[Neuroendocrine tumors in head and neck]. / Neuroendokrine Tumoren im Kopf-, Halsbereich.

INTRODUCTION: NETs are benign or malign tumors, which originate from cells of the endocrine (hormonal) and nervous systems. 0,5-2 % of the neoplasms are neuroendocrine tumors, which are mostly located in the gastrointestinal or bronchopulmonal tract. Die incidence is about 9000/100000. 1% of the head and neck tumors are NET. This study evaluates NETs with different locations, its therapy and outcome. METHODS: 14 patients with a neuroendocrine tumor of the head and neck between 2010 and 2017 were evaluated. 8 patients underwent an operation and adjuvant radiochemotherapy (RCT). Five patients had a prim. RCT with curative intention. One patient had a palliative chemotherapy because of the progress after the radiochemotherapy. RESULTS: The locations of the tumors are the larynx (n=7), parotid gland (n=2) and the paranasal sinuses (n=5). A resection in sano (R0) could be reached in 6 of 8 cases. The average survival rate was 19±6 months. 2 tumor recurrences occurred out of 14 patients. 1 patient died after 7 months und 1 patient is without recurrence after 32 months. 2 patients had no benefit of the combined radiochemotherapy and died after 6 and 13 months. Die overall survival depends on the stage and the R0 resection of the tumors. The R0 resection is better in comparison to the prim. according to the overall survival time. CONCLUSION: Patients with NET of the head and neck have to be treated in specialized cancer centers. Each patient should receive an individual therapy depending on localization and histopathological findings.

Outcomes of frontolateral vertical partial laryngectomy in T1b glottic carcinomas.

BACKGROUND: The treatment of T1b glottic carcinomas with invasion of the anterior commissure (AC) is still a challenge in larynx oncology. The diversity in treatment protocols is due to the difficulty in achieving safety margins of resection, especially in the AC. OBJECTIVE: The treatment success rate of frontolateral vertical partial laryngectomy (FVPL) for the treatment of stage T1b squamous cell carcinoma of the glottic larynx infiltrating the AC. MATERIAL AND METHODS: Clinical data of patients, who were diagnosed with stage T1b squamous cell carcinoma of the glottic larynx and who underwent a FVPL from 01/2003 to 12/2016 in our ENT clinic were retrospectively evaluated. Clinical and oncological outcomes were analyzed. RESULTS: 39 patients were included in this study. The mean follow-up duration was 79.95 ± 20.59 months. Intraoperative R0 resection was achieved in all patients. In 33.3% patients, documented complications were tissue granulation and synechia formation in the glottic area. The 5-year recurrence-free survival was 82.1%, the 5-year overall survival rate 97.4%, and the 5-year laryngeal preservation rate 94.8%. CONCLUSION: Our clinical data demonstrate that T1b glottic carcinomas with invasion of the AC can be effectively treated with FVPL. The outcome is similar to other methods such as transoral laser microsurgery, supracricoidal partial laryngectomy, and radiotherapy.

Vestibular Disorders.

BACKGROUND: Recent research findings have improved the understanding of the diagnosis, pathophysiology, genetics, etiology, and treatment of peripheral, central, and functional vestibular vertigo syndromes. METHOD: A literature search, with special attention to the current classification, treatment trials, Cochrane analyses, and other meta-analyses. RESULTS: There are internationally accepted diagnostic criteria for benign positional paroxysmal vertigo, Menière's disease, bilateral vestibulopathy, vestibular paroxysmia, and functional dizziness. Whether an acute vestibular syndrome is central or peripheral can usually be determined rapidly on the basis of the history and the clinical examination. "Cere - bellar vertigo" is a clinically important entity. For bilateral vestibulopathy, balance training is an effective treatment. For Menière's disease, preventive treatment with betahistine (48 mg and 144 mg per day) is not superior to placebo. For vestibular paroxysmia, oxcarbazepine has been shown to be effective. Treatments that are probably effective for functional dizziness include vestibular rehabilitation, cognitive behavioral therapy, and serotonin reuptake inhibitors. CONCLUSION: The diagnostic assessment of vestibular syndromes is much easier for clinicians now that it has been internationally standardized. There is still a lack of randomized, controlled trials on the treatment of, for example, Menière's disease, vestibular migraine, and "cerebellar vertigo."

