[The age effect in evaluation of hearing aid benefits by speech audiometry]. / Der Einfluss des Alters bei der Evaluierung des funktionellen Hörgerätenutzens mittels Sprachaudiometrie.

BACKGROUND AND AIM: Hearing loss is one of the most common disabilities in the elderly. The aim of this study was to investigate the relationship between pure-tone hearing loss and maximum monosyllabic perception and speech perception with hearing aids. The focus of the investigation was elderly patients. MATERIALS AND METHODS: In this prospective study, 188 patients with sensorineural hearing loss were included. The pure-tone audiogram (4FPTA), the Freiburg speech intelligibility test with headphones and the word recognition score with hearing aids at 65 dB SPL were measured and evaluated. RESULTS: An increasing age was associated with higher discrepancy between the maximum speech perception and speech understanding with hearing aids. The mean difference between maximum monosyllabic perception and speech perception with hearing aids is about 20% in the elderly population. CONCLUSION: The intended goal of hearing aid prescription, the match between maximum monosyllabic perception and word recognition score with hearing aids within 5 to 10%, is not achieved in the elderly population.

[S1 Clinical guideline"adenoids and adenoidectomy"]. / S1-Leitlinie "Adenoide Vegetationen/Rachenmandelhyperplasie".

On behalf of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, a clinical guideline for adenoids and adenoidectomy was developed in 5 consensus meetings after taking into consideration the current literature. This guideline was released by the presidium on 13 April 2011. Anatomy, pathology and pathophysiology, symptoms, diagnosis, therapy, and course are presented.

[Coincidental squamous cell cancers of the esophagus, head, and neck: risk and screening]. / "Field cancerization" im oberen Aerodigestivtrakt: Uberwachungsempfehlungen für Risikopersonen.

The term "field cancerization" was coined by Slaughter in1953 when describing multifocal synchronous and metachronous carcinogenesis in the upper aerodigestive system. Patients suffering from head and neck cancer (HNC) have or develop a second esophageal squamous cell cancer (ESCC) or bronchial cancer (BC) in 5-14% of cases. When a second esophageal cancer occurs in a patient with HNC, the prognosis is generally determined by the ESCC, and, unfortunately, it is poor. Screening and surveillance by Lugol chromoesophagoscopy enable early detection and curative treatment of second esophageal neoplasias. Surveillance appears to result in a survival benefit for HNC patients. Vice versa, patients with ESCC or BC have a risk of about 10% for developing HNC. Periodic pharyngolaryngoscopy is recommended for curatively treated ESCC or BC patients. Patients with field cancerization should be surveilled by a multidisciplinary approach.

[Coincidental squamous cell cancers of the esophagus and head and neck: risk and surveillance]. / Koinzidenz von Plattenepithelkarzinomen der Speiseröhre und Kopf-Hals-Karzinomen: Risiko und Früherkennung.

Patients suffering from head and neck cancer (HNC) have or will develop a second esophageal squamous cell cancer (ESCC) in 5 - 14 %. When a second esophageal neoplasm occurs in a HNC patient, the prognosis is generally determined by the ESCC, and unfortunately it is poor. Prospective clinical studies in Japan, Brazil, Taiwan, France and Germany have shown that screening or surveillance using Lugol chromoesophagoscopy enables early detection of second esophageal neoplasias. Such a surveillance results in a survival benefit for HNC patients. Vice versa, ESCC patients also have a risk of 9.3 - 11.4 % for a head and neck cancer. Periodic otolaryngeal examination and pharyngoscopy is recommended for curatively treated ESCC patients. Patients with a so-called field cancerisation of the airways and upper digestive tract thus require an interdisciplinary management and monitoring.

[Prolactinoma of the sphenoid sinus. Case report and literature review]. / Prolaktinom der Keilbeinhöhle. Kasuistik und Literaturübersicht.

In this case study, we report on a patient complaining of headache who, after CT and MRI, was found to have a neoplasia of the left sphenoid sinus. After a transnasal biopsy and histological examination, a prolactinoma was diagnosed. Based on this case, we discuss important aspects of tumor biology, diagnostic procedures, histology as well as differential diagnosis. Prolactinoma has to be considered as a differential diagnose in all sphenoid sinus neoplasias with close contact to the pituitary gland.

