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1.
Eur Arch Otorhinolaryngol ; 280(4): 1885-1891, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36357610

RESUMEN

PURPOSE: Abdominal ultrasound is a diagnostic staging procedure for distant metastases in head and neck squamous cell carcinoma (HNSCC). However, currently performed abdominal staging procedures do not follow consistent standards. Therefore, this retrospective study on 498 patients aimed at investigating on abdominal ultrasound as a staging procedure in HNSCC. MATERIALS AND METHODS: A retrospective analysis of 498 head and neck cancer patients treated in our Department of Head and Neck Surgery between 2008 and 2015 was performed. Disease-related data were collected over a mean follow-up time of 30.3 months, and results of abdominal ultrasound were analyzed. RESULTS: 426 patients received abdominal ultrasound as a staging procedure. 7% (29) were suspicious for metastases. In 19 cases (66%), the detected abnormalities were masses of the liver. In four patients, abdominal metastases were confirmed at the time of initial diagnosis. 16 patients developed abdominal metastases in the course of the disease (on average 623 days after initial diagnosis). 19 out of 20 patients with abdominal metastases had an N2/N3 cervical lymph node status. In this study, the negative predictive value of abdominal ultrasound for HNSCC staging was 99.03%, while the positive predictive value yielded 5.88% (N2/N3-patients). CONCLUSION: Only in patients with locally advanced lymph-node-status (N2/N3), abdominal ultrasound can be useful as a staging investigation to exclude abdominal metastasis in HNSCC patients. For N0/N1 patients, abdominal ultrasound might be dispensed. Of note, in case of a positive result, further diagnostic procedures are mandatory.


Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Humanos , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Estudios Retrospectivos , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Estadificación de Neoplasias
2.
Eur Arch Otorhinolaryngol ; 280(8): 3731-3736, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-36920556

RESUMEN

BACKGROUND: Dexpanthenol-containing ointments/fluids are recommended to restore impaired nasal mucosa. To date, there are no data about the influence of dexpanthenol or formulations including dexpanthenol on ciliary beat frequency (CBF) of nasal epithelial cells. METHODS: We tested the ciliary beat frequency of human nasal epithelial cells in RPMI 1640 cell solution using in vitro high-frequency video microscopy every 60 s over a period of 15 min (min). Bepanthen® solution and dexpanthenol in two clinically relevant concentrations (1.67% and 3.33%) were added to the cells. Addition of sterile water served as control group. To get a better overview, the measurements after 1 min, 5 min and 15 min were combined. RESULTS: The CBF in the control group (n = 17) after 15 min was 7.3 ± 2.6 Hz. In comparison, the CBF after 15 min was 1.8 ± 1.0 Hz in the 3.33% Bepanthen® group (n = 17) and 3.2 ± 1.2 Hz in the 1.67% group, which was statistically significantly lower in both groups (p < 0.001). With regard to the dexpanthenol group (n = 17) a CBF of 6.0 ± 2.6 Hz with 3.33% and 6.1 ± 2.4 Hz with 1.67% dexpanthenol, was detected, which was again statistically significantly lower (p = 0.06) compared to the control group except CBF at 15 min with 1.57% (n = 17; p = 0.04). In general, the effect on CBF was less pronounced with dexpanthenol compared with Bepanthen® with a statistically significant difference between the two formulations. The results were verified by calculating an analysis of variance (ANOVA). CONCLUSIONS: Bepanthen® as an ointment, solution or inhalation is commonly used in ENT for mucosal care. Our results have shown that both substances reduce CBF in clinically relevant concentrations, although the effect was more pronounced with Bepanthen® compared to dexpanthenol solution, which could be related to additives or change of physical properties in the solution. Further research is needed to assess potential clinical relevance.


