[Isolated functional loss of the lateral semicircular canal in vestibular neuritis]. / Isolierte Rezeptorfunktionsstörung des horizontalen Bogengangs.

Today, modern tools in vestibular testing are feasible to provide information about functional status of all five peripheral vestibular receptors. Isolated or combined loss of crista and macula receptor function can be determined in the diagnostic process. We describe a seldom case of isolated functional loss of lateral semicircular canal receptor function in a 55-year-old patient. Whereas there was no ispilateral caloric response and video head impulse test revealed a catch-up saccade, air-conducted (AC) cervical and ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP), subjective visual vertical and MRI were normal.

[The video head impulse test: first clinical experiences]. / Der Video-Kopfimpulstest: Erste klinische Erfahrungen.

BACKGROUND: Side-specific test procedures are mandatory in order to assess the function of peripheral vestibular receptors. Semicircular canals (SCC) and vestibulo-ocular reflex (VOR) can be tested by the Halmagyi and Curthoy head impulse test (HIT) and recently by means of the video head impulse test (vHIT). The vHIT procedure is a new method to measure eye and head velocity during brief and rapid head impulses. This method provides objective information of VOR and detects both overt and covert catch-up saccades. MATERIALS AND METHODS: As clinical experiences with vHIT are limited, in this study the horizontal VOR (hVOR) was examined by means of the vHIT in 142 consecutive patients with acute or chronic vestibular syndrome. RESULTS: A total of 20 healthy volunteers served as a control group and exhibited a normal average VOR gain of 0.97 ± 0.09 without re-fixation saccades. In patients, 47.6% showed a pathological vHIT whereas 52.4% revealed a normal test result. Covert catch-up saccades could be revealed in 13.7% by means of vHIT whereas in 86.3% overt catch-up saccades alone or in combination with covert catch-up saccades were found in the majority of catch-up saccades in peripheral vestibular disorders. CONCLUSIONS: By means of the vHIT it is possible to obtain a side-specific and quantitative assessment of hVOR. Video-head impulse test is a reliable tool for vestibular testing even in bedside examinations of patients suffering from dizziness.

[Video head impulse test or caloric irrigation?. Contemporary diagnostic tests for vestibular schwannoma]. / Video-Kopfimpulstest oder thermische Prüfung? Zeitgemäße Funktionsdiagnostik des Vestibularisschwannoms.

The video head impulse test (vHIT) is a new method for investigating vestibular function that is currently poorly studied in terms of its value for clinical diagnosis in otolaryngology. Both the caloric irrigation and vHIT serve to evaluate the horizontal vestibulo-ocular reflex. In the present study, caloric irrigation and vHIT were compared in 46 patients with vestibular schwannoma. Caloric irrigation exhibits a higher sensitivity than vHIT (72% versus 41%) and both tests show only a moderate correlation. Tumor size and hearing level was significantly correlated with caloric abnormalities but not with vHIT findings. Since caloric irrigation and vHIT measure the hVOR in low and high frequency ranges, respectively, these tests have to be considered complementary and are valuable in both diagnostics and therapeutic decisions.

[The EXIT procedure]. / Ex-utero-intrapartum-treatment-Manöver.

The ex utero intrapartum treatment (EXIT) procedure is used for unborn fetuses in cases of predictable complications of postpartum airway obstruction. Indications for the EXIT procedure are fetal neck tumors, obstruction of the trachea, hiatus hernia of the diaphragm and congenital high airway obstruction syndrome (CHAOS). Large cervical tumors prevent normal delivery of a fetus due to reclination of the head with airway obstruction. Therefore, a primary caesarean section or the EXIT procedure has to be considered. The EXIT procedure has time limitations as the blood supply by the placenta only lasts for 30-60 min. Airway protection has to be ensured during parturition.This article reports the case of an unborn fetus with a large cervical teratoma where an obstruction of the cervical airway was detected and monitored by ultrasound and magnetic resonance imaging (MRI) during pregnancy. The EXIT procedure was therefore used and successfully accomplished. The features of the interdisciplinary aspects of the EXIT procedure are described with the special aspects of each medical discipline.

[Receptor function of the semicircular canals: Part 1: anatomy, physiology, diagnosis and normal findings]. / Rezeptorfunktion der Bogengänge: Teil 1: Anatomie, Physiologie, Diagnostik und Normalbefunde.

