[Principles of hygiene in ENT endoscopy]. / Grundsätze der Hygiene bei der HNO-Endoskopie.

This article gives a report on principles of reprocessing of rigid and flexible endoscopes used in ENT units including structural and spatial requirements based on the general and also ENT-specific risks of infection associated with diagnostic and therapeutic endoscopy. The underlying legal principles as well as recommendations from scientific societies will be exemplified in order to give the otorhinolaryngologist a practical guidance.Preliminary results of a nation-wide survey on infection control standards based on data of 29 ENT practices in Germany reveal actual deficits of varying degree concerning infection control management including reprocessing of endoscopes. The presented review aims to give support to the establishment of a structured infection control management program including the evaluation of results by means of a prospective surveillance.

[Osteoma of the maxillary sinus]. / Osteom der Kieferhöhle.

BACKGROUND: Osteoma of the paranasal sinuses is a rare and benign entity that develops slowly. If they occur, locations within the frontal sinus and ethmoid cells are more frequent, whereas osteomas in the sphenoid or maxillary sinus are very rare. CASE: We report on a 25-year old female patient presenting with a bony mass in the right maxillary sinus. A standard external approach using a modified Caldwell-Luc procedure was successfully employed as endoscopic endonasal surgery was limited by the size of the bony lesion. CONCLUSIONS: Trauma or infection are often suggested as an etiologic factor in the pathogenesis of osteoma. In our case the development of maxillary osteoma was related to dental extraction and postoperative fistula. External standard procedures remain mandatory if endonasal endoscopic surgery fails in the removal of osteoma of the paranasal sinuses.

Massive epistaxis after rupture of intracavernous carotid artery aneurysm. Case report.

We present a case of massive epistaxis caused by an internal carotid artery aneurysm. The initial treatment with endovascular balloon embolization failed as a result of balloon displacement. After rebleeding, the intracavernous aneurysm was treated with an endovascular detachable balloon embolization technique, which resulted in cessation of epistaxis. The different treatment options for interventional radiology and management of ruptured carotid artery aneurysms are discussed.

[Diagnosis of recurrences of head and neck carcinoma with the tumor marker SSC-antigen]. / Diagnostik von Kopf-Hals-Karzinom-Rezidiven mit dem Tumormarker SSC-Antigen.

BACKGROUND: The follow-up of squamous cell carcinomas of the head and neck is often challenging. Due to tissue alteration and anatomic changes after primary treatment or submucosal tumor growth, recurrences are sometimes detected very late. The tumor marker SCC-Antigen (SCC-Ag) may provide additional information for early detection of such tumor recurrences. PATIENTS: Serum levels of SCC-Ag in 578 patients with primary squamous cell carcinomas of the head and neck were assayed by SCC-RIA and IMx-SCC before treatment and every 2-3 months during follow-up. During the observation period of 30-84 (mean 50) months, 179 recurrences were verified by histologic examination. RESULTS: Seventy-seven patients (43%) with tumor recurrence showed elevated serum levels of SCC-Ag (< 2.0 ng/ml). Fifty-eight (32%) of them exhibited elevated levels of SCC-Ag up to 11 months (mean 6.1 months) prior to histopathologic diagnosis. This mainly became evident in 48 (83%) patients whose SCC-Ag serum levels were elevated before treatment. CONCLUSION: Use of SCC-Antigen in head and neck tumors follow-up can provide early evidence of almost one third of all recurrences of squamous cell carcinomas of the head and neck. For clinical purposes, we recommend an initial analysis of the SCC-Ag serum level in every patient with primary squamous cell carcinoma of the head and neck. The SCC levels of all SCC positive patients should be closely monitored. Elevated SCC should be regarded as a potential early sign for recurrence and therefore indicates the need for intensified follow-up. Depending on the individual situation this should include ultrasonography, CT, MRI and especially frequent endoscopy in general anesthesia with multiple biopsies of suspicious regions.

Recurrent respiratory papillomatosis associated with gastroesophageal reflux disease in children.

The hallmark of gastroesophageal reflux disease (GERD) is an increased exposure of esophageal and laryngeal mucosa to gastric juice. This exposure can cause complications such as chronic laryngitis or chronic respiratory diseases. We report our experience in managing three pediatric patients with severe recurrent juvenile laryngeal papillomatosis (JLP) associated with GERD. All patients showed a high rate of recurrence requiring multiple laser surgeries. Systemic alpha interferon therapy over a period of more than 1 year and photodynamic therapy with dihematoporphyrin produced no improvement. However, after therapy for GERD, the rate of recurrence of JLP decreased significantly. Although the course of respiratory papillomatosis is known to fluctuate, our findings suggest that gastroesophageal reflux may have a role in aggravating papillomatosis.

[Autologous perichondrium-cartilage graft in the treatment of total or subtotal perforations of the tympanic membrane]. / Autologer Knorpel-Perichondrium-"Spannring" bei subtotalen oder totalen Trommelfelldefekten.