Asunto(s)
Mucosa Nasal , Ácido Pantoténico , Humanos , Ácido Pantoténico/farmacología , Administración por Inhalación , Cilios
3.
Eur Arch Otorhinolaryngol ; 279(7): 3355-3362, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34541608

RESUMEN

INTRODUCTION: During surgery in patients with labyrinthine fistula the mandatory complete removal of the cholesteatoma while preserving inner ear and vestibular function is a challenge. Options so far have been either the complete removal of the cholesteatoma or leaving the matrix on the fistula. We evaluated an alternative "under water" surgical technique for complete cholesteatoma resection, in terms of preservation of postoperative inner ear and vestibular function. METHODS: From 2013 to 2019, 20 patients with labyrinthine fistula due to cholesteatoma were operated. We used the canal wall down approach and removal of matrix on the fistula was done as the last step during surgery using the "under water technique". The pre and postoperative hearing tests and the vestibular function were retrospectively examined. RESULTS: There was no significant difference between pre and post-operative bone conduction thresholds; 20% experienced an improvement of more than 10 dB, with none experiencing a postoperative worsening of sensorineural hearing loss. Among seven patients who presented with vertigo, two had transient vertigo postoperatively but eventually recovered. CONCLUSION: Our data show that the "under water technique" for cholesteatoma removal at the labyrinthine fistula is a viable option in the preservation of inner ear function and facilitating complete cholesteatoma removal.


Asunto(s)
Colesteatoma del Oído Medio , Colesteatoma , Fístula , Enfermedades del Laberinto , Vestíbulo del Laberinto , Colesteatoma/complicaciones , Colesteatoma del Oído Medio/complicaciones , Colesteatoma del Oído Medio/cirugía , Fístula/complicaciones , Fístula/cirugía , Audición , Pruebas Auditivas , Humanos , Enfermedades del Laberinto/etiología , Enfermedades del Laberinto/cirugía , Estudios Retrospectivos , Vértigo/etiología , Agua
4.
Sleep Breath ; 25(2): 1011-1017, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32623557

RESUMEN

STUDY OBJECTIVES: Snoring is a common phenomenon which is generated by vibration of soft tissue of the upper airway during sleep. Due to the high incidence of isolated snoring and the substantial burden for the patient and the bed partner, a thorough examination and appropriate therapy are required. Many recommendations for the treatment of isolated snoring are either not evidence-based or are derived from recommendations for the management of obstructive sleep apnea. Therefore, the aim of this study is the identification and description of open questions in the diagnosis and treatment of isolated snoring and the illustration of areas for further research. METHODS: In the context of the development of the new version of the German guideline "Diagnosis and treatment of isolated snoring in adults," a multidisciplinary team of experts performed a systematic literature search on the relevant medical data and rated the current evidence regarding the key diagnostic and therapeutic measures for snoring. RESULTS: The systematic literature review identified 2293 articles. As a major inclusion criterion, only studies on primary snoring based on objective sleep medical assessment were selected. After screening and evaluation, 33 full-text articles remained for further analysis. Based on these articles, open questions and areas for future research were identified for this review. CONCLUSION: Several major gaps in the literature on the diagnosis and treatment of isolated snoring were identified. For the majority of diagnostic and therapeutic measures for snoring, high-level scientific evidence is still lacking.


Asunto(s)
Ronquido/diagnóstico , Ronquido/terapia , Investigación Biomédica , Predicción , Humanos
5.
Eur Arch Otorhinolaryngol ; 278(9): 3351-3356, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33538874

RESUMEN

BACKGROUND: Patients with recurrent epistaxis, particularly due to hereditary hemorrhagic telangiectasia (HHT) are recommended to apply topical tranexamic acid (TXA) to reduce bleeding events. Those patients may suffer ciliary dysfunction due to TXA's effects on ciliary beating frequency (CBF) and their consequences. METHODOLOGY/PRINCIPAL: Human nasal epithelial cells were harvested with a nasal brush in 30 healthy subjects. We investigated the CBF in RPMI medium using high-frequency video microscopy. TXA was added to the cells in various concentrations ranging from 2 to 5%, including the therapeutic concentration (2%) and a control (0%). RESULTS: CBF in the control condition was 6.1 ± 1.6 Hz. TXA reduces CBF in a time and concentration dependent manner, to, e.g. 4.3 ± 1.2 Hz with 2% TXA and 3.3 ± 0.9 Hz with 5% TXA after 16-20 min. The differences in CBF were statistically significant for all concentrations of TXA. CONCLUSIONS: TXA has the potential to significantly impair nasal epithelial function. Therefore, frequent or regular topical nasal application of TXA should be done under close monitoring of nasal function, especially in patients with co-morbidities like chronic rhinosinusitis.