The perception and conversion of motion stimuli by the vestibular receptors, unimpaired postural control and intact visual acuity are essential for spatial orientation. Disturbances in these three sensory systems can manifest as "vertigo", "dizziness" or "imbalance". The integrity of peripheral receptor function, especially of the three semicircular canals, plays a superficial role. They are sensitive to acceleration stimuli, which they transmit via reflexes to the eye muscles. The stabilization of a visual target is via vestibulo-ocular reflexes, which have a very short latency and thus ensure a permanently stable image on the retina. Modern lateral-specific testing procedures are available to diagnose the receptor function of the peripheral vestibular system. The function of the semicircular canals can be analyzed using a head impulse test (HIT) and, more recently, by means of video-HIT as well as on the basis of a caloric test. Using these techniques, all three semicircular canals can be assessed in a side- and receptor-specific manner.

[Receptor function of the semicircular canals. Part 2: pathophysiology, diseases, clinical findings and treatment aspects]. / Rezeptorfunktion der Bogengänge. Teil 2: Pathophysiologie, Erkrankungen, klinische Befunde und therapeutische Aspekte.

Perturbation of semicircular canal function may result in a pathological angular vestibulo-ocular reflex (aVOR). The resulting impairment in gaze stabilization is perceived as "vertigo" or "dizziness" and may occur following receptor function impairment of all three semicircular canals. The head impulse test reveals hidden (covert-catchup) or visible (overt-catchup) saccades in disturbances of semicircular function. Most peripheral vestibular disorders can be treated conservatively. There are surgical treatment options for some diseases, such as intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence. Vestibular training promotes central reorganization of the VOR. Impaired semicircular receptor function, in particular bilateral vestibulopathy, may affect spatial orientation and cognitive processes. Balance prostheses could serve as a replacement for receptors in the future.

[Aneurysmal bone cyst of the ethmoid sinus and skull base in a 3-year old child: a rare location of a benign bone lesion]. / Aneurysmatische Knochenzyste der Rhinobasis bei einem 3-jährigen Kind: Seltene Lokalisation einer benignen Knochenläsion.

Aneurysmal bone cyst is a benign osteolytic lesion in childhood and adolescence which primarily arises in metaphyseal long bones. Its presence in bones of the skull base is very rare. In a 3-year old girl presenting with proptosis, MRI demonstrated a well-defined displacing growing mass in the ethmoid sinus, orbita and anterior fossa. The histopathologic examination of biopsy specimens confirmed an aneurysmal bone cyst. Despite radical surgery the child suffered from two recurrences of the lesion in the first year after initial diagnosis. There has been no subsequent recurrence during the last 3 years. Since this lesion is rarely seen at the skull base, is difficult to differentiate clinically and by histopathology and may take an abnormal course, it is described in this case report to emphasize that it should be included in the differential diagnosis of ENT tumors at this location.

[Metastasis to the lateral skull base]. / Metastase eines Trachealkarzinoms im Bereich der Felsenbeinspitze.

BACKGROUND: Tumours and metastases of the lateral skull base are rare findings. Clinically, the progressive involvement of ipsilateral cranial nerves is important. CASE REPORT: A 69-year-old man presented with headache and palsies of the facial nerve and nerve VI. Furthermore, he had hearing loss and hypaesthesia of the trigeminal nerve (V3). Four months previously, laser therapy for carcinoma of the trachea (cT4 cN3 cM0) had been done. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an intrapetrosal mass with destruction of the lateral skull base. The findings suggested a metastasis of the tracheal carcinoma. We performed a mastoidectomy with specimen collection, and the pathological analysis revealed infiltration of a squamous cell carcinoma. The patient died within 3 weeks after radiotherapy with palliative intention despite malignant progression. CONCLUSION: The diagnosis and therapy of metastases to the lateral skull base is an interdisciplinary challenge. CT and MRI scans are essential for planning further procedures. In cases of headache and cranial nerve palsies, a metastasis to the lateral skull base must be considered in the differential diagnosis.

[Papillary thyroid carcinoma in a thyroglossal duct cyst: primary tumor or metastasis?]. / Papilläres Schilddrüsenkarzinom in einer medianen Halszyste : Primärtumor oder Metastase?

Thyroglossal duct cysts are the most common anomaly in thyroid development. The occurrence of carcinoma in a cyst is reported to be about 1% of cases. Histopathological examinations reveal a papillary thyroid carcinoma in about 94% of these. We report the case of 38-year-old female having a massive, cervical cystic mass over a period of 18 months. An ectopic papillary thyroid carcinoma was diagnosed. A total thyoidectomy and bilateral neck dissection were performed. This revealed a small thyroid carcinoma and three positive lymphatic nodes. Whether the cystic carcinoma is the primary or a metastasis of the thyroid carcinomais discussed.

