[The Königsteiner Empfehlung of 2012 - essential alterations and modifications]. / Die Königsteiner Empfehlung von 2012 - Wesentliche Neuerungen und Änderungen.

BACKGROUND: Since 1974, the recommendation for assessment of hearing impairment caused by noise - formerly known as "Königsteiner Merkblatt" (now: "Königsteiner Empfehlung") - has been representing the state of the art for the assessment of the occupational disease BK-No. 2301. It was updated several times, the last time in 2012. It provides a summary of the current medical knowledge. A new measurement for the entire working life - the Effective Noise Dose by Liedtke - was introduced. Otoacoustic emissions (OAE) are now the crucial tests in order to detect a hair cell dysfunction. As from now the tinnitus has to be put under a more comprehensive examination. On the strength of post experience the previous speech audiometry (Freiburger Test) is reliable, it was retrained. In future the indication for hearing aids will be oriented towards the aid guidelines of the legal health insurance. The questionnaire for the expert opinion was revised and the fee was adapted.

[Parastomal tumors after laryngectomy: etiology and therapy]. / Parastomale Tumoren nach Laryngektomie: Atiologie und Therapie.

BACKGROUND: Parastomal neoplasm after total laryngectomy for laryngeal carcinoma represents an extremely serious complication and one of the most formidable therapeutic problems encountered by the head and neck surgeon. Studies about the etiology of parastomal neoplasm have been controversial. The factors most strongly implicated in parastomal neoplasm have been recurrence spawned by metastases to deep cervical lymph nodes, undetected neoplasm at the margin of the laryngectomy resection, neoplastic cell implantation by pre-operative tracheotomy, and the development of an additional primary. PATIENTS: To clarify the controversial aspects of parastomal neoplasm etiology, a systematic analysis of parastomal neoplasm after laryngectomy was performed using data from 10 patients who developed parastomal neoplasm. RESULTS: Parastomal neoplasm occurred in 7.9%. The tumor site of the primary laryngeal carcinoma was found in 9/10 cases in the subglottic, supraglottic, or transglottic area. These tumor sites correlate with areas of a lymphatic vessel concentration and an increase of intralaryngeal lymphatic drainage. In average the parastomal neoplasms appear 10.3 months after the laryngectomy. Therapy was unsuccessful in spite of extensive surgical interventions. CONCLUSIONS: If the laryngeal carcinoma was resected with margins of healthy tissue, lymphatic metastasis to the pretracheal and paratracheal cervical lymph nodes is the probable cause of parastomal neoplasm. This could be the consequence of the continuous lymphatic drainage between the supraglottic and subglottic area with a midline crossing and an lymphatic outlet to the pretracheal and paratracheal cervical lymph nodes. The cervical metastasis formation cannot be detected due to the limitations in the assessment of small lymph nodes and the inability to ascertain with confidence the presence or absence of metastasis in any one lymph node in ultrasonography, computed tomography, and magnetic resonance imaging and due to the limitations in the removal of lymph nodes in the pretracheal and paratracheal area by means of a functional or radical neck dissection. The method of treatment should be in cases of a subglottic or a supraglottic laryngeal carcinoma an ipsilateral and contralateral pretracheal and paratracheal lymph node removal in combination with the laryngectomy.

[History of surgical interventions in the paranasal sinuses]. / Zur Geschichte operativer Eingriffe an den Nasennebenhöhlen.

Hippocratices was the first to describe lesions that obstruct the nasal passages. Andreas Vesalius described the maxillary, frontal, and sphenoid sinuses. Mikulicz, Lothrop and Claoué are considered to have been the first to perform inferior meatal antrostomy of the maxillary sinus. Siebenmann was apparently the first to recommend suprameatal antrostomy in the middle meatus, which is now fashionable again. Grünwald, Hajek, Killian, Halle and Uffenorde developed endonasal ethmoid surgery to an established procedure.

[The history of tracheotomy]. / Zur Geschichte der Tracheotomie.

Tracheotomy is one of the oldest operations in medicine. The development of tracheotomy from antiquity to our time is reported. After the beginnings of the operation in Greek and Roman medicine, the operation was called laryngotomy or bronchotomy. It was Heister who coined the name "tracheotomy". Tracheotomy is still an important operation even after more than 2000 years. In recent years there has been a change from simple tracheotomy to plastic tracheostomy.

[Treatment of tinnitus with iontophoresis and local anesthesia]. / Die Behandlung von Ohrgeräuschen mit der Iontophorese-Lokalanästhesie.

50 previously unsuccessfully treated patients suffering from tinnitus were given local-anaesthesia-iontophoresis. By iontophoresis it is possible to build up an electric field, in which a local anaesthetic (lidocaine hydrochloride) is able to penetrate through the tympanic membrane. Experimentally it has been proven that this local anaesthetic has a direct effect on the inner ear. In contrast to intravenous and intratympanal application there are no toxic side effects when applying local-anaesthesia-iontophoresis. Tinnitus was reduced completely or partly in 31 patients after repeated application to one or both ears. No connection was seen between the success of therapy and the origin of the tinnitus. Treatment was unsuccessful in 19 cases. No serious side effects were seen. Local-anaesthesia-iontophoresis can be recommended as an attempt to treat tinnitus, especially in those cases who have not yet responded to drugs.