Asunto(s)
Ácido Tranexámico , Cilios , Epistaxis , Células Epiteliales , Humanos , Mucosa Nasal , Ácido Tranexámico/farmacología
6.
HNO ; 69(2): 140-145, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-32885308

RESUMEN

Otorhinolaryngologists play a vital role in the management of patients with obstructive sleep apnea (OSA) in Germany, particularly with regards to outpatient diagnostics as well as conservative and surgical treatment of patients with intolerance to ventilation therapy. Although establishment of differential indications for surgical therapy and performance of additional preoperative drug-induced sleep endoscopy in patients with sleep-disordered breathing are among the core competencies of otorhinolaryngologists, differential diagnostic considerations and detection of comorbid sleep disorders can be challenging, particularly for those without extensive sleep medicine training and experience. However, detection of comorbid sleep disorders is of particular importance when permanent surgical treatment is considered. Daytime sleepiness is the typical leading symptom of OSA; nevertheless, other disorders of hypersomnolence need to be considered in these patients and can easily be overlooked. This may lead to inadequate indications for surgical treatment. Based on two case reports, narcolepsy is presented as a comorbid disorder and differential diagnosis in patients with OSA.


Asunto(s)
Trastornos de Somnolencia Excesiva , Medicina , Síndromes de la Apnea del Sueño , Diagnóstico Diferencial , Trastornos de Somnolencia Excesiva/diagnóstico , Alemania , Humanos , Sueño , Síndromes de la Apnea del Sueño/diagnóstico
7.
HNO ; 69(12): 961-968, 2021 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-33594495

RESUMEN

BACKGROUND: In the authors' department, a newly implemented clinical algorithm for application of perioperative thrombosis prophylaxis in head and neck surgery recommends restrictive handling of anticoagulants. This retrospective study aims to evaluate the algorithm by comparing incidences of venous thromboembolic events (VTE) and surgical revisions due to postoperative hemorrhage. MATERIALS AND METHODS: Perioperative incidences of deep vein thrombosis and pulmonary embolism as well as surgical revisions due to postoperative hemorrhage after head and neck surgery were determined based on all patients operated in the department over a period of 36 months. The incidences before (group I) and after (group II) implementation of the restrictive algorithm were compared. RESULTS: A total of 9276 patients were included. The incidences of VTE (0.12%) and surgical revisions due to postoperative hemorrhage (1.4%) were low. Incidences of VTE were non-significantly higher in group II (0.16%) than in group I (0.08%; p > 0.45, chi-square-test). Case analysis revealed that this difference was not due to implementation of the restrictive algorithm. The incidence of surgical revision due to postoperative hemorrhage was identical in the two groups (1.4%). CONCLUSION: After restricting the indication for thrombosis prophylaxis, the incidence of VTE or surgical revision due to postoperative hemorrhage did not change significantly. The provided clinical algorithm represents a low-risk and low-cost strategy of perioperative risk stratification.


Asunto(s)
Embolia Pulmonar , Tromboembolia Venosa , Trombosis de la Vena , Anticoagulantes/efectos adversos , Humanos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/epidemiología , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Estudios Retrospectivos , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & control
8.
HNO ; 69(1): 3-13, 2021 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-33354732

RESUMEN

Otolaryngologic surgery is one of the most frequent operative interventions performed in children. Tonsil surgery with or without adenoidectomy due to hyperplasia of the tonsils and adenoids with obstruction of the upper airways with or without tympanic ventilation disorder is the most common of these procedures. Children with a history of sleep apnoea (OSA) suffer from a significantly increased risk of perioperative respiratory complications. Cases of death and severe permanent neurologic damage have been reported due to apnoea and increased opioid sensitivity. The current guideline represents a pragmatic risk-adjusted approach. Patients with confirmed or suspected OSA should be treated perioperatively according to their individual risks and requirements, in order to avoid severe permanent damage.