[Foreign body reaction to materials implanted as biocompatible for internal fixation]. / Fremdkörperreaktion nach Implantation eines biokompatiblen Osteosynthesesystems.

After implantation of resorbable materials for internal fixation, foreign body reactions are described in 0-47% of cases. Copolymers of poly-l-lactic acid (PLLA) and polyglycolic acid (PGA) seem to offer better biocompatibility than other materials. One of our patients had a midfacial fracture, which we fixed using a resorbable system based on PLLA-PGA (82%-18%); a foreign body reaction developed after 22 months. When resorbable materials are used it is essential to be aware specifically of the risk of foreign body reactions, especially when the facial area is involved. This risk must be discussed with the patient in some detail during the preoperative period.

[Tuberculosis of the parotid gland]. / Tuberkulose in der Glandula parotidea.

The different tumours of the parotid gland can be divided in benign or malignant tumours, regional inflammations and enlarged lymph nodes. We report on a 26-year-old male from Uganda with a slowly growing tumour of the right parotid gland for several months. The CT scan showed a poorly defined intraparotideal tumour. Ultrasonography revealed multiple enlarged cervical lymph nodes. Suspecting a neoplasm of the parotid gland we decided to perform a superficial parotidectomy for histological examination. The pathological analysis revealed a caseous necrosis and epitheloid granulomata containing Langhans giant cells. The polymerase chain reaction could not confirm our suspicion of tuberculosis. The Ziehl-Neelsen staining did not show any acid-proof rods. Only the breeding of the suspicious probes generated Mycobacterium tuberculosis. Initially denying any infections the patient admitted to having had tuberculosis that had been treated with antibiotics 2 years previously. Tuberculosis is a rare finding in parotid tumours. It must be considered as a differential diagnosis of parotid enlargements.

[Secondary amaurosis after infraorbital injury with a wooden foreign body]. / Sekundäre Erblindung nach orbitaler Holzfremdkörperverletzung.

We report a 68-year-old male who had orbital trauma from a bicycle accident. His vision was initially normal but deteriorated over 8 days to complete blindness. After 13 days, when he first consulted a physician, clinical investigation revealed total ophthalmoplegia, ptosis, and chemosis. Computed tomographic scan showed fractures of the medial orbital wall, orbital floor, and posterior ethmoid with dislocation into the orbital apex near the optic nerve. The patient was sent to our department for optic nerve decompression. Clinical examination showed induration and an already healed infraorbital entry wound suggesting an orbital foreign body, which was confirmed by ultrasound. Renewed analysis of CT scans in different window settings could clearly demonstrate a wooden foreign body in the lower eyelid. Additionally, a diffuse inflammation in the orbital apex was diagnosed. The foreign body was removed and decompression of the orbita and optic nerve was performed. Antibiotics and corticosteroids were administered i.v. Unfortunately, no visual improvement could be achieved.

[Invasive aspergillosis of the skull base with orbit infiltration]. / Invasive Aspergillose der Schädelbasis mit Orbitaspitzensyndrom.

BACKGROUND: [corrected] Aspergillosis of the paranasal sinuses is subdivided into noninvasive and invasive types, depending on invasion of the tissue. The invasive form often occurs in immunodeficient patients and can be divided further into granulomatous, chronic invasive, and acute fulminating forms. CASE REPORT: We report the clinical course of an immunosuppressed 64-year-old male with invasive aspergillosis originating from the sphenoid sinus with infiltration of the orbit and intracranial extension into the cavernous sinus. The patient was referred to our hospital with loss of vision, ptosis, and ophthalmoplegia of 3-month duration. Additionally he suffered from diabetes mellitus II and kidney failure after kidney transplantation. After CT scanning, endonasal sinus debridement and decompression of the orbit were carried out immediately. Histology revealed invasive aspergillosis. Postoperatively, both systemic and local antimycotic therapy and antibiotic treatment were performed. According to recommendations of the Undersea and Hyperbaric Medicine Society, cerebral abscess is a certain indication of hyperbaric oxygenation. We decided to attempt therapy for that as well. The patient died 3 weeks after surgical intervention due to carotid dissection. CONCLUSION: Invasive aspergillosis of the paranasal sinuses and the skull base of immunsuppressed patients is usually lethal because of intracranial complications. Therefore, fast diagnosis using CT and MRI and surgical and antimycotic therapy are necessary.

