[Deforming endonasal mass during pregnancy]. / Deformierende endonasale Raumforderung während der Schwangerschaft.

This article presents the case of a 33-year-old woman who consulted the authors' ENT clinic in the 39th week of pregnancy with recurrent epistaxis. A livid endonasal mass was found on the left side, subtotally displacing the nose and leading to deformation of the external nose. External biopsy provided no indications of malignancy. Postpartum CT of the paranasal sinuses revealed a mass destroying the cartilaginous nasal septum. Endoscopic resection of the finding was performed with preservation of the clinically sound nasal septal cartilage. Histopathological examination revealed a capillary hemangioma, which was classified as granuloma gravidarum due to its occurrence during pregnancy.

[Perioperative management of coagulation in otorhinolaryngologic surgery]. / Perioperatives Gerinnungsmanagement in der HNO-Heilkunde.

Considering the increasing number of patients suffering from drug-induced coagulation disorders caused by antiplatelet or anticoagulant therapy, the right balance between minimizing the risk of bleeding and the risk of a venous thrombosis or embolism during otorhinolaryngologic (ORL) surgery is becoming increasingly important. According to a recent study, the highest risk of intraoperative bleeding in ORL surgery is associated with transoral tumor surgery, tonsillectomy, thyroidectomy, and glomus tumor surgery. The risk of venous thrombosis or embolism during ORL surgery is estimated to be 1%, and increases to 6% among tumor patients. Currently, there is no general recommendation for perioperative hemostatic management because of the limited available data. In the majority of patients who continue antiplatelet therapy with acetylsalicylic acid (ASS) to prevent thromboembolic events, the perioperative bleeding risk is considered to be acceptable. For patients with dual antiplatelet therapy, surgical procedures should be only performed after adaption of the medication.

Diagnostics and therapy of bilateral choanal atresia in association with CHARGE syndrome.

BACKGROUND: Bilateral choanal atresia in patients with CHARGE syndrome becomes symptomatic immediately after birth. A prompt diagnosis, the implementation of sufficient preliminary measures, and the delivery of surgical therapy are crucial. This article is intended to assist in terms of diagnostics and a therapy recommendation. METHODS: We performed a retrospective study using the medical records of all newborns in the University Hospital in Bonn, diagnosed with bilateral choanal atresia and CHARGE syndrome and underwent surgery at the Department of Otorhinolaryngology, Head and Neck Surgery. RESULTS: A total of 21 patients have been treated with a unilateral or bilateral choanal atresia. 14 patients were primarily treated with transnasal endoscopy or underwent transnasal endoscopic surgery as a follow-up intervention (73.68%). Nine patients had a syndromal appearance, which was considered a definite diagnosis in six patients (five with CHARGE syndrome). All five patients with CHARGE syndrome received transnasal endoscopic treatment and a stent was inserted. DISCUSSION: Bilateral choanal atresia can be a life-threatening situation requiring acute measures. The therapeutic trend goes towards transnasal endoscopic resection. Primary intervention should be: minimally invasive, one-stage surgery, functional, and associated with low complication rates. Patency can be increased by saline irrigations, topical corticosteroids, endoscopic controls, and regular dilatation. The insertion of stents is controversially discussed but can be useful in syndromal patients. However, adjuvant therapy with a stent and mitomycin C is increasingly being abandoned. A significantly higher recurrence rate must be expected in association with CHARGE syndrome. Stenting should be considered on an individual basis. Continuous training and support of the parents are obligatory.

[PET-CT in head and neck cancer]. / PET-CT bei Karzinomen im Kopf­Hals­Bereich.

The importance of 18F-fluorodesoxyglucose positron-emission tomography (FDG-PET) for the diagnosis of malignant disease is increasing. On one hand, this is due to the high sensitivity of this method, on the other, because the entire body can be examined. FDG-PET can be particularly advantageous for the diagnosis of head and neck tumors, where tumor staging is an important prognostic parameter and essentially determines the therapeutic regimen. This article presents the different possibilities for combined evaluation with PET and computed tomography (CT) for the diagnosis of patients with head and neck cancer. Special focus is placed on primary staging and tumor follow-up, as well as on the role of PET-CT in the diagnosis of patients with cancer of unknown primary origin (CUP). The use of PET-CT for radiotherapy planning and new aspects of PET technology are also discussed.

[Clinical otorhinolaryngological symptoms of metamizole-induced agranulocytosis]. / Klinische Symptome der metamizolinduzierten Agranulozytose in der HNO.