Asunto(s)
Tonsila Faríngea , Apnea Obstructiva del Sueño , Tonsilectomía , Adenoidectomía , Niño , Humanos , Tonsila Palatina , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/cirugía , Tonsilectomía/efectos adversos
9.
HNO ; 69(8): 633-641, 2021 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-33502578

RESUMEN

BACKGROUND: From spring 2020, SARS-CoV­2 began to spread worldwide, with what is now known as the first wave of the pandemic, starting in March 2020. This resulted in restructuring and shift of resources at many hospitals. The aim of our work was to detect the effects of the pandemic on the german Oto-Rhino-Laryngology (ORL) university hospitals in terms of research, student teaching and further specialist training. MATERIAL AND METHODS: The chairmen of the 39 ORL university hospitals in Germany were asked about the effects of the pandemic on research, student teaching and ORL specialist training (residency) in the period from March to April 2020 using a structured online survey. RESULTS: All 39 chairmen took part in the survey. Of these, 74.4% (29/39) stated that their research activities had deteriorated as a result of the pandemic. In 61.5% (24/39) pandemic-related research issues were addressed. All hospitals reported a restriction for in-house teaching and 97.5% (38/39) introduced new digital teaching methods. During the observation period, 74.4% of the chairmen did not see ORL specialist training (residency)at risk. CONCLUSION: Our results provide an insight into the heterogeneous effects of the pandemic. The fast processing of pandemic-related research topics and the introduction of innovative digital concepts for student teaching impressively demonstrates the great innovative potential and the ability of the ORL university hospitals to react quickly in order to maintain their tasks in research, student teaching and ORL specialist training in the best possible way even during the pandemic.


Asunto(s)
COVID-19 , Otolaringología , Alemania/epidemiología , Hospitales Universitarios , Humanos , Pandemias , SARS-CoV-2 , Estudiantes , Enseñanza
10.
Laryngorhinootologie ; 99(10): 694-706, 2020 10.
Artículo en Alemán | MEDLINE | ID: mdl-32767296

RESUMEN

INTRODUCTION: Since December 2019, the SARS-CoV-2 virus has been rapidly spreading worldwide. In Germany, an exponential increase in the number of infections was registered at the beginning of March 2020 and led to a call of the Ministry of Health to create more capacity for intensive medical treatment in hospitals. The aim of the present study was to determine the effects of the SARS-CoV-2 pandemic on Oto-Rhino-Laryngology (ORL) university hospitals regarding patient care. MATERIALS AND METHODS: An online survey was sent out to all chairmen of the 39 ORL university hospitals in Germany. The answers to the questions referred to the defined period from March 15th to April 15th 2020 and were carried out using the online survey tool "SurveyMonkey". 87 questions focused on general information, health care, and structural effects in the respective institution. RESULTS: All chairmen of the 39 university hospitals in Germany participated in the survey. The collected data prove the considerable impact on organizational, structural and medical aspects of patient care. For example, the surveyed clinics reported a decrease in outpatient cases by 73.8 % to 26.2 ±â€Š14.2 % and in surgical treatments by 65.9 % to 34.1 ±â€Š13.9 %. In contrast, emergency treatment remained unchanged or even increased in 80 % of the facilities and surgical treatment of emergency patients remained unchanged or even increased in more than 90 %. Emergency outpatient and surgical treatment of patients was provided throughout the pandemic in all facilities. In total, about 35 000 outpatients and about 12 000 surgical cases were postponed. As a result of the acute structural changes, the potential danger of falling below current treatment standards was seen in individual areas of patient care. DISCUSSION: The assessment of the impact of the SARS-CoV-2 pandemic is heterogeneous. The majority of the chairmen are critically aware of the risk of falling below current medical treatment standards or guidelines. In the phase of an exponential increase in the number of infections, significant changes in treatment processes had to be accepted for understandable reasons. However, with the currently significantly reduced number of infections, falling below treatment standards and guidelines should not be allowed to remain constant and tolerated. SUMMARY: This study shows a differentiated picture with regard to the effects of the SARS-CoV-2 pandemic on outpatient, inpatient and operative patient care at the ORL university hospitals in Germany and illustrates the importance of these institutions for ensuring patient care during this critical phase.


