Continuous investigation of the nasal cycle over 48 hours.

BACKGROUND: Previous results on the nasal cycle refer to measurements over up to 24h. The long-term rhinoflowmetry (LRFM) allows continuous observations over a longer period. The aim of the study was to observe the nasal cycle for the first time over 48h under everyday conditions. METHODOLOGY: The LRFM was continuously applied to 30 rhinologically healthy subjects (20 female, 10 male) over 48h. The different types of nasal cycle were classified as follows: "classic", "in concert", "one-sided", "no-cycle" and "mixed". The focus of this study was on the results over the entire 48 hours. The comparison of the two consecutive days was also made. RESULTS: A nasal cycle could be detected in 100% of the subjects over 48h. With 97%, the mixed type most commonly occurred as a combination of classical and in concert components. In all subjects, classical cycle components could be detected at least once. The no-cycle type was not observed. In the awake state, the mixed type dominated (80%), as a combination of classical and in concert parts. In the sleep state, the classical type was the most common type (97%). The average phase duration was 206 ± 83 minutes. CONCLUSIONS: In the very first continuous 48-hour study on the nasal cycle, 100% of the subjects presented a nasal cycle. The LRFM method is the only one that offers the possibility to perform continuous measurements over a longer period during daily routine. The results of previous single-stage examination methods should thus be questioned.

[Diagnosis and Treatment in frontobasal fractures]. / Vorgehen bei frontobasalen Frakturen.

Traumatic brain injury can result in frontobasal fractures (FBF). The goals of treatment for FBF are to eliminate primary morbidity and/or prevent secondary morbidity. Of particular importance in this regard is the proximity of important sensory organs for hearing, vision, smell, and taste, as well as their supplying nervous structures. Medical history, clinical findings, or CT scan are necessary and should lead to an individual evaluation. Depending on the severity of the fractures, the following disciplines may be involved in the treatment of FBF: neurosurgery, plastic surgery, oral and maxillofacial surgery, and/or otorhinolaryngology. Particularly less invasive endoscopic endonasal therapy is a specialty of otorhinolaryngologic surgeons and has not been widely established in other disciplines. The present work provides an overview of the current state of the art in terms of the following aspects, taking into account the current literature: anatomic principles, classification of fractures, diagnostics (in particular clinical examination, imaging, and laboratory chemistry tests), clinical symptoms, and treatment.

Treatment success after rhinosurgery: an evaluation of subjective and objective parameters.

PURPOSE: Septal deviation and nose deformities are widely prevalent. As a consequence, patients may complain about difficulties in nasal breathing leading to a perception of diminished disease-specific quality of life. In a prospective randomized trial, we aimed to analyse the outcome of septoplasty (SPL) and septorhinoplasty (SRP) on patient satisfaction. METHODS: Patients with functional indication for SPL (n = 19) or SRP (n = 54) were included and randomized for additional turbinoplasty. Preoperative clinical symptoms were collected with SNOT-20 GAV (Sinu-nasal outcome test-20-German adapted version) and NOSE© (nasal obstruction symptom evaluation) questionnaires. The final evaluation of treatment success was performed 9 months after surgery with SNOT-20 GAV, NOSE© and a self-established feedback questionnaire. Nasal breathing and obstruction were objectively measured with rhinomanometry and acoustic rhinometry [minimum cross-sectional area 2 (MCA2)]. RESULTS: Minimum cross-sectional area 2 was statistically improved compared to the pre-treatment value in SPL (p = 0.0004) and SRP (p = 0.0001). Regarding MCA2 values of matched patient groups, similar findings were detected (SPL: p = 0.0013, SRP: p < 0.0001). Sinu-nasal outcome test-20 GAV and NOSE© scores were significantly reduced after both surgical procedures (NOSE©: SPL: p < 0.0001, SRP: p < 0.0001; SNOT-20 GAV: SPL: p = 0.0068, SRP: p < 0.0001). Evaluation of patient satisfaction in a self-established feedback questionnaire revealed a motivation of 81% of patients to redo the surgery (SPL 13/16, SRP 34/42) and a notably general satisfaction of 86% for SPL and 80% for SRP. CONCLUSION: Rhinosurgery leads to quantitative better nasal breathing and increased disease-specific satisfaction. However, this study implies the importance of the right selection of patients and the correct indication of the surgical technique.