[Enlarged vestibular aqueduct syndrome-dehiscence syndromes-honeycomb mastoid : Pathophysiology and evidence for clinical differentiation]. / Der erweiterte vestibuläre Aquädukt ­ Dehiszenzsyndrome ­ "Honeycomb Mastoid" : Pathophysiologie und Evidenzlage für die klinische Differenzierung.

BACKGROUND: Differential diagnosis of dizziness with hearing loss requires standardized procedures for detection and classification of rare congenital and acquired malformations of the petrous part of the temporal bone. OBJECTIVE: The aim of this study was to present the physiology and pathophysiology of endolymphatic and perilymphatic pressure regulation, diagnostic guidelines, and aspects of prognosis and treatment. MATERIALS AND METHODS: Relevant publications and guidelines were evaluated and own cases are reported. RESULTS: Enlarged vestibular aqueduct (EVA) is the most frequently observed malformation of the inner ear, which leads to increased internal hydrostatic pressure and cochleovestibular dysfunction. Non-syndromic and syndromic forms, e.g., Pendred syndrome, are known. Other pressure-relevant malformations are semicircular canal dehiscence syndrome (SCDS) and enlargement of the cochlear aqueduct. There are currently no treatment options for EVAS and enlarged cochlear aqueduct. Pendred syndrome generally requires treatment with cochlea implants (CI) in early childhood. Dizziness and autophony in patients with SCDS syndrome can be effectively treated by semicircular canal occlusion and coverage. CONCLUSION: Complaints in non-syndromic EVA and SCD syndrome are mainly caused by exposure of the inner ear to provoked and spontaneous pressure increases. Deafness and vestibular dysfunction in syndromic EVA (i.e., Pendred syndrome, branchiootorenal syndrome) are caused by malformation of the cochlea, genetic maldevelopment of the hair cells, and pressure effects.

[Dizziness, vertigo and unsteadiness with emphasis on problems in elderly patients]. / HNO-ärztliche Therapie des Schwindels bei älteren Patienten.

Gait disturbance and risk for falls of the elderly are a major problem for neurotologic diagnosis and treatment. Diagnostic differentiation especially in the case of acute vestibular syndrome and in cases of chronic or recurrent paroxysmal vestibular deficits is mandatory for treatment indications. Criteria for medical, surgical conservative and surgical destructive therapy as well as for vestibular rehabilitation are outlined.

Combination of vascularization and cilia formation for three-dimensional airway tissue engineering.

Tissue engineering is a promising approach to treat massive airway dysfunctions such as tracheomalacia or tumors. Currently, there is no adequate solution for patients requiring the resection of more than half of the length of their trachea. In this study, the best conditions for combination of three different cell types from the respiratory airway system were investigated to develop a functional ciliated and pre-vascularized mucosal substitute in vitro. Primary human fibroblasts were combined with respiratory epithelial cells and endothelial cells. As scaffolds, fibrin gel and agarose-type I collagen blends were used and cultured with different medium compositions to optimize both vascularization and differentiation of the respiratory epithelium. A mixture of endothelial growth medium and epithelial differentiation medium was shown to optimize both vascularization and epithelial growth and differentiation. After 28 days of co-culture, significantly increased formation of capillary-like structures was observed in fibrin gels with more than three times higher structure volumes compared to agarose-collagen gels. After 35 days, epithelial differentiation into a pseudostratified epithelium with typical marker expression was improved on fibrin gels. While cilia formation was shown on both scaffolds, a higher number of ciliated cells and longer cilia were observed on fibrin gels. The data elucidate the important interplay of co-culture parameters and their impact on vascularization as well as epithelium development and provide a basis for development of functional three-dimensional airway constructs.

The Neurophysiology and Treatment of Motion Sickness.