Asunto(s)
Infecciones por Coronavirus , Otolaringología , Pandemias , Neumonía Viral , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/terapia , Betacoronavirus , COVID-19 , Alemania , Hospitales Universitarios , Humanos , SARS-CoV-2
11.
Rhinology ; 57(3): 231-239, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-30739126

RESUMEN

STATEMENT OF PROBLEM: Hereditary hemorrhagic telangiectasia (HHT) is characterized by recurrent epistaxis that can lead to a feeling of losing control. We assessed potential benefits and side effects of different nasal packings used by patients themselves. METHOD OF STUDY: An online-questionnaire in English and German was used to analyze nasal self-packings. RESULTS: 588 of the 915 respondents suffered from HHT with most of them having moderate or severe epistaxis. Almost two thirds of the patients had already treated themselves with nasal packings. While one quarter used non-pneumatic nasal packings (NPNP) or pneumatic nasal packings (PNP), nearly half of the patients took only tissues to stop the bleeding. Patients with severe epistaxis used PNP more often than NPNP. Using nasal packings, most patients could stop their nosebleeds after a while. Patients using PNP reported the feeling of losing control less often and significant improvements in quality of life with a positive GBI. CONCLUSIONS: Our study showed that most patients with HHT using nasal self-packings could stop the bleeding after a while. Nasal self-packing is a user-friendly and secure method leaving patients more self-confident and independent.


Asunto(s)
Epistaxis , Telangiectasia Hemorrágica Hereditaria , Epistaxis/etiología , Epistaxis/terapia , Humanos , Nariz , Calidad de Vida , Autocuidado , Encuestas y Cuestionarios , Telangiectasia Hemorrágica Hereditaria/complicaciones
13.
Eur Arch Otorhinolaryngol ; 275(6): 1483-1490, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29675754

RESUMEN

PURPOSE: MP 29-02, which contains fluticasone propionate and azelastine hydrochloride, is used as a topical nasal application for the treatment of seasonal and perennial allergic rhinitis. Although a multitude of data is available on the clinical symptom reduction and treatment safety of MP 29-02, the effect of MP 29-02 on ciliary beat frequency (CBF) has not been evaluated thus far. METHODS: MP 29-02-containing solution was applied at concentrations of 2.5, 5, 10, and 20% to 14 healthy subjects, and nasal ciliated epithelial cells were then visualized using a phase-contrast microscope. CBF was measured after the application of MP 29-02. For a comparison, fluticasone propionate was used. CBF measurements were then performed for 15 min at 22 °C. Ringer's solution was applied as a negative control. RESULTS: MP 29-02 significantly reduced CBF at all the tested concentrations compared with that of the control group within the observation time. At a 2.5% concentration, MP 29-02 significantly reduced CBF from 6.81 Hz (SD ± 1.35 Hz) at baseline to 4.88 Hz (SD ± 1.52 Hz, p < 0.001) after 15 min. In contrast, for fluticasone propionate, a significant reduction was observed only with the 20% concentration after 5, 10, and 15 min. CONCLUSIONS: MP 29-09 significantly reduced CB, with an almost linear relationship between the MP 29-09 concentration and reduction in CBF. For fluticasone propionate, a significant reduction of CBF was observed only at the highest analyzed concentration. The findings have implications for the long-term use of the MP 29-02. Yet, further clinical studies are needed to confirm these results in vivo, especially in patients with seasonal or perennial allergic rhinits.


