[Botulinum toxin in otorhinolaryngology - an update]. / Botulinumtoxin in der HNO­Heilkunde ­ ein Update.

During recent decades, the clinical use of botulinum toxin has become increasingly well established. In the field of otorhinolaryngology there are many indications for which botulinum toxin can improve patients' quality of life. These include applications in the region of the head and neck muscles and the autonomic nervous system in patients suffering from movement disorders of special muscles and secretory disorders (salivary, lacrimal, and sweat glands). The present article presents an overview of well-established and new indications for application of botulinum toxin in the head and neck region.

[Surgery of benign vocal fold lesions]. / Chirurgie gutartiger Stimmlippenbefunde.

Surgical treatment of benign vocal fold lesions can be indicated for clinical or functional reasons. The principles of phonosurgery have to be maintained in either case. The appropriate phonosurgical technique depends on the type of vocal fold lesion. Depending on the findings, phonosurgery aims to maintain or improve voice quality. The evaluation of clinical and functional results includes indirect laryngoscopy, videostroboscopy, and voice analysis.

[On the reliability of brainstem electric response audiometry (BERA)]. / Zur Verlässlichkeit hirnstammaudiometrischer Hörschwellenbestimmungen.

BACKGROUND: Brainstem electric response audiometries (BERA) are in clinical use for a number of years. The aim of our study was to evaluate data regarding the long-term reliability of BERA-determined frequency specific thresholds in hearing disabled children. MATERIAL AND METHODS: In a group of 97 hearing disabled children we sought to compare Notched-Noise- (NN) BERA threshold as well as Click-BERA thresholds taken shortly after birth with behavioral audiometry thresholds determined after 3.2 years (mean). RESULTS: We found a significant correlation between both BERA methods and the behavioral tests. However, the correlation coefficients for NN-BERA were higher than for Click-BERA thresholds. CONCLUSION: Our results provide evidence for a high reliability of the NN-BERA for characterization of early onset hearing disabilities in children. Our data suggest that pathologic findings in the Click-BERA should always be followed by a frequency specific analysis with NN-BERA.

[The application of botulinum toxin in oromandibular, pharyngeal and laryngeal dystonia]. / Zur oromandibulären, pharyngealen und laryngealen Anwendung von Botulinumtoxin.

Dystonias of the oral, pharyngeal and laryngeal muscles are potential causes of deglutitive, respiratory and communicative disorders. In addition to functional deficits such as dysphagia, dysarthria and dysphonia, social disadvantages may arise from the visible or audible manifestations. Treatment with botulinum toxin offers symptomatic and temporary therapeutic effects. Examples of applications in oromandibular dystonia, palatoclonus, dysphagia and laryngeal dystonia (e.g., spasmodic dysphonia) are described.

Molecular epidemiology of group A rotavirus diarrhea among children in Buenos Aires, Argentina, from 1999 to 2003 and emergence of the infrequent genotype G12.

To examine the epidemiology of rotaviruses in Buenos Aires, Argentina, we screened 1,212 stool samples from children with diarrhea in the southern district of Buenos Aires from 1999 to 2003. We identified 187 samples (15.4%) that were positive for group A rotavirus by use of antigen enzyme-linked immunosorbent assay. Among these specimens, 112 were available for typing: 93 (83.0%) were single-type infections, 9 (8.0%) were mixed-type infections with more than one G or P type, and 10 (8.9%) were G and/or P nontypeable. In contrast to the findings in our last study, from 1996 to 1998, genotype P[4], G2 strains were almost completely absent and P[8], G1 and P[8], G4 strains were dominant, representing more than 80% of the G and P types found. Genotypes G2 and G9 were detected in few samples, and type G3 was completely absent. We identified several uncommon genotype G12 strains, representing the first detections outside of Asia and the United States, by sequencing. Using a genotype G12-specific reverse transcription-PCR, we identified eight (6.7%) positive samples for the 1999 to 2003 period. The high degree of sequence identity between recent G12 isolates from Argentina, the United States, and Asian countries suggests a relatively recent introduction(s) of these strains into humans from a common progenitor. The Argentinean G12 strains belonged to genotype P[9], similar to most of the recently described Asian G12 strains. The finding of G12 strains in several other regions of the world raises the possibility that G12 may be emerging globally and suggests that surveillance for this strain should be conducted routinely.

Quality of life after treatment for laryngeal carcinomas.

The objective of this study was to evaluate the impact of different surgical treatments as well as of radiotherapy for laryngeal carcinomas on health-related quality of life (QL). In a prospective, randomized multicenter study (five university hospitals in Germany), a total of 146 patients with laryngeal carcinomas (UICC stages: I-IV) underwent different surgical treatments (32 total laryngectomies, 81 CO(2) laser microsurgical partial laryngectomies, 33 open partial laryngectomies). Postoperative radiotherapy was performed in 44 patients. QL data were obtained by using the EORTC QLQ-C30 questionnaire (developed by the European Organization for Research and Treatment of Cancer). Impaired QL data were seen after total laryngectomy and after radiotherapy. Radiotherapy seemed to have more impact on QL than surgical treatment. Global QL was not affected by any treatment. In general, the QL data were not as discriminating as presumed. To evaluate coping abilities, objective measures (voice, swallowing, breathing) should be obtained for comparison in further investigations.

Botulinum toxin type A induces apoptosis in nasal glands of guinea pigs.