BACKGROUND: In myringoplasty or tympanoplasty, fascia of the temporalis muscle and perichondrium or cartilage-perichondrium composite grafts are most commonly used to reconstruct the tympanic membrane (TM). Primary failures or recurrent perforations in the anterior part of the TM frequently occur in cases of eustachian tube dysfunction or total perforations of the TM. The purpose of this paper is to introduce a perichondrium-cartilage composite graft for closure of total perforations of the TM. Twenty-one patients (17 adults, 4 children) were included in this study, all of whom had a total perforation of the TM. METHODS: An oval shaped piece of cartilage with perichondrium on one side was harvested from the cavum conchae. The cartilage was cut in the shape of a U without removing the inner layer of perichondrium. The inner diameter of the cartilage ring should be nearly the same as the diameter of the tympanic ring. This cartilage framework stabilizes and fixes the perichondrium and prevents the perichondrium from subsiding into the middle ear cavity. Shrinking of the perichondrium is also reduced by the cartilage ring. In all patients introduced in this study, the TM was closed and no residual perforation occurred. The hearing results in tympanoplasty were the same as in other techniques with a residual air-bone gap of about 20 dB. CONCLUSIONS: This technique seems to be a valuable method for the closure of total perforations of the TM. Especially in perforations near the anterior anular region the underlay technique with fascia or perichondrium is an uncertain method. The soft material which is only fixed by adhesion can easily be displaced during wound healing. The hearing results are comparable to that achieved in other techniques. Further studies with greater number of patients are necessary to assess long term results.

A possible role of Helicobacter pylori infection in the etiology of chronic laryngitis.

In order to study a possible role of Helicobacter pylori infection in chronic laryngitis, we performed endoscopic and histological assessments in addition to a urease test for the bacterium in 35 patients with chronic hoarseness. Six of the patients investigated (17.1%) revealed a positive urease test of the laryngeal biopsy (four male and two female patients). These H. pylori-positive patients were treated with omeprazole and an antibiotic regimen using clarithromycin and metronidazole. This led to an eradication of the H. pylori and resolution of clinical signs and symptoms. These findings show a possible role of H. pylori infection in the etiology of chronic laryngitis in certain patients and can be important for clinical diagnosis and treatment.

Argyrophilic nucleolar organizer regions in auditory meatal skin and middle ear cholesteatoma.

Comparative silver-staining of argyrophilic nuclear organizer regions (AgNORs) was performed to study the proliferative activity of auditory meatal skin and middle ear cholesteatoma. AgNOR expression patterns were counted by standardized methods in two centres, Bochum and London, and mean numbers of dots per nucleus were calculated. Specimens of normal auditory meatal skin showed 1.54 dots/nucleus (n = 12) in the Bochum study, whereas cholesteatoma had 3.71 dots/nucleus (n = 21). In the London study normal meatal skin showed two dots/nucleus (n = 4), whereas acquired cholesteatoma (n = 8) gave a mean of 4.90 dots/nucleus and congenital cholesteatoma a mean of 4.70 dots/nucleus (n = 2). Our findings confirm the hyperproliferative state of middle ear cholesteatoma, suggest that the congenital variety of cholesteatoma may have a similar activity and indicate that AgNOR staining is a useful technique for assessing cellular proliferation in cholesteatoma and objectifying and quantifying its aggressive behaviour.

[Perforation of the ear drum. On the history of paracentesis and grommet insertion]. / Der Trommelfellstich. Zur Geschichte von Parazentese und Paukenröhrchen.

As early as 1649, Jean Riolan the Younger pierced an ear drum, after which the patient's hearing improved. This occurred as a result of an accidental ear drum injury while cleaning an ear canal with an ear-spoon. In 17th and 18th centuries, several pioneers in medicine (Thomas Willis, Antonio Mario Valsalva, William Cheselden) conducted experiments in an effort to ascertain the function of the ear drum in hearing. At the end of the 18th century, ear drum perforation, like perforation of a cataract, was indiscriminately performed by itinerent quacks and "physicians" in England, France, and Germany. Ear drum perforation was performed in many places even for the healing of deaf and dumb. Astlee Cooper reported about success with ear drum perforation in 1800 and listed strict indications. He recommended the operation only in the presence of obturation of the Eustachian tube. Because of the negative results of indiscriminate ear drum perforation, the operation soon acquired a bad reputation and was not performed for decades. It was only Herrmann Schwartze who reintroduced paracentesis into the daily practice of otorhinolaryngology. He was director of the royal ENT clinic in Halle and published a trailblazing treatise on the indications, value, and success of this operation. Since physicians had soon realized that spontaneous healing tendencies of the ear drum quickly lead to closure of an artificial perforation, many physicians tried different techniques to obtain a permanent opening. Gruber resected half of the ear drum--unsuccessfully. Others put foreign bodies into the ear drum apertures, such as catgut, whalebone rods, and lead wires. In his textbook of 1845, Martell Frank first described a grommet made of gold foil. Politzer experimented with a hard rubber ring but later abandoned his attempts because of lack of success. Voltolini manufactured an open hollow ring of gold foil or aluminium, which had to be fixed at the handle of the malleur. Armstrong described a "new" therapy for chronic secretory otitis media consisting of inserting a vinyl tube into the ear drum. While he was not the inventor of the grommet, he was the first to reintroduce grommets in the middle of the 20th century. Theromoparacentesis was performed as early as 1867 by Voltolini, who performed this operation using a galvanic cautery device. After more than 100 years, the Japanese physician Saito reintroduced thermoparacentesis into the therapy of tube ventilation disorders. Paracentesis, grommet insertion, and thermoparacentesis are among the most successful treatments currently available to the ENT specialist when used properly. They are treatments with a long history.