BACKGROUND: Despite the controversial international debate on the use of metamizole as a standard analgesic, the prescription figures for Germany have increased constantly during recent years. However, metamizole can lead to the rare and severe medical condition called agranulocytosis. MATERIALS AND METHODS: Between January 2009 and January 2014, 5 patients with metamizole-induced agranulocytosis presented themselves at the Interdisciplinary Emergency Center of the University Clinic Bonn. According to their leading ENT symptoms, they were transferred to the otorhinolaryngological department. We retrospectively evaluated metamizole medication, all general patient data and previous diseases, as well as disease course and the respective therapies. RESULTS: Within the scope of the different treatments--surgery after trauma (n=2), elective orthopedic surgery (n=2), tonsillitis treatment (n=1)--the patients (n=5; mean age 30 years) had made regular ambulant use of metamizole for several days or weeks (4-28 days, mean 16.8 days). Daily oral dose ranged from 625 to 2000 mg/d (mean 1500 mg/d). Subsequently, patients required treatment for clinical symptoms of agranulocytosis (e.g. tonsillitis with severe odynophagia and significantly reduced general condition). All patients were monitored in an intermediate or intensive care unit (3-14 days, mean 10 days). No patients died. DISCUSSION: As our cases show, when using metamizole as a standard analgesic, the treating otolaryngologist should look for clinical symptoms of agranulocytosis and inform patients about possible adverse effects. We recommend strict indication setting, regular blood analyses during long-term medication and consideration of alternative analgesics (e.g. NSAR).

Multiple causes for rhinolithiasis.

BACKGROUND: Rhinoliths are rare affections of the main nasal cavity and the paranasal sinuses. Initially, as a result of their low incidence, they are often incorrectly classified as calcified tumors in clinical examination. METHODOLOGY: We have identified three cases in our patient population and evaluated the clinical symptoms as well as the pathological findings and the causes of the disease. RESULTS: Due to their extension and the respective clinical pattern, all masses were surgically removed under endotracheal anesthesia. The histopathological findings comprised an ectopic tooth, a vegetable (most likely a leaf from the garden) as well as a textile foreign body (probably of iatrogenic origin). CONCLUSION: Undiscovered foreign bodies of the main nasal cavity are a common cause for the formation of rhinoliths. We have also displayed the respective incidence and the therapeutic options.

[Management of postoperative pain in ear-nose-throat surgery]. / Postoperative Schmerztherapie nach Hals-Nasen-Ohren-ärztlichen Eingriffen.

The degree of pain following different types of ear-nose-throat surgery varies greatly and must be adjusted on an individual basis. Post-operative pain therapy can be classified into basic pain therapy and additive pain therapy (as needed). Effective pain therapy can lead to lower morbidity and to considerable economic advantages. The subjective pain intensity experienced by patient should be the basis for the dose adaptation and is essential for rapid recovery.

[Histology after tonsillectomy?]. / Histologie nach Tonsillektomie?

BACKGROUND: The necessity to rule out clinically occult malignancies by routine histological examination of all tonsillectomy specimens is a controversial topic. METHODS: Clinical and histological findings of all patients who underwent tonsillectomy at the University of Bonn, Germany from January 2002 to March 2007 were retrospectively reviewed. A meta-analysis of PubMed literature regarding the histological results of tonsil specimens was performed. The incidence of clinically occult tonsil malignancy was recorded and potential risk factors for malignancy were analyzed. A cost-effectiveness ratio of microscopic analysis of all specimens was also performed. RESULTS: Clinically occult tonsil malignancies were detected in 2 out of the 1,523 patients (0.13%) in this study. In the meta-analysis of 24 studies (61,550 patients) 6 cases of clinically occult tonsil malignancies (0.01%) were identified. Statistically 7,694 tonsils have to be histologically examined to detect 1 case of occult malignancy which corresponds to an average cost per case of 385,000 EUR. DISCUSSION: Considering economical aspects we recommend that histological examination should be performed when the following risk factors are present: a history of cancer, tonsil firmness or lesions, tonsillar asymmetry, swelling of neck lymph nodes, constitutional symptoms, anamnestic unilateral symptoms and prior peritonsillar abscess.

The role of histology and other risk factors for post-tonsillectomy haemorrhage.

Tonsillectomy is a frequently performed surgical procedure in children and adults. Postoperative bleeding is the most severe complication; however, the factors leading to postoperative haemorrhage are still discussed controversially. 1,522 tonsillectomies were retrospectively reviewed. Histopathological tonsil composition was correlated with the incidence of postoperative haemorrhage. Patient charts were analysed with regard to demographic data, characteristics of postoperative haemorrhage and indication for surgery. Patients with post-tonsillectomy haemorrhage were compared with uneventful cases. Histopathological signs of cryptic tonsillitis and actinomyces infection displayed a statistically significant correlation with the risk of postoperative haemorrhage (P = 0.018 and P = 0.02), but the odds ratio was low (1.9 and 2.0). 7.7% of all patients had postoperative bleeding and 3.5% had to return to theatre for haemostasis. The incidence of haemorrhages within hospitalization (5 postoperative days) was 45% and after discharge 55%, respectively. In 11% of cases bleeding occurred on the fourth or fifth day after surgery. While gender, season of surgery, abscess tonsillectomy "en chaud" in comparison with elective tonsillectomy were not associated with an increased rate of postoperative haemorrhage (P > 0.05), significant more postoperative haemorrhages were detected in the group of adults (P = 0.02). Despite significant correlation of cryptic tonsillitis and actinomyces infection with postoperative haemorrhage, the risk for postoperative bleeding is only slightly elevated and, therefore, the predictive value is low. Because a multifactorial aetiology of post-tonsillectomy haemorrhage has to be assumed, large multicenter studies are necessary to evaluate the significance of different risk factors.