Asunto(s)
Androstadienos/farmacología , Células Epiteliales/efectos de los fármacos , Fluticasona/farmacología , Ftalazinas/farmacología , Administración Intranasal , Adulto , Combinación de Medicamentos , Femenino , Humanos , Técnicas In Vitro , Masculino , Persona de Mediana Edad , Mucosa Nasal/citología , Rinitis Alérgica Perenne/fisiopatología
14.
Rhinology ; 55(4): 355-362, 2017 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-28888026

RESUMEN

INTRODUCTION: Surgery is the primary treatment option for squamous cell carcinomas of the nasal cavity (NCSCC). Nodal involvement is rare at the time of initial diagnosis, and the role of diagnostic neck dissection as well as potential adjuvant irradiation of the neck remains controversial. The objective of this study was to assess the oncologic outcomes of patients with NCSCC with special emphasis on cervical lymph node treatment and recurrence. METHODS: 37 previously untreated patients were included in this study. Demographic data, tumor characteristics, therapeutic management, and clinical outcome were analyzed. RESULTS: Patients with advanced stage tumors were slightly overrepresented in this study and overall 3-year disease-free survival was 63%. A surgical treatment approach was pursued in 89% (n=33) of patients. After total rhinectomy, there were no cases of local recurrence. Overall, 12% (n=4) of all surgically treated patients developed local recurrence. While in 45% of patients (n=15), neck dissection was performed at the time of tumor resection, initial lymph node metastasis was histologically confirmed in only 6% (n=2) of surgically treated patients. Cervical lymph node recurrence occurred in 18% (n=6) of patients, predominantly those with advanced stage tumors, despite prior treatment of the neck. CONCLUSION: Excellent local control is achievable for patients with NCSCC, especially with radical tumor resection. While cervical lymph node metastasis is rare at the time of diagnosis, regional lymph node recurrence needs to be taken into consideration when planning therapy and follow-up. Multimodal treatment of the neck may be required for patients with advanced stage tumors.


Asunto(s)
Carcinoma de Células Escamosas/terapia , Cavidad Nasal/cirugía , Recurrencia Local de Neoplasia , Neoplasias Nasales/terapia , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Cavidad Nasal/patología , Disección del Cuello , Neoplasias Nasales/mortalidad , Neoplasias Nasales/patología , Radioterapia Adyuvante
15.
HNO ; 65(Suppl 1): 13-18, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27299890

RESUMEN

Over the past few years, the diagnostic tools and therapeutic approaches for obstructive sleep apnea (OSA) have evolved further. Based on a review of the current literature and the personal experiences of the authors, the most relevant developments are summarized in this article and discussed with regard to their impact on the clinical management of the disease. In the third edition of the International Classification of Sleep Disorders, the classification of sleep-disordered breathing was modified. Notably, additional clinical criteria for the diagnosis of OSA were established and out-of-center sleep testing was introduced as an alternative to polysomnography. Recent technical advancements in diagnostic tools (e. g., peripheral arterial tonometry and pulse wave analysis) have further expanded the diagnostic possibilities. Drug-induced sleep endoscopy allows for a reliable assessment of the level and degree of upper airway obstruction. Whether this gain in diagnostic information leads to an improvement in surgical outcome is, however, still being discussed. The relevance of positional OSA has received increasing attention - the subgroup of patients in whom sleeping position significantly impacts their disease is reported to be above 50 %. For these patients, the introduction of the sleep position trainer offers a new therapeutic option. Further, hypoglossal nerve stimulation (upper airway stimulation) has substantially expanded the surgical spectrum for the treatment of OSA. In regard to the established surgical treatment options, randomized trials with superior methodology have been published, especially for bimaxillary advancement and tonsillectomy with uvulopalatopharyngoplasty. These developments are of particular interest for the otolaryngologist and will influence daily practice.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Monitoreo Ambulatorio/métodos , Polisomnografía/métodos , Pruebas de Función Respiratoria/métodos , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/terapia , Instituciones de Atención Ambulatoria , Diagnóstico Diferencial , Endoscopía/métodos , Alemania , Humanos , Clasificación Internacional de Enfermedades , Avance Mandibular/métodos , Examen Físico/métodos , Modalidades de Fisioterapia , Polisomnografía/tendencias , Pruebas de Función Respiratoria/tendencias , Apnea Obstructiva del Sueño/clasificación , Resultado del Tratamiento
16.
HNO ; 65(2): 90-98, 2017 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-27933351

