Two-Year Outcomes After Radiofrequency Neurolysis of Posterior Nasal Nerve in Chronic Rhinitis.

OBJECTIVE: To assess the long-term safety and effectiveness of temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN), a minimally invasive treatment for chronic rhinitis. METHODS: A prospective, single-arm study of 129 patients at 16 centers (United States, Germany) was conducted. Patient-reported outcome measures were the 24-h reflective total nasal symptom score (rTNSS) and mini rhinoconjunctivitis quality of life questionnaire (MiniRQLQ). Postnasal drip and cough symptoms were assessed using a 4-point scale. RESULTS: The mean pretreatment rTNSS was 7.8 (95% CI, 7.5-8.1). The significant rTNSS treatment effect at 3 months (-4.2 [95% CI, -4.6 to -3.8]; p < 0.001) was sustained through 2 years (-4.5 [95% CI, -5.0 to -3.9]; p < 0.001), a 57.7% improvement. At 2 years, the proportion of patients with a minimal clinically important difference (MCID) of ≥30% improvement in rTNSS from baseline was 80.0% (95% CI, 71.4%-86.5%). Individual postnasal drip and cough symptom scores were significantly improved from baseline through 2 years. The proportion of patients who reached the MCID for the MiniRQLQ (≥0.4-point improvement) at 2 years was 77.4% (95% CI, 68.5%-84.3%). Of 81 patients using chronic rhinitis medications at baseline, 61.7% either stopped all medication use (28.4%) or stopped or decreased (33.3%) use of ≥1 medication class at 2 years. No device/procedure-related serious adverse events were reported throughout 2 years. CONCLUSION: TCRF neurolysis of the PNN resulted in sustained improvements in chronic rhinitis symptom burden and quality of life through 2 years, accompanied by a substantial decrease in medication burden. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:2077-2084, 2024.

[Persistent olfactory impairment after COVID-19-recommendations of the Working Group on Olfactology and Gustology of the German Society of Oto-rhino-laryngology, Head and Neck Surgery]. / Persistierende Riechminderung nach COVID-19 ­ Empfehlungen der Arbeitsgemeinschaft Olfaktologie und Gustologie der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

This article does not intend to comprehensively review the existing literature on coronavirus disease 2019 (COVID-19)-associated smell disorders, but aims to summarize scientific evidence for otorhinolaryngological practice and provide recommendations for diagnosis and treatment of persistent smell disorders following COVID-19.

[Assessment of olfactory and gustatory function with validated tests]. / Beurteilung der chemosensorischen Funktion mit validierten Riech- und Schmecktests.

Approximately 5 % of the general population is affected by functional anosmia. An additional 15 % exhibit decreased olfactory function. Many of these individuals ask ENT-doctors or neurologists for help. A cornerstone of the counselling process is the assessment of olfactory function. The aim of this work is to give a differentiated overview about the administration of commonly used psychophysical tests for olfactory and gustatory function including their normative data. The use of standardized, reliable and validated tools is mandatory to provide patients with state-of the-art counseling on treatment options.

Reduced Mass and Diversity of the Colonic Microbiome in Patients with Multiple Sclerosis and Their Improvement with Ketogenic Diet.

Background: Colonic microbiome is thought to be involved in auto-immune multiple sclerosis (MS). Interactions between diet and the colonic microbiome in MS are unknown. Methods: We compared the composition of the colonic microbiota quantitatively in 25 MS patients and 14 healthy controls.Fluorescence in situ hybridization (FISH) with 162 ribosomal RNA derived bacterial FISH probes was used. Ten of the MS patients received a ketogenic diet for 6 months. Changes in concentrations of 35 numerically substantial bacterial groups were monitored at baseline and at 2, 12, and 23/24 weeks. Results: No MS typical microbiome pattern was apparent.The total concentrations and diversity of substantial bacterial groups were reduced in MS patients (P < 0.001). Bacterial groups detected with EREC (mainly Roseburia), Bac303 (Bacteroides), and Fprau (Faecalibacterium prausnitzii) probes were diminished the most. The individual changes were multidirectional and inconsistent. The effects of a ketogenic diet were biphasic. In the short term, bacterial concentrations and diversity were further reduced. They started to recover at week 12 and exceeded significantly the baseline values after 23-24 weeks on the ketogenic diet. Conclusions: Colonic biofermentative function is markedly impaired in MS patients.The ketogenic diet normalized concentrations of the colonic microbiome after 6 months.