Nasal hypersecretion is predominantly caused by overaction of nasal glands, which are mainly under cholinergic control. In this work, we investigated the influence of botulinum toxin A (BTA) on the nasal mucosal tissue of the maxillary sinus turbinates of guinea pigs (n = 10) that were painlessly sacrificed 10 days (short-term group) or 3 months (long-term group) after local treatment with 20 units of BTA (Botox) or 0.2 mL of 0.9% sodium chloride (control). Histologic investigation of the nasal mucosal tissue of the BTA-treated animals (short-term group) showed degeneration of glands and ducts and apoptotic nuclei on TUNEL staining of these structures. The control animals revealed normal glandular tissue and no apoptosis. The animals of the long-term group showed almost normal glandular tissue and only a few apoptotic nuclei. In conclusion, BTA induces temporary apoptosis in the nasal glandular compartment of guinea pigs.

A method for measuring interrater agreement on checklists.

A method for measuring interrater agreement on checklists is presented. This technique does not assign individual scores to raters, but computes a single agreement score from the concordance of their check mark configurations. An overall coefficient of agreement, called phi, is derived. The agreement coefficient that is expected by chance and the statistical significance of phi are determined by statistical simulation. Despite the dichotomous nature of the checklist agreement (raters either agree or disagree on items), we show that the binomial distribution does not provide a means for testing the statistical significance of phi. A medical education study is used to illustrate the phi methodology.

[Nd:YAG laser treatment of the lower turbinates with contact in hyperreflexic and allergic rhinopathy]. / Nd:YAG-Laserbehandlung der unteren Nasenmuscheln im Kontaktverfahren bei der hyperreflektorischen und der allergischen Rhinopathie.

BACKGROUND: Nasal obstruction caused by mucosal swelling due to hyperreflectory or allergic rhinitis is a very frequent disorder. We would like to report about our first results (ENT department, University of Göttingen) in the reduction of hyperplastic inferior turbinates by Nd:YAG Laser treatment. PATIENTS AND METHOD: One hundred seventeen patients with nasal obstruction were treated by Nd:YAG laser between October 1993 and February 1997. We used the laser in "contact mode" and all outpatients were under local anaesthesia. Follow-up was possible in 83 cases. A subjective scale was used to evaluate our results. One quarter of the patients suffered from an allergic rhinitis. RESULTS: For 80% the nasal airflow was increased. Sixty percent had excellent or good results without any nasal obstruction after therapy. The patients with allergic rhinitis performed as well as the patients with hyperreflectory rhinopathy. This improvement appeared as early as four weeks after treatment and was permanent in 37 of 40 cases with long-term observation of at least one year. Side effects: 14% reported a dry nasal mucosa for two weeks; 31% had a bloody nasal secretion for two days after treatment, but did not bleed. Fifteen percent complained of pain during the procedure. CONCLUSION: The reduction of the inferior turbinates by Nd:YAG laser is an effective treatment of equal value in symptomatic therapy of the hyperplastic turbinates due to hyperreflectory and allergic rhinopathy. Seventy-three percent of these patients would like to be treated in this way again if necessary.

[Early detection and hearing aid management of pediatric unilateral hearing loss]. / Früherkennung und Hörgerätversorgung unilateraler kindlicher Schwerhörigkeiten.

BACKGROUND: Unilateral hearing loss in children is frequently an incidental diagnosis, usually late. As in binaural hearing disorders, early detection is extremely important to protect the function of the "remaining ear" and thus ensure acquisition of speech. Prompt initial probatory treatment with a conventional hearing aid is necessary to take advantage of the sensitive phases of development and maturation of the auditory pathways. This allows lateralisation as well as a better discrimination, avoiding cocktail party and non-physiologic head shadow effects. PATIENTS: The study includes 32 children with a conventional hearing aid. The average age of diagnosis was 5.5 years. The children were initially treated with a conventional hearing aid. RESULTS: The etiology remained unknown in the majority of the cases. Twenty-seven of the children were observed over a longer period, averaging 2 years. Hearing aid acceptance was found to be 63% with a measurable hearing improvement in 59% of the patients, even in the presence of severe hearing disorders. In the majority of the cases, the etiology remained unknown. CONCLUSION: More knowledge about risk factors for unilateral hearing losses in children should improve the chances for early detection, making hearing aid supply at a younger age possible. This should happen firstly in a probatory manner and in cases with hearing aid acceptance and a measurable hearing improvement definitely.

A student health HMO as a partnership model within an academic medical center.

The Department of Family Practice, College of Medicine, in partnership with the University of Illinois at Chicago, was responsible for the reorganization of the Student Health Service into a health maintenance organization (HMO), Campus Care. Historically, the two campuses of the University of Illinois at Chicago operated student health as an infirmary model. Reorganization of student health into the Campus Care HMO provided expanded health care services to students, preserved more health care dollars in the university system, and provided a nonincremental increase in the size and responsibility of the Department of Family Practice. One year's experience showed that while the capitation was low compared with standard HMOs, the variable and less frequent use of services by the student population resulted in a fiscally viable operation. Numerous transition difficulties were encountered, including the need for rapid systems conversion within a complex university system, reeducation of students as well as traditional university-based practitioners for operation in a managed care system, and the rapid expansion of a small family practice department. The positive experience of the University of Illinois at Chicago supports the notion that family practice is better suited to providing student health care than other primary care disciplines. Three issues are paramount to success: (1) approval, support, and protection by higher level administration from university territorialism, (2) a core family practice faculty with strong leadership and experience in high-volume clinical activity, and (3) a close examination of financial resources in light of expected utilization.