RESUMEN

Uvulopalatopharyngoplasty (UPPP) was first described in 1964 with regard to surgical treatment of snoring and in 1981 with regard to treatment of obstructive sleep apnea (OSA). The initial surgical techniques for OSA were very invasive, frequently leading to significant morbidity and complications. Wolfgang Pirsig et al. were the first in Germany to recognize that a radical surgical technique increased only the complications, not the efficacy of UPPP. The less invasive surgical technique developed based on these findings is still established in Germany. A meta-analysis from 1996 described a success rate of UPPP of about 50%. High-quality randomized trials demonstrate significant superiority of UPPP plus tonsillectomy compared to untreated controls. However, the objective outcome measures of classic UPPP could not be improved even with additional patient selection criteria, and the effects of UPPP often deteriorate over time. To overcome these limitations, various modifications of UPPP have been developed. Due to limited data, evaluation of these new techniques and their comparison with conventional UPPP is difficult at present. In studies comparing a modification of UPPP with the standard approach, the tested modification was demonstrated to be superior. A relevant limitation of the available data results from the small number of institutions (usually not more than two) that investigated the respective modification and the follow-up periods of usually only 6 months. Data are also too sparse to reliably assess complication rates. For conventional UPPP there are considerably more data, wider experience with long-term outcome, and more robust studies examining treatment effects beyond basic respiratory parameters. At present, modifications of UPPP should be principally employed in clinical trials.


Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Faringe/cirugía , Complicaciones Posoperatorias/prevención & control , Apnea Obstructiva del Sueño/cirugía , Ronquido/cirugía , Medicina Basada en la Evidencia , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Otorrinolaringológicos/efectos adversos , Paladar Blando/cirugía , Complicaciones Posoperatorias/etiología , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Ronquido/diagnóstico , Ronquido/etiología , Resultado del Tratamiento
17.
HNO ; 65(2): 167-176, 2017 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-27933354

RESUMEN

Zenker's diverticulum occurs at the dorsal pharyngoesophageal junction through Killian's dehiscence and is caused by increased intrabolus pressure. Symptomatic disease most frequently affects male elderly patients. Primary symptom is oropharyngeal dysphagia, as well as regurgitation of undigested food, halitosis, and chronic aspiration. A barium swallow study is performed to confirm diagnosis. Treatment options for symptomatic patients include open surgery, as well as transoral rigid or flexible endoscopic procedures. Transoral procedures have become the main treatment approach over the past year thanks to reduced intraoperative complication rates compared to open surgery. The septum dividing the diverticulum from the esophagus is most commonly divided by a stapler device, papillotome, or laser. For high-risk patients who are poor candidates for general anesthesia, the procedure can be performed via flexible endoscopy in awake patients, albeit at an increased risk of recurrence.


Asunto(s)
Trastornos de Deglución/diagnóstico , Trastornos de Deglución/terapia , Esofagectomía/métodos , Esofagoscopía/métodos , Divertículo de Zenker/diagnóstico , Divertículo de Zenker/terapia , Trastornos de Deglución/complicaciones , Diagnóstico Diferencial , Medicina Basada en la Evidencia , Humanos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Divertículo de Zenker/complicaciones
18.
HNO ; 65(11): 894-900, 2017 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-28699039

RESUMEN

BACKGROUND: Application of perioperative thrombosis prophylaxis in head and neck surgery lacks consistent standards in Germany. Due to sparse data, the latest German S3 guideline concerning prophylaxis of thromboembolic events recommends a restrictive handling of anticoagulants in head and neck surgery, with few specific recommendations. OBJECTIVE: The aim of this paper is to provide concrete clinical recommendations based on a systematic literature review and the S3 guidelines. MATERIALS AND METHODS: A keyword-based literature search was performed and the German S3 guideline "Prophylaxis of Venous Thromboembolic Events" was used to state the current level of evidence and provide a clinical algorithm. RESULTS: Eight additional cohort studies dealing with the incidence of thromboembolic events in head and neck surgery were identified. There were no randomized controlled trials. In the proposed algorithm, a classification of dispositional (patient history) and expositional (operation time) risk into three groups enables preoperative risk evaluation indicating the individual demand for prophylaxis. In short operations without major tissue traumatization, routine drug-based thrombosis prophylaxis is not necessary, provided no third-grade risk factors (earlier thromboembolic event, coagulopathy, or malignant disease) are present. Low molecular weight heparins should be used as anticoagulants for drug-based prophylaxis. CONCLUSION: Prophylaxis of thromboembolic events in head and neck surgery is of high clinical relevance but there is currently limited evidence regarding its implementation. This paper is based on a systematic literature review and provides a clinical algorithm for head and neck surgeons.