[Ultrastructural localization of nitric oxide synthase (NOS I and III) in human nasal mucosa]. / Immunelektronenmikroskopische Lokalisation von NOS I und NOS III in der menschlichen Nasenschleimhaut.

BACKGROUND: Nasal vasculature and seromucous glands are exposed to complex mechanisms influenced by external as well as internal stimuli. In addition to classic and peptidergic neurotransmitters, Nitric oxide (NO) was increasingly found to be important in the control of various physiological functions. NO regulates nasal immunology, influences macrophages activity and has antiviral and bacteriostatic properties. The aim of this study was to detect the localization of nitric oxide synthases (NOS) I and III in the normal human nasal mucosa with immunoelectron microscopical techniques. METHODS: Specimens of non-inflamed inferior turbinates from 35 patients who required nasal surgery were fixed in phosphate-buffered glutaraldehyde. After dehydration, incubation in unicryl and polymerization ultrathin sections were cut. Primary antibodies against NOS I and III were applied and the immunocomplexes were visualized by an immunocytochemical staining-technique using a gold-labeled antibody. Immunostained structures were photodocumented by using a transmission electron microscope. RESULTS: NOS-immunoreactive nerve fibers were mainly colocated in parasympathetic nerves in the adventitia of arterial vessels and in periglandular axons. Electron microscopy showed that NOS-positive axons were in close contact with acinus cells. A strong NOS III-immunoreactivity was found in endothelial cells of capillaries near the glands as well as in arterial vessels. Furthermore, immunoreaction products were deposited throughout the cytoplasm of fibroblasts. CONCLUSIONS: Nitric oxide in nerval fibers, seromucous glands and endothelial cells of capillaries and arterial vessels suggests that NO takes part in the regulation of physiological processes of the human nasal mucosa. NO was colocalized in parasympathetic nerves and plays a role in the neurotransmission and neuromodulation of the vascular tone and glandular secretion. Arteries showed a distinctly developed nitric innervation and endothelial accumulation. The NO production in axons of the adventitia and in the endothelium of arteries demonstrated that these vessels are influenced by a dual NO system. Mainly NO could act on these structures with vasodilatory effects. Finally NO would be able to influence the functions of perivascular fibroblasts.

[Immunoelectron microscopic findings in patients with allergic rhinitis]. / Immunelektronenmikroskopische Untersuchungen bei Rhinitis allergica.

BACKGROUND: In middle Europe the prevalence of allergic rhinitis is up to 15 % to 25 %. Allergic rhinitis is characterised by an inflammation of the nasal mucosa induced by different allergens. The patients suffer from symptoms like sneezing, rhinorrhea and nasal airway obstruction caused by morphological changes of the nasal mucosa. This symptomatology is considered to be a result of accumulation and activation of inflammatory cells. Further some neuropeptides like Calcitonin Gene Related Peptide (CGRP) and Substance P (SP) play an additional role in pathophysiology of allergic rhinitis. PATIENTS AND METHODS: Tissue samples from 28 human turbinates of patients with perennial rhinitis were taken during nasal surgery and preserved in phosphate-buffered glutaraldehyde or paraformaldehyde. Ultrathin sections were cut. The samples were dehydrated and embedded in Araldit. After polymerization an immunocytochemical staining-technique using a gold-labeled antibody was carried out. Immunostained structures were photodocumented by using a transmission electron microscope. RESULTS: In the lamina propria mucosae an extensive edema and several inflammatory cells like lymphocytes, plasma cells, eosinophiles and macrophages was found. The capillaries showed an activated endothelium. Immunoreactive nerve fibers were found in the periglandular tissue around the acini, ducts and in the glandular connective tissue. Neuroglandular synapses with dense core vesicles and positive immunoreactions to CGRP and SP could be detected. Neuropeptidergic axons were often observed near to plasma cells. CONCLUSIONS: In the edematous nasal mucosa an infiltration with different inflammatory cells was found. Using electron microscopical techniques nerve structures near the submucosal glands could be demonstrated. Immunoreactions to the neuropeptides CGRP and SP were detected in the periglandular nerves and in neuroglandular synapses. These findings demonstrate the direct nerve control of glandular functions in allergic rhinitis. CGRP is generally known to have a vasodilatatory effect and to stimulate the secretion of nasal seromucous glands. In addition, SP as a short-acting vasodilatator may induce vascular permeability and glandular secretion. These immunoelectron microscopical findings further elucidate pathomorphological mechanisms in allergic rhinitis.