Olfactory dysfunction in patients with primary progressive MS.

OBJECTIVE: We tested the hypothesis that olfactory function is more impaired in patients with primary progressive MS (PPMS) than that in relapsing-remitting MS (RRMS). METHODS: Standardized olfactory testing was performed in 32 patients with PPMS, 32 patients with RRMS, and 32 healthy controls (HCs). Patients with olfactory dysfunction due to an alternative primary etiology were excluded. The validated olfactory testing method yielded individual scores for olfactory threshold, odor discrimination, and odor identification, along with a composite Threshold Discrimination Identification (TDI) score. RESULTS: Olfactory dysfunction was identified in 27 (84%) patients with PPMS, 10 (31%) patients with RRMS, and 1 (3%) HC. While age and sex were similar between PPMS and HCs, the TDI score and all olfactory subscores were significantly worse in patients with PPMS compared with HCs (all p < 0.001). After adjustment for differences in age, sex, Expanded Disability Status Scale (EDSS), and disease duration, odor discrimination, odor identification, and the composite TDI score were worse in patients with PPMS vs RRMS (p = 0.03, 0.04, and 0.02, respectively). Neither age, sex, EDSS, nor disease duration was significantly associated with the composite TDI score. CONCLUSIONS: Olfactory dysfunction was more frequent and severe in PPMS compared with RRMS, independent of disease duration and overall disability status. Further research on cellular level differences in olfactory neural pathways may lead to new insights about disease pathogenesis in MS.

Impact of humic acids on the colonic microbiome in healthy volunteers.

AIM: To test the effects of humic acids on innate microbial communities of the colon. METHODS: We followed the effects of oral supplementation with humic acids (Activomin®) on concentrations and composition of colonic microbiome in 14 healthy volunteers for 45 d. 3 × 800 mg Activomin® were taken orally for 10 d followed by 3 × 400 mg for 35 d. Colonic microbiota were investigated using multicolor fluorescence in situ hybridization (FISH) of Carnoy fixated and paraffin embedded stool cylinders. Two stool samples were collected a week prior to therapy and one stool sample on days 10, 31 and 45. Forty-one FISH probes representing different bacterial groups were used. RESULTS: The sum concentration of colonic microbiota increased from 20% at day 10 to 30% by day 31 and remained stable until day 45 (32%) of humic acid supplementation (P < 0.001). The increase in the concentrations in each person was due to growth of preexisting groups. The individual microbial profile of the patients remained unchanged. Similarly, the bacterial diversity remained stable. Concentrations of 24 of the 35 substantial groups increased from 20% to 96%. Two bacterial groups detected with Bac303 (Bacteroides) and Myc657 (mycolic acid-containing Actinomycetes) FISH probes decreased (P > 0.05). The others remained unaffected. Bacterial groups with initially marginal concentrations (< 0.1 × 109/mL) demonstrated no response to humic acids. The concentrations of pioneer groups of Bifidobacteriaceae, Enterobacteriaceae and Clostridium difficile increased but the observed differences were statistically not significant. CONCLUSION: Humic acids have a profound effect on healthy colonic microbiome and may be potentially interesting substances for the development of drugs that control the innate colonic microbiome.

Longitudinal Testing of Olfactory and Gustatory Function in Patients with Multiple Sclerosis.

