[Update on vocal fold augmentation]. / Update Stimmlippenaugmentation.

Unilateral vocal fold palsy is a frequent cause of hoarseness. In the presence of glottis closure insufficiency, the effectiveness of conservative voice therapy is often limited and phonosurgery may be indicated. Injection laryngoplasty is effective for correction of insufficiency. Early intervention during the first 6 months after diagnosis is desired to avoid subsequent insufficient endogenous compensation. Particularly patients with glottic closure insufficiency ≤2 mm in stroboscopy may benefit from this procedure. With appropriate patient selection, duration of the effect exceeding 12 months has been described for hyaluronic acid, calcium hydroxylapatite, and autologous fat. Due to rare complications such as allergic swelling at the injection site, regular laryngoscopic monitoring and observation for two nights after injection are recommended. The voice must only be rested for a few hours.

The role of oral anticoagulants in epistaxis.

PURPOSE: The purpose of this retrospective study was to identify the impact of oral anticoagulants on epistaxis with the focus on new oral anticoagulants. METHODS: The study was conducted at the Department  for Ear- Nose- and Throat (ENT), Head and Neck Surgery, Technical University Munich, Germany. All patients presenting in 2014 with the diagnosis of epistaxis to a specialized ENT accident and emergency department were identified and analyzed in clinical data and medication. RESULTS: 600 adult cases, with a median age of 66.6 years were identified with active bleeding. 66.8% of all cases were anticoagulated. Classic oral anticoagulants (COAC) were three times more common in patients than new-generation oral anticoagulants (NOAC). Recurrent bleeding was significantly associated with oral anticoagulants (OAC) (p = 0.014) and bleeding location was most often anterior (p = 0.006). In contrast, severe cases, which required surgery or embolization were significantly more likely in non-anticoagulated middle-aged patients with posterior bleedings (p < 0.05). In our epistaxis cohort, OAC were highly overrepresented (40%) when compared to the general German population (1%) but COAC as well as NOAC played only a minor role in severe courses of epistaxis. CONCLUSION: Oral anticoagulation, especially with new-generation drugs, is not associated with more complicated and severe courses of epistaxis, but rather with recurrent bleeding. One should keep this information in mind when triaging the patient in the emergency room and when planning further procedures.

[Manifestation of rheumatic diseases in the larynx]. / Erkrankungen des rheumatischen Formenkreis mit Manifestation im Larynx.

Rheumatic disorders (rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, Wegener's granulomatosis, relapsing polychondritis) may affect the larynx. The clinical symptoms are often unspecific, leading to delayed diagnosis. Malignant tumours should be considered in differential diagnosis with necessitating biopsy. Treatment may require interdisciplinary approach together with a specialist in internal medicine and rheumatology.

[Vocal cord paralysis--analysis of a cohort of 400 patients]. / Stimmlippenparesen--Untersuchungen an einem Kollektiv von 400 Patienten.

Vocal cord paralysis has diverse etiologies. In the present study, vocal chord paralysis caused by surgery/trauma was present in more than two thirds of the cases, followed by primary malignancy-associated paralysis. Thyroidectomy was the most common cause in bilateral paresis, especially if performed in recurrent or malignant disease. Voice therapy was promising in pa-tients with unilateral paresis and hoarseness as main symptom. Persistent dysphonia due to insufficiency of the glottic closure led to an operative glottis restricting procedure in only 6% of cases. In almost half the patients with dyspnea as the main symp-tom of bilateral vocal cord paresis, temporary tracheotomy or surgical glottis widening procedures had to be performed. The group of idiopathic and traumatic paresis patients showed the best spontaneous recovery within the first 12 months in comparison to primary malignancy-associated paralysis, which showed no recovery of the recurrens nerve.

[Etiology, diagnosis, differential diagnosis and therapy of vocal fold paralysis]. / Ätiologie, Diagnostik, Differenzialdiagnostik und Therapie von Stimmlippenparesen.

Etiology of vocal fold paralysis is broad: e. g. iatrogenic/traumatic, associated with neoplasms or with systemic diseases. The cause of idiopathic paralysis is unknown. The main symptom of unilateral vocal fold paralysis is hoarseness because of a remaining glottic gap during phonation. Patients with bilateral vocal fold paralysis typically have no impairment of the voice but dyspnea. Examination of patients with an idopathic vocal fold paralysis is a CT of the vagal nerve and recurrent laryngeal nerve from skull base to neck and mediastinum. Serological tests are not obligatory. Differential diagnosis of vocal fold immobility is vocal fold paralysis/neurological causes and arthrogene causes such as arytenoid subluxation, interarytenoid adhesion and vocal fold fixation in laryngeal carcinomas. Voice therapy is a promising approach for patients with unilateral vocal fold paralysis, but not all patients benefit sufficiently. Temporary vocal fold augmentation by injection medialization results in satisfactory voice quality that is comparable with a thyroplasty. Patients with bilateral vocal fold immobility show typically dyspnea requiring immediate therapy such as temporary tracheotomy or reversible laterofixation of the paralyzed vocal chord. If the paralysis persists a definitive enlargement of the glottic airway by eg. arytenoidectomy needs to be performed.

[Management of T1a vocal fold carcinoma]. / Management des T1a Stimmlippenkarzinoms.