[Chronic rhinosinusitis in hypogammaglobulinemia. A morphological study]. / Chronische Rhinosinusitis bei Hypogammaglobulinämie. Eine morphologische Untersuchung.

Primary hypogammaglobulinemia (Bruton's disease) is a rare X-linked infantile immunodeficiency syndrome due to a B-cell defect. The patients suffer from acute and recurrent bacterial infections with chronic rhinosinusitis and chronic lung disorders. Immunoglobulin replacement therapy and antibiotics do not suffice in some cases, making sinus surgery to advance the drainage necessary. A 25-year-old man with hypogammaglobulinemia was treated with functional endoscopic sinus surgery and mucotomy of the turbinates. Tissue samples of the inferior turbinates were taken for histological and electron-microscopic examination. Immuno-electron-microscopic methods were carried out with antibodies against substance P and calcitonin gene-related peptide (CGRP). Morphological investigations to better understand pathophysiological changes in hypogammaglobulinemia are rare. Pathological changes in the glands and venous vessels could be demonstrated. A rich neural supply and participation of neuropeptides such as substance P and CGRP could play a role in the unspecific defense via neurogenetic inflammation in these cases.

[Ultrastructural changes of the nasal mucosa in primary ciliary dyskinesia]. / Ultrastrukturelle Veränderungen der Nasenschleimhaut bei primärer ziliarer Dyskinesie.

Primary ciliary dyskinesia syndrome (PCD) is a rare, autosomal receive disorder. Kartagener's syndrome is a subgroup of the PCD with situs inversus, bronchiectasis, and sinusitis. The symptoms results from an abnormal ultrastructural morphology of the cilia such as absence of dynein arms and other changes. As a consequence ciliary motility is disturbed. A 25-year-old man was examined because he suffered from recurrent severe pneumonia and Aspergillus infections of the lungs. On electron micrographs, ciliary abnormalities including deficiency of inner and outer dynein arms, dysmorphic outer dynein arms, and disorientation of the cilia were demonstrated. The diagnosis of PCD requires electron-microscopic investigations of the ciliated mucosa. Special attention should be given to ultrastructural changes of nasal or bronchial mucosa if a young patient suffers from recurrent severe respiratory infections.

[Morphological changes of nasal and duodenal mucosa in patients with cystic fibrosis]. / Elektronenmikroskopische Befunde der Nasen- und Dünndarmschleimhaut bei der Zystischen Fibrose.

BACKGROUND: Cystic fibrosis (CF) is an inherited multisystemic disorder that results in generalized dysfunction of exocrine glands. In patients with cystic fibrosis dyscrinia with affection of exocrine glands function is a main problem of the upper and lower respiratory tract. In addition to chronic obstructive pulmonary disease, chronic sinusitis, nasal polyposis and hypertrophy of inferior turbinates with nasal airway obstruction are typical signs. To understand pathophysiological mechanisms in CF and to correlate morphological findings with clinical symptoms, investigations of nasal mucosa are important. METHODS: Tissue samples of inferior turbinates were taken during nasal surgery from 7 children, ranging from 3 to 11 years of age between September 1998 and May 2000. Histological sections were cut followed by a light- and electron microscopical examination (EM 902 A Zeiss). Additionally, specimens of duodenal mucosa were investigated. RESULTS: In comparison with sections of normal nasal mucosa the lamina propria mucosae shows different morphological changes. Under a thick layer of respiratory epithelium with a high portion of goblet cells and particulary vacuoles there is an edematous subepithelial area. The capillary layer is reduced and the seromucous glands show an atypical morphological structure with widely mucous cells and cystic dilatation. On an ultrastructural level the glandular cells show atypical and inhomogeneous glandular droplets in the supranuclear cell portion. A viscous secretion was detectable at the glandular lumen. The nucleus contains dispersed chromatin as a sign of increased activity and the structures of Golgi apparatus were obviously detectable. CONCLUSIONS: In respective literature studies on the different morphological changes on light- and electron microscopical level in CF-associated rhinopathies are rare. This histological study demonstrated various morphological changes of nasal mucosa and shows a correlation between the glandular dysfunction and the typical symptoms in CF. Additionally a comparison with ultrastructural findings of CF-enteropathies is proposed. These findings could help to look at new aspects in the pathophysiology for patients with CF.