BACKGROUND: Seasickness and travel sickness are classic types of motion illness. Modern simulation systems and virtual reality representations can also induce comparable symptoms. Such manifestations can be alleviated or prevented by various measures. METHODS: This review is based on pertinent publications retrieved by a PubMed search, with special attention to clinical trials and review articles. RESULTS: Individuals vary in their susceptibility to autonomic symptoms, ranging from fatigue to massive vomiting, induced by passive movement at relatively low frequencies (0.2 to 0.4 Hz) in situations without any visual reference to the horizontal plane. Younger persons and women are considered more susceptible, and twin studies have revealed a genetic component as well. The various types of motion sickness are adequately explained by the intersensory conflict model, incorporating the vestibular, visual, and proprioceptive systems and extended to include consideration of postural instability and asymmetry of the otolith organs. Scopolamine and H1-antihistamines, such as dimenhydrinate and cinnarizine, can be used as pharmacotherapy. The symptoms can also be alleviated by habituation through long exposure or by the diminution of vestibular stimuli. CONCLUSION: The various types of motion sickness can be treated with general measures to lessen the intersensory conflict, behavioral changes, and drugs.

Evaluation of gender-specific aspects in quality-of-life in patients with larynx carcinoma.

CONCLUSIONS: The results suggest that gender-specific differences in health-related quality-of-life (HRQoL) exist in patients with larynx carcinoma. In previous studies these differences might have been concealed by predominantly male subject groups. Future studies should consider a gender-specific analysis that suits the patient's idiosyncrasies associated with laryngeal cancer. OBJECTIVES: There is little research concerning gender differences in quality-of-life (QoL) in patients with larynx carcinoma. Since laryngeal cancer is predominantly found in males, most studies examining HRQoL are based on a mainly male subject group. HRQoL needs to be assessed to determine the impact of disease and treatment and to evaluate possible treatment regimes. This study examined gender differences concerning HRQoL in 53 patients using EORTC QLQ-C30, and QLQ-H&N35 questionnaires. METHODS: Patients treated with larynx carcinoma were given two questionnaires to assess HRQoL. The questionnaires were analyzed for each sex separately, as well as for the entire population. RESULTS: Female patients report significantly worse HRQoL than males. Age could not be identified as a significant predictor for HRQoL when males and females were analyzed together, and does not significantly predict HRQoL in men. However, age was found to be a significant predictor for HRQoL when only females were analyzed.

The relationship between jugular bulb position and jugular bulb related inner ear dehiscence: a retrospective analysis.

OBJECTIVE: High jugular bulb (HJB) can erode inner ear structures creating a jugular bulb related inner ear dehiscence (JBID). The aim of this study was to analyze the relationship between the position of jugular bulb (JB) and JBID using high-resolution computed tomography (HRCT). MATERIAL AND METHODS: In this retrospective study HRCT images of 552 ears of 276 patients with hearing loss, otogenic vertigo, tinnitus or idiopathic peripheral facial nerve paralysis were analyzed. HJB type-1 was defined when JB dome reached above the inferior part of the round window, but was below the inferior edge of the internal acoustic meatus (IAM). HJB type-2 was defined when the dome of JB was higher than the inferior edge of IAM. The frequencies and types of HJB were evaluated. JBID for each HJB type was determined. Frequencies of JBID eroding the vestibular aqueduct (VA), the cochlear aqueduct and the posterior semicircular canal were examined. RESULTS: HJB type-1 and HJB type-2 were found in 19% (105/552) and in 15.8% (87/552) of studied ears. JBID showed to be in 3.8% (21/552) of all ears. 90.5% (19/21) of JBID revealed eroding of VA. Jugular bulb related cochlear aqueduct dehiscence and jugular bulb related posterior semicircular canal dehiscence were found in one ear each. The frequency of jugular bulb related vestibular aqueduct dehiscence (JBVAD) in patients with HJB reaching above IAM was higher than in patients with HJB lower than IAM. CONCLUSIONS: HJB is common, but JBID is rare. JBID prevalently erodes VA. HJB rising above IAM is most at risk to show JBVAD.

Promontory electrical stimulation to elicit vestibular evoked myogenic potentials (VEMPs).