BACKGROUND: The aim of the study was to investigate changes of the olfactory and gustatory capacity in patients with multiple sclerosis (MS). METHODOLOGY: 20 MS patients were tested longitudinally for 3 years after initial testing. The Threshold Discrimination Identification test (TDI) was used for subjective olfactometry. Objective olfactometry was performed by registering olfactory evoked potentials (OEP) by EEG. The Taste Strip Test (TST) was used for gustatory testing. RESULTS: 45% of the patients showed olfactory dysfunction in the follow-up TDI test and 50% showed delayed OEP´s. 20% of the patients showed gustatory dysfunction on follow-up visit. The patients showed mild disease activity with 0,3 ± 0,5 relapses over the testing period and no significant change of their olfactory and gustatory capacity. The olfactory capacity for the discrimination of odors correlated inversely with the number of relapses (r = -0.5, p ≤ 0.05). The patients were aware of their olfactory deficit. CONCLUSIONS: Olfactory and gustatory dysfunction is a symptom in MS patients and may be a useful parameter to estimate disease progression in MS patients. As the discrimination of odors is processed in higher central regions of the central nervous system (CNS), the results suggest that olfactory dysfunction could be due to CNS damage.

Long-term results in obstructive sleep apnea syndrome (OSAS) after laser-assisted uvulopalatoplasty (LAUP).

Obstructive sleep apnea syndrome (OSAS) is a serious disease. The etiology of and optimum therapy options for this disorder have been much discussed and have been the subject of many publications. One much discussed therapy option is laser-assisted uvulopalatoplasty (LAUP). Despite conflicting opinions and guidelines which recommend that it should not be used, it remains in use. Patients who had previously undergone this procedure were invited for follow-up appointments, at which they were asked to complete a questionnaire, underwent an ENT examination and underwent sleep laboratory analysis using a portable sleep lab device. The average time since LAUP treatment was 11 years. The cohort comprised 25 patients. The average preoperative apnea-hypopnea-index (AHI) score was 25.25/h; the average postoperative AHI score 23.62/h. Closer examination of our data enabled us to identify 10 responders (40%) and 15 non-responders (60%). 12% (3/25) of non-responders experienced either no reduction in their AHI score or an increase compared to their preoperative AHI score of less than 5/h. In the remaining 48% (12/25), AHI increased by more than 5/h compared to the preoperative figure. Our questionnaire showed that 40% (10/25) of patients suffered from dry mouth and 20% (5/25) from foreign body sensation. The data led us to conclude that laser-assisted uvulopalatoplasty can indeed result in a reduction in AHI score comparable to other mucosal resection methods. Also in common with these methods, the efficacy of the therapy reduces with time and the procedure carries a high risk of bringing about an increase in the patient's AHI score.

Effect of laser treatment on olfactory dysfunction.

Olfactory disorders are not rare and affect quality of life in patients. The purpose of our study was to evaluate the outcomes of an outpatient-based diode laser inferior turbinate reduction (ITR) in otherwise therapy-refractory olfactory disorder. In a prospective clinical investigation, 20 patients (7 male, 13 female, mean age 53.2 ± 15.34) with olfactory disorder and 10 patients (8 male, 2 female, mean age 52.5 ± 17.55) without olfactory disorder underwent ITR under videoendoscopic control with a continuous diode laser in "contact" mode after topical anesthetic preparation. Treatment efficiency was assessed before and 2 months after surgery. Subjective nasal airflow (NA) and the olfactory function were rated by means of visual analogue scales (VAS). Olfactory function was assessed using the "Sniffin' Sticks" test battery. VAS showed very low median values for intraoperative pain (0) [0-1.20] and high postoperative patient satisfaction (8) [5-9]. After 2 months there was no significant improvement of objective olfactory function as measured by the TDI score (threshold, discrimination and identification). The VAS displayed a slight significant improvement in the group of patients with olfactory disorder from 2.95 to 3.65 (P = 0.04). After 2 months, NA data revealed a statistically significant improvement of subjective VAS from 5.05 to 6.25 (P < 0.0005) and of objective NA from 353.77 to 443.50 (P = 0.007) as measured by rhinomanometry in both groups. Outpatient diode laser ITR represents an effective option providing recovery by NA improvement but not a significant improvement of the olfactory function.

Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study.

