[Fear of Recurrence (FoR) after Partial Laryngectomy (PA)]. / Progredienzangst (PA) nach Kehlkopfteilresektion (KTR).

BACKGROUND: Fear of recurrence (FoR) is a common problem in cancer patients. However, it is quite unknown in which extent patients who underwent a PL have FoR. This pilot study examines the extent of FoR and coping strategies in cancer patients after PL as well as associations between FoR and medical, treatment-related, psychosocial and demographic parameters. MATERIAL AND METHODS: In a multicentre cross-sectional study, data was taken from 154 cancer patients after PL. Data was collected in personal interviews and with standardised questionnaires (e. g., PA-F; HADS; EORTC H&N-C35). RESULTS: The study participants had a low level of FoR (MW=6.67; SD=2.43) and a high level of coping strategies (MW=3.24; SD=0.83). FoR was higher in young patients (r=-0.265; p=0.002) and in users of medical rehabilitation programs (U=1 480; p=0.025). Patients who thought smoking (r=0.197; p=0.029) or/and inner conflicts (r=0.177; p=0.050) was/were the reason(s) for their cancer and who reported more swallowing problems, had a significantly higher level of FoR (r=0.496; p<0.001). There was a negative correlation between the extent of FoR and time passing by since the last surgery of the larynx (r=- 0.322; p<0.001). CONCLUSIONS: Frequently occurring swallowing problems as well as internal causal attributions for the development of cancer as smoking increase the level of FoR. Since internal causal attributions may cause feelings of guilt, psycho-oncological treatment can be indicated for patients with higher levels of FoR. Furthermore, younger individuals and patients with more swallowing problems need more attention by physicians and therapists.

Psychological distress and need for psycho-oncological support in spouses of total laryngectomised cancer patients-results for the first 3 years after surgery.

PURPOSE: A total laryngectomy (TLE) leads to a variety of functional restrictions, which reduce the quality of life of cancer patients as well as their spouses. However, to date, there is little research focusing on the psychological distress of spouses of total laryngectomised cancer patients. The current study assesses psychological distress, need for psycho-oncological treatment and use of professional psychological care among spouses of total laryngectomised cancer patients. METHODS: A prospective multi-centre cohort study was conducted. Participants were interviewed in person 1, 2 and 3 years subsequent to their spouses' TLE with standardised questionnaires (HADS, Hornheide Screening) and self-designed items. RESULTS: One year after their partners' TLE, 154 spouses were interviewed. Over half of spouses (57 %) reported a high level of psychological distress and 33 % reported restlessness. Majority of spouses (21 %) reported wanting to learn relaxation methods and eight (5 %) had received psychological treatment in the past. Sixty-two spouses took part in the complete study. Over all three time points, psychological distress, the need for psycho-oncological support and the use of professional support among spouses remained stable. The need for additional professional counselling was low. CONCLUSIONS: In view of the stability of psychological distress among half of the spouses within 3 years after TLE and their refusal of professional support, there is a need for the development and evaluation of new treatment strategies to help spouses cope with psychological distress. Our results indicated the most common additional professional need was learning relaxation methods, which may be used as a starting point for the investigation of new coping strategies in future studies.

[Social integration and its relevance for quality of life after laryngectomy]. / Soziale Integration und deren Bedeutung für die Lebensqualität nach Laryngektomie.

BACKGROUND: Social networks and social participation generally have positive effects on health. Yet, little is known about how patients after total laryngectomy (TLE) are integrated into the society. Aim of this study was to investigate how patients are socially integrated after a TLE and if social integration is associated with certain areas of quality of life. PATIENTS AND METHODS: In a longitudinal multi-centred study 161 laryngectomees were interviewed 1 year after the total laryngectomy. Social integration was measured on the basis of an index formed by the questionnaire "Psychosocial Adjustment after Laryngectomy" and questions about social support. To assess quality of life, we used the questionnaire from the European Organisation for Research and Treatment of Cancer EORTC QLQ-C30. RESULTS: 58% of all patients are well integrated 1 year after surgery. Well integrated persons have less problems in different components of quality of life. They report higher levels of social (OR 4.07; CI: 1.96-8.47) and role functioning (OR 3.59; CI: 1.61-8.02). Successful social integration is also associated with higher emotional well-being (OR 8.57; CI: 3.59-20.46). CONCLUSIONS: There is evidence that 1 year after TLE only about half of the patients feel socially integrated. Because of the negative association of poor social integration with social, emotional and role functioning, patients should be supported in their attempts to take actively part in social life.

[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.

[Evaluation of the Freiburg monosyllabic speech test in background noise]. / Evaluation des Freiburger Einsilbertests im Störschall.