CONCLUSION: Vestibular evoked myogenic potentials (VEMPs) provoked electrically at the promontory provide a feasible method to record vestibular responses in awake patients. OBJECTIVES: Electrically evoked VEMP testing has been performed by galvanic stimulation at the mastoid so far. The present study examined an electrical stimulation mode close to the otolith organs at the promontory. METHODS: Fourteen cochlear implant candidates who were planned for clinical routine promontory stimulation testing (PST) to assess auditory nerve function underwent promontory VEMP testing. After testing the cochlear nerve function during PST promontory cervical VEMPs (p-c-VEMPs) and promontory ocular VEMPs (p-o-VEMPs) were recorded during subsequent transtympanic electrical stimulation at the promontory. RESULTS: Promontory VEMP testing was well tolerated by the patients. Mean latencies for p-c-VEMPs were 10.30 ± 2.23 ms (p1) and 17.86 ± 3.83 ms (n1). Mean latencies for p-o-VEMPs were 7.64 ± 1.24 ms (n1) and 11.2 ± 1.81 ms (p1). The stimulation threshold level was measured at 0.15 ± 0.07 mA for p-c-VEMPs and at 0.19 ± 0.11 mA for p-o-VEMPs. The discomfort level was found to be at 0.78 ± 0.29 mA for p-c-VEMPs and at 0.69 ± 0.25 mA for p-oVEMPs. Mean p1-n1 amplitude in p-c-VEMPs was 124.78 ± 56.55 µV and p-o-VEMPs showed a mean n1-p1 amplitude of 30.94 ± 18.98 µV.

Jugular bulb abnormalities in patients with Meniere's disease using high-resolution computed tomography.

Temporal bone abnormalities such as hypoplasia of the vestibular aqueduct or hypopneumatization of the mastoid have been described in Meniere's disease (MD). Jugular bulb abnormalities (JBA) are one of the most common temporal bone abnormalities. The aim of this study was to evaluate the frequency of JBA in MD. Radiological data obtained by temporal bone high-resolution computed tomography of 200 ears of 167 MD patients (MD group) and 218 ears of 109 patients with normal inner ear function (control group) were analyzed retrospectively. The frequencies of high jugular bulb (HJB), jugular bulb diverticulum (JBD), inner ear adjacent jugular bulb (IAJB) and jugular bulb related inner ear dehiscence (JBID) were evaluated and compared between MD group and control group. IAJB was differentiated into vestibular aqueduct adjacent jugular bulb (VAAJB), cochlear aqueduct adjacent jugular bulb and posterior semicircular canal adjacent jugular bulb. JBID was further analyzed by differentiating into jugular bulb related vestibular aqueduct dehiscence (JBVAD), jugular bulb related cochlear aqueduct dehiscence and jugular bulb related posterior semicircular canal dehiscence. The frequencies of HJB, JBD and IAJB were higher in MD group compared to control group (21, 13.3 %, p = 0.036; 8.5, 3.7 %, p = 0.037; 13.5, 4.6 %, p = 0.001). No differences between both groups were seen in JBID (4.0, 2.3 %, p = 0.315). Most IAJB and JBID were seen in VAAJB and JBVAD. There is a higher frequency of JBA in patients with MD than in patients without inner ear symptoms. Temporal bones of MD patients might be constituted anatomically different, carrying predisposing factors for the development of clinically apparent MD.

Radiological findings of the cochlear aqueduct in patients with Meniere's disease using high-resolution CT and high-resolution MRI.

The objective of the present study was to evaluate the cochlear aqueduct (CA) in Meniere's disease (MD) and to disclose radiological differences of CA between MD and non-MD patients by means of high-resolution computed tomography (HRCT) and high-resolution magnetic resonance imaging (HRMRI). Radiological data of 86 ears of MD patients which were separated into 52 ears of diseased side group (MD-D group) and 34 ears of contralateral non-affected side group of unilateral MD (MD-ND group), 27 ears of patients with sensorineural hearing loss (SNHL group) and 56 ears of patients with somatoform dizziness and normal hearing (control group) were analyzed retrospectively. The bony type of CA, the bony length of CA, and the bony width of CA medial orifice was measured in HRCT. The visibility of CA in HRMRI was scored. Fluid length in CA and fluid width in medial orifice were measured in HRMRI. Data were compared between MD-D, MD-ND, SNHL, and control group. There were no significant differences in the bony type of CA, bony length of CA, bony width of CA medial orifice, and fluid width of CA medial orifice between MD-D, MD-ND, SNHL and control group (p > 0.05). However, CA fluid length of MD-D (5.13 ± 1.88 mm) and of MD-ND group (5.44 ± 1.81 mm) was significantly shorter than fluid length of SNHL (6.90 ± 1.55 mm) (p < 0.001, p = 0.001) and of control group (7.43 ± 1.24 mm) (p < 0.001, p < 0.001). The ratio between CA fluid length and CA bony length was the smallest in MD-D group (0.403; p = 0.009). CA bony dimensions of affected ears of MD are normal, but CA fluid length is decreased.

