of the two proteins was categorized in no expression, mild, moderate and strong (grade 0-3). In LPR patients (n=14) the mean grade of E-cadherin and beta-catenin expression was 1.57 and 1.21, while in specimens of patients without pH-documented LPR it was 2.57 and 1.29. The difference in E-cadherin expression was statistically significant (P=0.011). From our findings we conclude that LPR can cause a decrease in the laryngeal expression of E-cadherin but not of beta-catenin. The reduction of E-cadherin-mediated adhesion could contribute to the development of laryngeal neoplasms. E-cadherin immunostaining of laryngeal biopsies could be a further diagnostic tool to confirm the diagnosis in patients with suspected LPR.

Spontaneous intratonsillar haemorrhage with acute dysphagia.

In this brief study, we describe a rare tumorlike malformation of both tonsils, that we have named tonsilla partim pendulans. It seems to favour intratonsillar bleeding, resulting in enlargement and obstruction of the oropharynx. The presented case is a 34-year-old healthy woman without history of acute or chronic tonsillitis who complained of an oropharyngeal foreign body sensation since 1 day. Examination revealed a dark red and mobile tumor of 2 cm diameter attached to the lower part of the right tonsil. Furthermore, both tonsils showed a division into two hypertrophic parts. The stem of the tumor was coagulated and the tumor resected under local anaesthesia. Histology showed regular lymphoepithelial tissue with acute haemorrhage and an intact capsule. Actinomyces were found in the tonsillar crypts. Further physical and laboratory findings were unsuspicious. We conclude that patients with this newly described malformation of the tonsils can subsequently develop dysphagia, e.g. in combination with inflammation and mechanical stress. However, tonsillectomy seems not to be mandatory, though in more suspicious cases, histological investigation should exclude rare malignant tumors. Intratonsillar bleeding may cause oropharyngeal obstruction or even ongoing bleeding with relevant blood loss, which should be treated immediately.