OBJECTIVES/HYPOTHESIS: The aim of this study was to evaluate the effects of olfactory training (OT) on olfactory function in patients with persistent postinfectious olfactory dysfunction (PIOD). STUDY DESIGN: Randomized, single-blind, controlled, multicenter crossover study. METHODS: Twelve tertiary university medical centers participated. Investigations were performed at three visits (baseline, after 18 weeks, and after 36 weeks), including only subjects with PIOD of <24-months duration. At each visit, participants received detailed assessment of olfactory function. Seventy subjects trained with high concentrations of four odors for 18 weeks; the other half (n = 74) trained with low concentrations of odors. For the following 18 weeks this regimen was switched. RESULTS: After 18 weeks, olfactory function improved in the high-training group in 18 of 70 participants (26%), whereas only 11/74 improved in the low-training group (15%). In subjects with a duration of olfactory dysfunction of <12 months, olfactory function improved in 15/24 participants (63%) of the high-training group and in 6/31 participants (19%) of the low-training group (P = .03). CONCLUSIONS: OT improves PIOD, and the use of odors at higher concentrations is beneficial to improvement. OT is a safe procedure and appears to be particularly useful in patients who start OT within 12 months after the onset of the disorder. OT is the first successful therapy regime in patients with PIOD. LEVEL OF EVIDENCE: 1b.

Olfactory dysfunction in patients with neuromyelitis optica.

Background. Neuromyelitis optica (NMO) is a severely disabling autoimmune disorder of the CNS, which mainly affects the optic nerves and spinal cord. However, recent studies have shown that extra-opticospinal are more common in NMO than previously thought. Objective. To investigate olfactory function (OF) in patients with neuromyelitis optica (NMO) versus healthy controls (HC). Methods. Psychophysical testing of the orthonasal OF was performed using the Threshold-Discrimination-Identification test (TDI), measuring different qualities of olfaction, in 10 unselected NMO patients and 10 HC. Results. Five of 10 NMO patients (50%) showed hyposmia, while all 10 HC were normosmic. Moreover, NMO patients had significantly lower mean TDI-scores compared to HC, based on a poorer performance in both the Discrimination and the Identification subtests. Conclusions. Our results suggest that hyposmia might be part of the expanding clinical spectrum of NMO.

Active olfactory training for the treatment of smelling disorders.

Olfactory function appears to be influenced by repeated odor stimulation. We conducted a nonrandomized, nonblinded, retrospective study of the impact of an 8-month period of olfactory training in patients with olfactory dysfunction. Our study population was made up of 46 adults-14 men and 32 women (mean age: 59.17 ± 13.25 yr)-with olfactory dysfunction of different etiologies (sinonasal: n = 15; post-upper-respiratory-tract infection [URTI]: n = 16; post-traumatic: n = 7; and idiopathic: n = 8). All patients had been previously treated without success with systemic or topical corticosteroids. For their training, patients exposed themselves to four different odors twice a day. Olfactory function was evaluated at baseline and again at 4 and 8 months, and results were quantified in the form of each patient's TDI (threshold, discrimination, and identification) score. Of the 46 patients, 28 had undergone olfactory training only, while the remaining 18 had received topical corticosteroids in addition to training. At study's end, the mean overall TDI score in the entire group increased by 4.09 points over baseline--a statistically significant increase (p = 0.01); this increase was mainly attributable to improvement in the identification component of the TDI, which increased by 2.51 points (p = 0.02). Among the 18 patients who received a topical corticosteroid in addition to training, the mean TDI increased by 6.83 points (p = 0.001), primarily because of improvements in the discrimination and identification components. The 28 patients who underwent olfactory training alone experienced a mean increase in the identification component of only 2.20 points (p = 0.14) after 8 months. Olfactory function in the post-URTI patients increased significantly at 4 months. We conclude that olfactory discrimination and identification can be enhanced by the addition of a topical corticosteroid to a program of defined, daily, short-term exposure to olfactory training.

Structural correlates of taste and smell loss in encephalitis disseminata.