[Intracochlear schwannoma as a cause of a deafness: a case report]. / Intrakochleäres Schwannom als Ursache für eine Surditas: Eine Falldarstellung.

Inner ear extension caused by schwannomas, which can cause hearing loss, tinnitus and vertigo, is an extremely rare finding. We report a male patient who presented with progressive hearing loss as well as tinnitus in the right ear. Despite rheologic infusion therapy with glucocorticosteroids at another hospital, the patient showed an explicit hearing loss and vertigo related to the right ear. In the pure tone audiogram, we found complete deafness of the right ear, the equilibriometry with caloric testing showed complete loss of the labyrinth. In the HR-MRI, a structure appeared in ranges of the basal and middle cochlea with enhancement of the contrast medium. From the MRI aspect, this appeared to be a small intracochlear schwannoma. As a differential diagnosis, a chronic granulation is also possible. In agreement with the patient, we decided to control the structure clinically every 6 months using MRI; no further growth of the structure appeared. A precise imaging via HR-MRI is required to detect intracochlear schwannomas. Observation is an appropriate option for patients who have serviceable hearing. Surgical exploration can be recommended in cases of progressive diseases and growth into the inner ear with recurrent vertigo attacks. The option of radiotherapy for the treatment of intrameatal acoustic neurinomas should be considered.

[Stomal metastases after translaryngeal tracheotomy (TLT) according to Fantoni: a rare complication]. / Impfmetastasen nach translaryngealer Tracheotomie nach Fantoni: Eine seltene Komplikation bei Tumoren des oberen Aerodigestivtrakts.

The translaryngeal tracheotomy (TLT) according to Fantoni with rigid endoscopy is well known and easy to execute. In our department we have used this method since 2002. In 17 patients suffering from carcinomas of the upper aerodigestive tract, we performed a TLT. Peri- and postoperative complications were examined. In 17 patients there were no intraoperative complications. As an early complication we found in one case a dislocation of the tracheostomy tube postoperatively. In one patient we observed metastases in the prior TLT stoma as a major late complication. Another patient also probably suffered from metastases in the prior TLT stoma. We did not find tracheoesophageal fistulas or stenosis of the trachea. Iatrogenic neoplastic seeding of squamous cell carcinomas of the upper aerodigestive tract is a serious complication. Our experience with these two cases and a review of the literature indicates that in patients with head and neck cancer, pull procedures for placement of TLT tubes may induce metastases by direct implantation of tumor cells because of contact between the TLT tube and the primary tumor cells. TLT according to Fantoni cannot be recommended for the treatment of cancer of the upper aerodigestive tract. Methods of tube insertion that avoid such contact, e.g., Ciaglia, surgical tracheostomy, should be preferred.

[Primary nasal natural killer/T-cell lymphomas: classification and clinicopathological features]. / Primäre nasale NK/T-Zell-Lymphome: Klinisch-pathologisches Erscheinungsbild und Einteilung.

BACKGROUND: Nasal NK/T-cell lymphomas are rare malignancies in Europe or North America. Histological diagnosis is difficult, because tumors imbedded in large necrotic areas and neoplastic infiltrates may be admixed with small lymphocytes, plasma cells, eosinophils, and histiocytes, and thus the process could be misdiagnosed as chronic inflammation. Progression of the disease leads to septal perforation and may also result in destruction of the hard palate, and if left untreated it ends fatally. This introduced the term "lethal midline granuloma", a term which should not be used any more. MATERIAL AND METHODS: Clinical features, pathohistology, and current classification of primary nasal NK/T-cell lymphomas are described against the background of the recent literature and a case report. RESULTS: Immunophenotyping is essential for the diagnosis. Tumor cells are uniformly infected by Epstein-Barr virus, which could be verified by EBER in situ hybridization. Immunohistochemically, tumor cells are positive for CD56, cytoplasmic CD3epsilon, and CD2 and they express cytotoxic molecules like granzyme B, TIA-1, GMP17, and perforin. Therapeutic options are radio- or radiochemotherapy. On average, 2- and 5-year survival rates of 50% are obtained in stages I and II. The prognosis of advanced tumor stages is very poor. CONCLUSIONS: Immunohistochemical and molecular genetic early diagnosis is of crucial prognostic relevance.