[Electron microscopic studies of the rabbit nasal mucosa after short-term application of naphzoline nitrate]. / Elektronenmikroskopische Untersuchungen der Nasenschleimhaut des Kaninchens nach kurzzeitiger Applikation von Naphazolinnitrat.

BACKGROUND: Vasoconstricting nasal drops are applied frequently. Especially early ultrastructural alterations of the vessels were not examined up to now in animal models. Our goal was the systematic investigation of the submucosal vessels and the epithelium after topic application of naphazoline nitrate (Privin) in an animal model. METHODS: Three times daily over 6 days 3 ml of 0.1% naphazoline nitrate solution (Privin) were instilled into the right nasal cavity of 5 rabbits. At the 7th and 14th day an incisional biopsy of the lower nasal turbinate was carried out in ketamine/rompun anesthesia. RESULTS: In the naphazoline group the capillaries showed an edematous endothelium with narrowed lumina. Thrombosis of the arterioles were frequently observed. The more cubic epithelial cells had deciliated areas with microvilli. Venules, submucosal glands and the surrounding connective tissue was normally configurated. Analogous findings were also observed after 2 weeks. CONCLUSIONS: The disturbance of the microcirculation shows impressive endothelial alterations. These structural changes can result in nonreversible mucosal damages. A regeneration time of more than 1 week is assumable. Our results should be considered critically in order to prevent damages of the nasal mucosa.

[Ames test as biomarker]. / Der Ames-Test als Biomarker.

BACKGROUND AND OBJECTIVE: The incidence of squamous cell carcinomas in the upper aerodigestive tract has increased worldwide. The main risk factors are chronic tobacco and alcohol consumption. The detection of high-risk persons is important because early diagnosis of these tumors provides a good chance for permanent healing. Biomonitoring programs may help to give precise information about the individual cancer risk among smoking and drinking persons. The aim of this study was to evaluate the Ames test as a biomarker to detect the genotoxicity of saliva. PATIENTS AND METHODS: Saliva specimens of 131 probands were investigated for their genotoxic effects using the Ames test. RESULTS: Our results showed an increased trend of genotoxic activity in the saliva of smokers. A highly significant additional increase of genotoxicity was measured in smoking and drinking individuals. CONCLUSIONS: Our study shows that the Ames test could be used to show genotoxic effects in saliva specimens. In combination with other biomarkers, this test may help to develop a valid concept for detecting cancer-endangered people.

[Hyperacusis after tympanoplasty]. / Hyperakusis nach Tympanoplastik.

A case of hyperacusis after tympanoplasty is presented. A 62-year-old woman experienced unilateral conductive hearing loss for about 60 years after antrotomy in infancy. Neurological or otoneurological symptoms were not evident. Tympanotomy showed a missing incus with discontinuity of the chain. Reconstruction was performed by interposition of a partial ossicular replacement prosthesis (PORP). The postoperative audiogram revealed minimal perceptive hearing loss in the high-frequency field in the operated ear. Several weeks after middle ear surgery, the patient complained of hyperacusis on the operated side, which persisted for more than 2 years. To alleviate the unpleasant sensations, an ear plug was used by the patient. In spite of the asymmetric hearing loss, no late onset auditory deprivation could be diagnosed. The pathophysiological causes of the hyperacusis have not yet been clarified. Possible reasons are discussed.

[Orbital space-occupying lesions. Practical aspects of imaging]. / Orbitale Raumforderungen. Praktische Aspekte zur Bildgebung.

During the period 1992-1998,we diagnosed orbital tumors in 23 cases at the MLU Halle-Wittenberg. In the intraconal compartment we mostly saw cavernous hemangiomas and neurogenic tumors. Lymphomas and a primary meningioma were located in the extraconal space. Beneath the periosteum, bony processes, tumors of the sinuses, dermoid-and epidermoid-cysts normally occur, but we only observed metastases and hematomas. Furthermore,tumors of the lacrimal gland and inflammatory lesions were diagnosed. Orbital tumors are uncommon lesions, whose location in the orbit gives an important hint to differential diagnosis, because a high percentage of various pathologies is located in special compartments of the orbit. According to our results,the MRI-scan is usually sufficient for differentiation and for preoperative planning in order to reduce the X-ray dose of the lens. CT-scans with contrast are sometimes necessary for examining bone destroying processes and for planning the surgical approach to removing the tumor. X-rays of the skull widely lost their importance in the exact diagnostic of orbital tumors. B-scan ultrasonic imaging is reserved for screening and follow-up examination. Despite the use of MRI and CT scanning, the histological examination remains necessary.