Asunto(s)
Neoplasias de Cabeza y Cuello , Complicaciones Posoperatorias , Trombosis de la Vena , Anticoagulantes , Alemania , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Complicaciones Posoperatorias/prevención & control , Factores de Riesgo , Trombosis de la Vena/prevención & control
19.
HNO ; 65(2): 148-153, 2017 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-28108790

RESUMEN

BACKGROUND: Positional obstructive sleep apnea (POSA) is common in mild and moderate forms of obstructive sleep apnea (OSA). Two smartphone applications (apps) professing to avoid the supine position (SP) are available: for Android the "Apnea Sleep Position Trainer" and for iOS the "SomnoPose-Sleep Position Monitor". The smartphone needs to be attached to the chest to recognize SP, which then triggers a vibration alarm. This is intended to encourage the patient to change position and the vibration stops as soon as SP is left. These apps, however, have not yet undergone a systematic evaluation. METHODS: Adult patients with polysomnographically diagnosed POSA were invited to participate in the study. POSA was defined as an apnea-hypopnea index (AHI) in SP >10, with AHI in a lateral position <10 and doubling of the AHI in SP. After 1 month, a control polysomnography (PSG) was performed and compliance (at least 4 h/night on 5 of 7 days) was evaluated after 6 months by phone. A sufficient therapy was defined as reduction in SP to <10% of the total sleep time and to an overall AHI <10. RESULTS: Although 57 patients entered the study, 24 did not appear to the PSG control; therefore, 33 patients finished the study, of whom 25 were treated successfully. The overall AHI in 33 patients was reduced from 14.5 ± 9.0 to 9.5 ± 12.6 and the time in SP decreased significantly from 71.1 ± 50.5 to 25.4 ± 65.0 min. Compliance among the 25 continuously treated patients after 6 months was 79.2%. CONCLUSION: Both smartphone apps have the capability to prevent PS in POSA patients and can potentially offer a cost-effective option in the treatment of POSA.


Asunto(s)
Aplicaciones Móviles , Posicionamiento del Paciente/métodos , Apnea Obstructiva del Sueño/terapia , Teléfono Inteligente , Posición Supina , Terapia Asistida por Computador/métodos , Actigrafía/métodos , Diagnóstico por Computador/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía/métodos , Autocuidado/métodos , Apnea Obstructiva del Sueño/diagnóstico , Resultado del Tratamiento
20.
Sleep Breath ; 20(4): 1301-1311, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27179662

RESUMEN

The German Society of Otorhinolaryngology, Head and Neck Surgery recently has released the abbreviated version of its scientific guideline "ENT-specific therapy of obstructive sleep apnoea (OSA) in adults", which has been updated in 2015 and can be found online at the Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). A summary of the main recommendations is provided in this revised English version. All recommendations are based on a systematic literature research of articles published up until March 2014. Literature research followed the Cochrane Handbook for Systematic Literature Research to create Guidelines published by the German Cochrane Centre. Studies were evaluated with respect to their scientific value according to the recommendations of the Oxford Centre for Evidence-based Medicine, and grades of recommendation are provided regarding each intervention.


Asunto(s)
Comunicación Interdisciplinaria , Colaboración Intersectorial , Otolaringología , Enfermedades Otorrinolaringológicas/terapia , Apnea Obstructiva del Sueño/terapia , Adulto , Alemania , Humanos , Enfermedades Otorrinolaringológicas/diagnóstico , Apnea Obstructiva del Sueño/diagnóstico
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