BACKGROUND: The Freiburg speech test has been the gold standard in speech audiometry in Germany for many years. Previously, however, this test had not been evaluated in assessing the effectiveness of a hearing aid in background noise. Furthermore, the validity of particular word lists used in the test has been questioned repeatedly in the past, due to a suspected higher variation within these lists as compared to the other word list used. PATIENTS AND METHODS: In this prospective study, two groups of subjects [normal hearing control subjects and patients with SNHL (sensorineural hearing loss) that had been fitted with hearing aid] were examined. In a first group, 113 control subjects with normal age- and gender-related pure tone thresholds were assessed by means of the Freiburg monosyllabic test under free-field conditions at 65 dB. The second group comprised 104 patients that had been fitted with hearing aids at least 3 months previously to treat their SNHL. Members of the SNHL group were assessed by means of the Freiburg monosyllabic test both with and without hearing aids, and in the presence or absence of background noise (CCITT-noise; 65/60 dB signal-noise ratio, in accordance with the Comité Consultatif International Téléphonique et Télégraphique), under free-field conditions at 65 dB. RESULTS: The first (control) group exhibited no gender-related differences in the Freiburg test results. In a few instances, inter-individual variability of responses was observed, although the reasons for this remain to be clarified. Within the second (patient) group, the Freiburg test results under the four different measurement conditions differed significantly from each other (p>0.05). This group exhibited a high degree of inter-individual variability between responses. In light of this, no significant differences in outcome could be assigned to the different word lists employed in the Freiburg speech test. CONCLUSION: The Freiburg monosyllabic test is able to assess the extent of hearing loss, as well as the effectiveness of a fitted hearing aid, in the presence or absence of background-noise (CCITT-noise). The present study could not evidence statistically significant differences in outcome when using the different word lists in this test battery.

[Swallowing disorders after partial laryngectomy. Prevalence and predictors]. / Schluckstörungen nach Kehlkopfteilresektion. Auftrittshäufigkeit und Prädiktoren.

BACKGROUND: Improvements in surgical techniques have led to a higher percentage of larynx preservations. These do not always include preservation of the swallowing function. This study investigates the prevalence of swallowing disorders after partial laryngectomy and their predictors. PATIENTS AND METHODS: In a multicenter cross-sectional study with patients who received a partial laryngectomy (n=154) the prevalences of problems related to swallowing and eating were gathered. Additionally, medical and sociodemographic data were obtained as well as information about alcohol and tobacco consumption. RESULTS: Twenty percent of the patients had problems related to swallowing and eating; more specifically, eating solid foods and eating in public. Chances of having swallowing disorders were significantly lower for patients who received laser therapy (OR=0.12; 95% CI: 0.04-0.37; p<0.01), when time since the last laryngeal surgery was longer (OR=0.89; 95% CI: 0.75-0.99; p<0.03) and when patients were non-smokers (OR=3.39; 95% CI: 1.29-8.94; p<0.02). CONCLUSION: Swallowing disorders correlate with post-surgery smoking. Physicians and therapists should focus more on the negative side effects of smoking on swallowing during patient consultations.

[Current recommendations of dacryocystorhinostomy]. / Aktuelle Empfehlungen zur Dakryozystorhinostomie.

UNLABELLED: CURRENT RECOMMENDATIONS OF DACRYOCYSTORHINOSTOMYOBJECTIVE: With the implementation and the development of endoscopic systems, especially in functional endoscopic sinus surgery (FESS) in the last two decades, the gold standard considered external dacryocystorhinistomy (DCR) by Toti in patients with an obstruction of the lacrimal sac or the nasolacrimal duct has been replaced more and more by endonasal techniques. The endonasal approach, first performed in 1893 by Caldwell and publiciced by West 1911, has been modified since than, reached increasing acceptance and is nowadays often performed be ENT surgeons and ophthalmologists. MATERIAL AND METHODS: This review article presents the possible reasons of an obstruction of the lacrimal sac or the nasolacrimal duct with consecutive epiphora or recurrent dacryocystitis, describes diagnostic procedures and indications of therapy, and tries to demonstrate the surgical change towards endoscopic endonasal techniques. We compare both operation techniques and discuss their advantages with the focus on the endonasal approach. The relevance of additional adjuvants described in literatur (laser, use of mitomycin or fluoruracil or silicon intubation) are presented and discussed, too. RESULTS: At the end we discuss the published results of both techniques (endonasal vs. external DCR) and compare their success rates. In spite of the tendency towards endonasal endoscopic techniques the results of this approach seem to be a little worse in comparison to the results after external DCR.