[Basic classical, peptidergic and nitrergic innervation pattern of human nasal glands--a histochemical and immunohistochemical study]. / Die klassisch-vegetative, peptiderge und nitrerge Innervation der Drüsen der menschlichen Nasenschleimhaut1.

BACKGROUND: Seromucous glands are important components of the human nasal mucosa. The innervation patterns are relevant for understanding the control of the different physiological and pathophysiological glandular functions. Beside classic neurotransmitters some neuropeptides seem to influence the glandular secretion. METHODS: Tissue samples of 35 human inferior turbinates were taken during nasal surgery and preserved. Serial cryosections or paraffin sections were cut and incubated with antibodies either to Tyrosinhydroxilase or to Vasoactive Intestinal Peptide (VIP), Calcitonin Gene-Related Peptide (CGRP) and endothelial or brain Nitric Oxide Synthase (eNOS or bNOS). AChE- and NADPH-diaphorase-histochemistry were performed. RESULTS: Immunoreactive nerve fibers were found in the periglandular tissue around the acini, ducts and in the periglandular connective tissue. The density of positive immunoreactive structures depended on the different antibodies. VIP was found in contact to acinus cells, CGRP in the connective tissue around glandular cells. Particular immunoreactions to VIP and CGRP-antibodies could be detected near the glandular duct system. The eNOS-reactions were found in small capillaries near the acinus cells. CONCLUSIONS: Immunohistochemical and histochemical methods allow a detailed marking of nerval structures in nasal mucosa. The localization of neurons with different neurotransmitters and neuropeptides in the periglandular tissue confirms the direct nerval control of the diverse glandular functions. The detection of bNOS- and NADPH-d-positive structures around glandular cells and eNOS in the endothelium of periglandular capillaries suggests that NO takes an additional part in the regulation of nasal glands.

[Electron microscopy studies of innervation of nasal mucosa glands in humans]. / Elektronenmikroskopische Untersuchungen zur Innervation der Drüsen der Nasenschleimhaut des Menschen.

BACKGROUND: Seromucous glands are one of the main components of human nasal mucosa. The innervation pattern is important to understand the control of the different physiological glandular functions. In addition to light-microscopical findings electronmicroscopic investigations were performed to get more detailed information on the innervation of nasal glands. PATIENTS AND METHODS: Tissue samples of 16 human inferior turbinates were taken during nasal surgery and preserved in Unicryl or 3.5% phosphate-buffered glutaraldehyde. After fixation ultrathin sections were cut. Electron microscopical structures were photodocumented by using a transmission-electron microscope (EM 902 A Zeiss). RESULTS: Few axons were found in the periglandular tissue. No myo- or glandular-neural tight junctions could be identified. Unmyelinated nerve fibers showed typical components such as neurofilaments, neurotubules and mitochondria in their cytoplasm. An additional control of the glandular secretion by the vascular tone of the fenestrated capillary vessels will be discussed. CONCLUSIONS: Based on these ultramorphological findings further immunoelectron microscopical investigations will follow to demonstrate the various neurotransmitters and their distribution in periglandular axons.

[Endoscopic treatment of iatrogenic esophageal perforation]. / Endoskopische Behandlung einer iatrogenen Osophagusperforation.

BACKGROUND: Esophageal perforations are the most frequent complications of endoscopy of the upper gastrointestinal tract. Life-threatening consequences such as mediastinitis, septic disease, or multiple organ failure are possible. Traditional surgical and conservative methods of treatment should be distinguished. In serious cases, thoracotomy in particular is a high-risk operation. PATIENTS AND RESULTS: This case demonstrates the successful endoscopic treatment of an esophageal perforation with mediastinal empyema by fibrin gluing. CONCLUSIONS: Esophageal perforations up to 20 cm aboral and a maximum diameter of 1.5 cm could be treated by rigid endoscopical fibrin gluing. High-risk patients could be managed effectively avoiding extensive surgery.