BACKGROUND: Olfactory dysfunction in MS patients is reported in the literature. MRI of the olfactory bulb (OB) is discussed as a promising new testing method for measuring olfactory function (OF). Aim of this study was to explore reasons for and optimize the detection of olfactory dysfunction in MS patients with MRI. MATERIALS AND METHODS: OB and olfactory brain volume was assessed within 34 MS patients by manual segmentation. Olfactory function was tested using the Threshold-Discrimination-Identification-Test (TDI), gustatory function was tested using Taste Strips (TST). RESULTS: 41% of the MS patients displayed olfactory dysfunction (8% of the control group), 16% displayed gustatory dysfunction (5% of the control group). There was a correlation between the OB volume and the number and volume of MS lesions in the olfactory brain. Olfactory brain volume correlated with the volume of lesions in the olfactory brain and the EDSS score. The TST score correlated with the number and volume of lesions in the olfactory brain. CONCLUSION: The correlation between a higher number and volume of MS lesions with a decreased OB and olfactory brain volume could help to explain olfactory dysfunction.

Impact of laser eustachian tuboplasty on middle ear ventilation, hearing, and tinnitus in chronic tube dysfunction.

OBJECTIVES: Long-term Eustachian tube dysfunction (ETD) predisposes to various secondary middle ear diseases. Most surgical and prosthetical interventions on the Eustachian tube itself have proven to be ineffective, whereas middle ear surgeries treat the sequelae of ETD without major influence on the underlying tubal pathology. The purpose of our study was to evaluate the outcome of laser Eustachian tuboplasty (LETP) on tubal function and associated otological symptoms in topically anesthetized ETD patients with intact or perforated eardrums. DESIGN: In a prospective clinical investigation, outpatient LETP was carried out in 31 subjects with therapy-refractory chronic ETD. The study population comprised two groups: 16 patients with mesotympanic eardrum perforations diagnosed with noninflammatory chronic otitis media (COM) and 15 patients with intact eardrums including otitis media with effusion, adhesion processes, and dysfunctional pressure equalization. Clinical examination and data acquisition were performed 2 wks before LETP as well as 8 wks and 1 yr postoperatively. On COM patients, LETP was done at 10-wk intervals before the scheduled tympanoplasty. Assessment of clinical effectiveness was based on transnasal videoendoscopy, ear microscopy, tubal function tests (Valsalva maneuver and passive tubal opening), audio- and tympanometric measurements, and visual analog scales. Tansnasal, fiber-guided laser surgery was performed in contact mode using a semiconductor diode laser (λ = 830 nm, 4 W). We hypothesized that regulated laser ablation of hyperplastic mucosa at the epipharyngeal dorsal circumference of the tubal ostium could be effective in improving the associated symptoms such as dysfunctional pressure equalization, aural fullness, conductive hearing loss, and tinnitus. RESULTS: LETP resulted in persistent volume reduction of the posterior tubal circumference in all patients. Objective parameters revealed significant improvement of tubal function tests and middle ear ventilation in 62% of subjects after 8 wks (66% after 1 yr). Significant long-term reduction of conductive hearing loss was achieved in both patient groups. Besides, tinnitus loudness was significantly reduced in COM subjects after tympanoplasty. Visual analog scales showed very low values for intraoperative pain and discomfort and high scores for long-term overall patient satisfaction as well as improvement of the symptoms such as dysfunctional pressure equalization and aural fullness. Subjects with post-LETP Valsalva feasibility marked higher values for satisfaction and symptom improvement than patients without successful Valsalva maneuver. COM subjects scored higher in hearing improvement and satisfaction after LETP and successful tympanoplasty than patients with intact eardrums. CONCLUSIONS: Outpatient LETP seems to be a suitable, safe, easily applicable, and well-tolerated treatment option before (revision) tympanoplasties and in all investigated diseases developing from long-lasting pathologic middle ear ventilation. Minimally invasive shaping of the hyperplastic nasopharyngeal Eustachian tube under topical anesthesia seems to be effective in improving tubal function as well as the associated symptoms such as dysfunctional pressure equalization, aural fullness, and conductive hearing loss in otherwise therapy-refractory chronic ETD.