About 2/3 of the larynx carcinomas affect the vocal chords. The main risk factor is smoking. Carcinomas in this localisation often arise from leukoplakias with dysplasia. A typical symptom is dysphonia. Arrest of vibration in microlaryngostroboscopy is a hint that a carcinoma could be present. Transoral laser cordectomy or radiotherapy show equivalent oncological results and results in quality of voice in the treatment of vocal fold carcinoma (T1a). As lymph node and distant metastasis are very rare, follow-up can concentrate on microlaryngoscopy. In case of a suspicious area on the vocal fold, biopsy of the affected tissue is needed to plan correct treatment. The prognosis of the T1 vocal chord carcinoma is quite good with a 5-year survival rate of almost 100%.

[Benign vocal fold lesions]. / Benigne Stimmlippentumore.

Benign vocal fold lesions are grouped in lesions arising from the epithelium like papillomas, lesions affecting the Reinke's space (nodules, polyps, cysts, Reinkes's edema as a form of chronic laryngitis) and lesions affecting the arytenoid (granulomas). A multifactorial genesis is assumed. Main symptoms are dysphonia and hyperfunctional vocal behavior that might also be a cause of these lesions.

[Guillain-Barré syndrome with dysphagia after frontal sinusitis]. / Guillain-Barré-Syndrom mit Dysphagie nach Sinusitis frontalis.

One week after an acute sinusitis, a male patient developed a hypernasal voice, dysphagia, diplopic images, ataxia and paresthesias. He had paresis of the glossopharyngeal and abducens nerves, weakness of the arms and legs, and reflex deficiency. The neurography showed a motor axonal demyelinating neuropathy, so that the diagnosis of Guillain-Barré syndrome was made. After five courses of plasmapheresis, the symptoms improved rapidly.

[Disorders of the larynx and chronic inflammatory diseases]. / Manifestation internistischer Erkrankungen im Larynx: Chronisch entzündliche Erkrankungen.

Chronic inflammatory diseases including tuberculosis, rheumatic disorders (rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, Wegeners's granulomatosis, relapsing polychondritis) and reflux disease are considered as systemic diseases, and may affect the larynx. The clinical symptoms are often unspecific, leading to prolonged intervals to diagnosis. Solid and haematological tumours should be considered in differential diagnosis and may require bioptic sampling. Treatment may require interdisciplinary approach.

[Management and prognosis of patients with squamous cell carcinomas of the nasal cavity and the paranasal sinuses]. / Management und Prognose von Patienten mit Plattenepithelkarzinomen der Nasenhaupt- und Nasennebenhöhlen.

Squamous cell carcinomas (SCC) of the nasal cavity and the paranasal sinuses are a very rare and poorly understood tumor entity. To date, no consistent management strategy exists. The purpose of our study was to demonstrate our therapeutic strategy and to correlate clinicopathological features with clinical follow-up data.45 patients with primarily resected SCC of the nasal cavity (n=35) and the paranasal sinuses (n=10) between 1994 and 2010 were reviewed retrospectively (mean follow-up period 2.6 years; range 0.3 to 14.9 years).Tumors of the nasal cavity were diagnosed at an early stage (97% T1 and T2) whereas tumors of the parasinuses were found at an advanced stage (90% T3 and T4). Lymph node metastases were only found 2 patients. 13 patients (29%) had a local tumor progress, 2 patients showed lymph node metastases and 4 patients had distant metastases in follow up. The prognosis of tumors of the nasal cavitiy or the paranasal sinuses was bad (31% 5-year overall survival) especially by patients with a relapse.Reconstructive surgery was performed after 12 months, when early local relapse could be excluded. There was no positive correlation between clinicopathological features and survival data.The prognosis of tumors of the nasal cavity and paranasal sinuses depends mainly on the control of local tumor growth. Modern strategies of surgical treatment in combination with radiotherapy need to be implemented in an effort to achieve continuous tumor-free survival.

[Hearing impairment and language development]. / Periphere Hörstörungen und Spracherwerb.

A child has the first 4 years of life in which to develop speech. The first 8-10 months see the ability to distinguish sounds; later comes further linguistic ability. A hearing impairment more than 25 dB in the better ear in the speech frequencies (500-4 000 Hz) for more than 3 months has clear consequences, especially in the first 4 years of life. Therefore early diagnosis and treatment with rehabilitation of hearing loss is important for proper speech development.

[Grisel's syndrome after otoplasty]. / Grisel-Syndrom nach Anthelixplastik.

Grisel's syndrome is known as a very rare complication of ENT surgery. It is described as non-traumatic atlantoaxial rotatory subluxation, often seen after tonsillectomy or adenoidectomy in children. Therapy is staged according to the Fielding classification. We report the case of a 9-year-old female patient with Grisel's syndrome after otoplasty. The diagnosis was confirmed by CT scan. Manual reposition was performed under general anaesthesia, followed by temporary immobilization with a Minerva orthesis.

[Recurrent abcesses of the parotid gland in Sjögren's syndrome]. / Rezidivierende Parotisabszesse beim Sjögren-Syndrom.

We report on a 48-year old female patient suffering from recurrent suppurative sialo-adenitis. Resections of both parotid and the left submandibular glands had to be performed due to abscesses. The woman had suffered from recurrent swelling of the salivary glands as well as xerostomia and xerophthalmia for years. Sjögren's syndrome was diagnosed with a delay of 17 years. The current case implicates recurrent bacterial suppurative sialo-adenitis caused by longstanding Sjögren's syndrome. In every case rheumatic disorders have to be considered in the differential diagnosis of recurrent suppurative parotitis. A detailed anamnesis, ultrasound, a differential hemogram, testing for rheumatoid factor and anti-nuclear antibodies (ANA) as well as SS-A and SS-B ENAs can give early information years before Sjögren's syndrome becomes clinically apparent.