Eustachian tube function in patients with inner ear disorders.

The influence of Eustachian tube (ET) dysfunction on the inner ear fluid pressure and thus on the inner ear function in Meniere's disease has been discussed controversially. So far, most of the studies examining ET function in inner ear disorders indirectly analyzed ET function by tympanometric methods. The present study directly studied ET function in inner ear disorders by sonotubometry. Healthy subjects and patients with Meniere's disease, sudden sensorineural hearing loss, cholesteatoma and chronic suppurative otitis media were examined by sonotubometry. Mean increase of sound pressure intensity (dB) and mean duration of sound pressure increase (s) were analyzed. Highest mean increase of sound pressure intensity was seen in healthy subjects when using >5 dB peaks (11.6 ± 0.7 dB) and >0 dB peaks (9.6 ± 0.6 dB). Comparative analysis including bilateral ears showed decreased ET function in patients with cholesteatoma (p = 0.002) and in patients with Meniere's disease (p = 0.003) when using >0 dB peaks. Examination of each specific ET opening maneuver showed impaired ET function in pathological ears of patients with cholesteatoma and with Meniere's disease, during yawning (p = 0.001; p < 0.001), dry swallowing (p = 0.010; p = 0.049), Toynbee maneuver (p = 0.033; p = 0.032) and drinking (p = 0.044; p = 0.027). Mild ET dysfunction is detected in patients with Meniere's disease by direct sonotubometric assessment of ET function.

Vestibular rehabilitation using the Nintendo® Wii Balance Board -- a user-friendly alternative for central nervous compensation.

CONCLUSION: The Nintendo® Wii Balance Board is a cost-effective and user-friendly alternative to other popular frequently used systems that aid vestibular compensation, particularly in elderly patients. In addition, further treatment in the home environment is possible. OBJECTIVE: This cohort study was designed to investigate the impact of the Nintendo® Wii Balance Board as a visual compensation device after acute vestibular neuritis. METHODS: Subjects were randomly assigned to one of two treatment groups. Group A (n = 37) performed customized exercises with the Nintendo® Wii Balance Board. Group B (n = 34) performed only two elected exercises as a control group for comparison of the results. Both groups underwent additive therapy with steroids (intravenous) in decreasing doses (250 mg decreasing to 25 mg over 10 days). The Sensory Organization Test (SOT), Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale (VSS), and Tinneti questionnaire were evaluated immediately before treatment (baseline), at the end of treatment, i.e. at day 5, and after 10 weeks. RESULTS: The early use of a visual feedback system in the context of the balance training supports the central nervous vestibular compensation after peripheral labyrinthine disorders. Patients in group B (without training) required a longer in-patient stay (average 2.4 days, SD 0.4) compared with patients following early Wii rehabilitation. The absence of nystagmus under Frenzel's goggles in group A was observed 2.1 days (SD 0.5) earlier than in group B. Group A showed significantly better results in the SOT, DHI, VSS, and Tinneti questionnaire at all time points measured (p < 0.05).

Hydrostatic fluid pressure in the vestibular organ of the guinea pig.

Since inner ear hair cells are mechano-electric transducers the control of hydrostatic pressure in the inner ear is crucial. Most studies analyzing dynamics and regulation of inner ear hydrostatic pressure performed pressure measurements in the cochlea. The present study is the first one reporting about absolute hydrostatic pressure values in the labyrinth. Hydrostatic pressure of the endolymphatic system was recorded in all three semicircular canals. Mean pressure values were 4.06 cmH(2)O ± 0.61 in the posterior, 3.36 cmH(2)O ± 0.94 in the anterior and 3.85 cmH(2)O ± 1.38 in the lateral semicircular canal. Overall hydrostatic pressure in the vestibular organ was 3.76 cmH(2)O ± 0.36. Endolymphatic hydrostatic pressure in all three semicircular canals is the same (p = 0.310). With regard to known endolymphatic pressure values in the cochlea from past studies vestibular pressure values are comparable to cochlear values. Until now it is not known whether the reuniens duct and the Bast's valve which are the narrowest passages in the endolymphatic system are open or closed. Present data show that most likely the endolymphatic system is a functionally open entity.