Topical beclomethasone in the therapy of smelling disorders-a new application technique.

Systemic corticosteroid is the first-line-treatment for olfactory dysfunction of sinonasal origin but is afflicted with many side-effects. Topic corticosteroid does not reach the same efficacy but has a remarkable safety profile. In this trial we investigated the efficacy of topic therapy with beclomethasone (BDP) -spray. The drug was applied precisely to the olfactory cleft by a special spraying top-part. In addition we determined extinction and volume of a gelaspon sponge placed in the olfactory cleft to show the difference of the topical spray application. 18 patients with anosmia or hyposmia of different genesis and duration applied BDP-spray twice daily for four weeks. The olfactory function was determined using the TDI score ('Sniffin'-Sticks test battery'). Factors correlated with therapy efficacy were assessed. The median TDI score increased from 13.5 (0-25) at the beginning to 18.5 (1-26) after therapy of four weeks (P = 0.005). The extinction and volume in the moistened sponge was more than two times greater with the top-part than without. The direct application of BDP-spray to the olfactory cleft attained superior therapeutic effects than a usual applied mometasone spray, but did not perform as good as systemic corticosteroid treatment.

Endoscopic diode laser polypectomy and high-dose intranasal steroids in recurrent nasal polyposis.

BACKGROUND: The aim of this clinical investigation was to determine the outcomes of an outpatient videoendoscopic diode laser polypectomy (DLPE) and subsequent topical high-dose corticosteroid application in chronic rhinosinusitis with recurrent nasal polyposis (NP). METHODS: After ineffective revision sinus surgery and prolonged mometasone furoate application, 19 consecutive mild and moderate NP patients suffering from nasal obstruction (NO) and olfactory dysfunction (OD) were prospectively entered into the study to undergo DLPE under topical anesthesia. Beginning 1 week postoperatively, 250 microg of beclomethasone dipropionate aerosol spray (BDPAS) was self-administered into each nostril twice a day. Treatment efficacy was assessed after 1, 6, and 12 weeks and at quarterly long-term follow-ups based on objective parameters (videoendoscopic photodocumentation and rhinomanometry) and subjective evaluation of NO, OD, and satisfaction (visual analog scales [VASs]). RESULTS: VASs indicated very low values for intraoperative pain and discomfort and high postoperative satisfaction. After 6 weeks, subjective and objective data revealed a significant improvement of NO and OD (p < 0.0005). Topical BDPAS application was well tolerated. At a median follow-up of 32 months (range, 1-4 years), 21% of the patients developed NP disappearance, 53% had a stable disease, and 26% had a progressive disease. CONCLUSION: In therapy-refractory NP, endonasal DLPE represents a minimally invasive, symptom-oriented, safe and easily reapplicable outpatient treatment option that provides effective improvement of NO and OD. Compared with the pre-DLPE period, the proposed long-term quarterly follow-up combined with high-dose topical BDPAS application might reduce or delay the need for major surgery and appears to be suitable for disease control.

Chemosensory function in Wegener's granulomatosis: a preliminary report.

Despite the fact that Wegener's granulomatosis affects the nasal and paranasal cavities and the cranial nerves regularly, chemosensory impairments have not been reported. The objective of this study is to test the three chemosensory systems, olfaction, taste, and intranasal trigeminal function in Wegener disease patients. We tested olfactory, gustatory, and intranasal trigeminal function in nine patients (5 women, 4 men, mean age 57 years) with confirmed Wegener's granulomatosis. Olfaction was tested with the Sniffin'Sticks, gustatory function with the "Taste strips" and intranasal trigeminal function with a lateralization task. One patient had anosmia (11%), four patients had hyposmia (44%) and four patients were normosmic (45%). Gustatory testing function showed pathological taste strip results in five patients (55%) and normal results in three patients (33%). One patient did not undergo taste testing. Intranasal trigeminal function was lowered in five patients (56%) and normal in four patients (44%). Neither previous nasal surgery status nor endoscopic status was associated to a higher frequency in pathological scores for any of the three chemical senses. In conclusion, these preliminary results suggest a consistent affection in chemosensory functions in Wegener's granulomatosis patients.

Foreign body aspiration in children: field report of a German hospital.

BACKGROUND: The aspiration of foreign bodies (FB), especially by small children, is a life-threatening situation and can be fatal. The aim of this survey was to study the types of foreign bodies in the upper airways and digestive tract, and the circumstances leading to the aspiration on the basis of hospital records of the Berlin University Hospital in Germany from 1997-2002. METHODS: We performed a retrospective review of hospital records using a standardized protocol. Foreign body aspiration that occurred in children aged 0-14 were considered for inclusion in the database. During the study period, 78 patients with a diagnosis of FB were included in the database. Forty-five patients were male and 33 were female. The median age was 1. RESULTS: In 89.5% of all cases, the children were under the age of 3. Seventy-five of the 78 patients had a foreign body in the trachea/bronchial trees/lungs based on International Classification of Diseases-9 codes at the time of discharge. At the time the injury occurred, the children had either been eating (41.1%) or playing (50.0%). More than 50% of the children were being supervised by an adult at the time the injury occurred. The foreign bodies (FB) were always extracted by using an endoscopic procedure (n= 43 rigid, n= 6 flexible and n= 29 combination of both methods). Moreover, hospitalization was always required due to an institutional requirement. The most commonly found foreign bodies were seeds, nuts, berries and grains. CONCLUSION: Most of the foreign bodies were found in the bronchial tubes, trachea, and lungs. The extraction method from these areas is rigid and/or flexible bronchoscopy or gastrointestinal endoscopy, a procedure requiring anesthesia. There seems to be no association between the aspirated foreign bodies and other purchased objects or packaging material. The fact that a large fraction of the injuries occur under the supervision of the adults suggests that the number and severity of the injuries could be reduced by educating parents and children. Our experience confirms, therefore, that further research into the behavioral aspects leading to FB injuries is needed.

Cancer of the external auditory canal-diagnostic and treatment.

BACKGROUND: Ear squamous cell carcinoma (SCC) is a tumor with a poor prognosis, due to a late initial diagnosis because of a concealment by primarily benign symptoms and due to the unfavorable localization including the infiltration of important structures such as the middle ear, mandibular joint or dura. PATIENTS AND METHODS: We retrospectively examined 10 patients, medium age: 63.8 ± 9.3 years between 2002 and 2008 with a histological confirmed SCC of the external auditory canal. The median follow-up period was 20.5 months (range 7-60 months). RESULTS: The treatment involving surgery, radiotherapy and/or chemotherapy yielded a survival rate of 38.3 ± 11.3 months for T1 and a survival rate of 17.0 ± 3.0 months for T2-T4 tumors. 3/10 patients at T1 stage are under follow-up, all 7/10 (70%) patients at T2 and T4 stage did not survive 5 years. CONCLUSION: The prognosis for ear SCC primarily depends on early clinical and histopathological diagnostics and requires a sufficient and standardized staging to determine the therapy involving surgery and radiochemotherapy.

Rehabilitation of the olfactory sense after laryngectomy: long-term use of the larynx bypass.

Patients who undergo laryngectomy typically lose their sense of smell. One device that has been used to rehabilitate olfactory function in these patients is the larynx bypass. We conducted a long-term study of the larynx bypass in 16 laryngectomized patients. After undergoing objective and subjective baseline evaluations, patients were asked to use the device at home for at least 30 minutes each day for 3 months. They were also asked to record in a diary subjective ratings of their sense of smell and the practicability of using the device every day. At study's end, patients experienced a statistically significant improvement (p < 0.001) in olfactory function on objective measurement (Sniffin' Sticks testing). Subjective improvement was seen after 1 week (p < 0.001) and maintained throughout the study. Practicability scores improved statistically (p = 0.003), but the device remained difficult to use. The long-term use of the larynx bypass has not been studied previously, and we hope that our findings will serve as a basis for further investigation.