Emotional and analytic music perception in cochlear implant users after optimizing the speech processor.

CONCLUSION: Cochlear implant (CI) users are able to detect harmonic differences and the emotionally exciting effect of music (arousal) even when using a speech adapted program. Raising the power of lower frequencies of speech processors in CIs for a music program further improved this ability and enhanced subjectively perceived pleasure during listening to music. OBJECTIVE: This pilot study compares aspects of analytical and emotional music perception before and after optimizing the speech processor compared to results of normal-hearing subjects. METHODS: Six adult post-lingually deafened CI users and six subjects with normal hearing abilities were tested on different aspects of analytical and emotional music perception. After optimizing speech processors for a music program, the CI users were tested again after a period of 1 week. RESULTS: The CI users were able to detect different levels of emotional arousal conveyed by music. Switching to the music program resulted in an even better distinction between different levels of musical arousal. With both the speech and music programs, CI users gave overall higher ratings for arousal and valence of the heard music when asked to estimate how listeners with normal hearing perceived the music than when asked about their own perception.

Role of neck ultrasound during follow-up care of head and neck squamous cell carcinomas.

CONCLUSION: No impact of neck ultrasound on the detection rate of neck recurrences of head and neck squamous cell carcinomas (HNSCCs) was seen. The outcome of salvage therapy was not influenced by close neck ultrasound monitoring during follow-up. Tendencies of earlier detection of neck recurrences were noticed. OBJECTIVES: Neck ultrasound is more feasible for frequent application than computed tomography, while having comparable sensitivity and specificity in detecting neck metastasis. Before this study the effect of neck ultrasound on salvage therapy of neck recurrences when used in short defined intervals during follow-up was unknown. METHODS: A total of 140 patients with primarily surgically treated HNSCC were enrolled in a follow-up program with defined close time intervals. Neck ultrasound was applied during every follow-up visit. Recurrence rate, survival rate, and outcome of salvage therapy were determined. RESULTS: Overall recurrences occurred in 35.0% of patients. Local, regional, and distant recurrences were found in 11.4%, 7.9%, and 15.7%. Hypopharyngeal carcinoma and advanced staged tumor showed highest recurrence rates. In all, 24.5% of all recurrences were treated successfully by salvage therapy. Resection of local, regional, and distant recurrences resulted in 3-year survival rates of 43.8%, 36.4%, and 4.5%. The outcome of secondary therapy worsened with advancing initial primary tumor stage.

Long-term middle ear pressure measurements in inner ear disorders.

CONCLUSION: Repetitive portable tympanometry is a feasible method to examine long-term middle ear pressure profile. This method might be suitable for detecting patients with Meniere's disease whose middle ear pressure shows intermittently pathological values. OBJECTIVES: Contradictory study results regarding middle ear pressure in patients with Meniere's disease might be due to solitary tympanometric measurements. Pathological pressure conditions in patients with pressure regulation disorders might be missed by a single examination. The aim of the study was to examine the pressure profile of patients with Meniere's disease by long-term measurements. METHODS: Patients with Meniere's disease (n = 33), patients with sudden hearing loss (n = 20), and healthy subjects (n = 30) were examined. Patients carried out long-term middle ear pressure measurements with the portable tympanometer Otoflex 100. Examinations were carried out during daily activities at defined time intervals. RESULTS: Significant negative middle ear pressure were seen in patients with Meniere's disease compared with patients with sudden hearing loss and healthy subjects (p < 0.01). Average middle ear pressure in patients with Meniere's disease was -43 daPa, in patients with sudden hearing loss it was 2 daPa, and in healthy subjects it was 4 daPa. Patients with Meniere's disease showed a large variability of pressure values ranging from strongly pathological to normal values during long-term measurements.