[Symptoms, causes, and treatment options of geriatric nose]. / Symptome, Ursachen und Behandlungsmöglichkeiten der Altersnase.

With increasing age, structures of the internal and external nose change. Many elderly patients complain about rhinitis with nasal obstruction, endonasal crusting, epistaxis, intermittent rhinorrhea, and olfactory disorders. These symptoms are mainly caused by atrophy of the mucosa and the olfactory epithelium, but may also be an expression of drug side effects. Additionally, there are changes in the shape of the nose (continuous growth, altered elasticity of supporting structures) and in the dermis, which may develop tumors due to its sun-exposed position. These multiple internal and external changes of the nose can be summarized by the collective term "aging nose," whose treatment options are complex. These range from conservative (nasal care, medication changes, hemostatic measures) to surgical lines of therapy (septorhinoplasty, tumor excision, vascular ligation) and will require further scientific study in the future.

Re-evaluating the nasal cycle by long-term rhinoflowmetry: most individuals demonstrate a 'mixed' nasal cycle.

BACKGROUND: The nasal cycle seems to be more complex than a strictly alternating swelling of the nasal mucosa. Long-term rhinoflowmetry (LRFM) allows continuous investigation of changes in nasal airflow over 24 hours (24h). We evaluated the various types of nasal cycle with LRFM over 24 hours and investigated the influence of age and gender. METHODS: LRFM was continuously performed over 24h in 55 rhinologically healthy subjects (36 female, 19 male). The LRFM flow curves were examined for phases of the 'classical' 'in-concert' 'one-side' and'no-cycle' cycle types. Subjects were divided into 4 age subgroups (19-29; 30-49; 50-69; >70 years). Correlations of age and gender with the individual cycle forms were analyzed. RESULTS: 85.5% of the subjects presented a 'mixed' nasal cycle within 24h. 'classical' nasal cycle was seen most often (92.7% vs. 'in-concert' 56.4% vs. 'one-sided' 18.2% vs. 'no-cycle' 5.5%). Older age groups significantly more often presented the 'no-cycle' type. A tendency was seen towards a mixed nasal cycle with increasing age. The mixed nasal cycle was significantly more often seen in the female subjects. CONCLUSIONS: LRFM is an easy-to-use measurement tool. The 'mixed' nasal cycle predominates. However, all 4 different cycle types can be detected, alternating over 24h in each subject. Moreover, the cycle type varies with age.

Preclinical Performance Evaluation of a Robotic Endoscope for Non-Contact Laser Surgery.

Despite great efforts, transoral robotic laser surgery has not been established clinically. Patient benefits are yet to be proven to accept shortcomings of robotic systems. In particular, laryngeal reachability and transition from microscope to accurate endoscopic laser ablation have not been achieved. We have addressed those challenges with a highly integrated robotic endoscope for non-contact endolaryngeal laser surgery. The current performance status has been assessed in multi-level user studies. In addition, the system was deployed to an ex vivo porcine larynx. The robotic design comprises an extensible continuum manipulator with multifunctional tip. The latter features laser optics, stereo vision, and illumination. Vision-based performance assessment is derived from depth estimation and scene tracking. Novices and experts (n = 20) conducted teleoperated delineation tasks to mimic laser ablation of delicate anatomy. Delineation with motion-compensated and raw endoscopic visualisation was carried out on planar and non-planar nominal patterns. Root mean square tracing errors of less than 0.75 mm were feasible with task completion times below 45 s. Relevant anatomy in the porcine larynx was exposed successfully. Accuracy and usability of the integrated platform bear potential for dexterous laser manipulation in clinical settings. Cadaver and in vivo animal studies may translate ex vivo findings.

[Function and physiology of the maxillary sinus]. / Funktion und Physiologie der Kieferhöhle.

BACKGROUND: The question of the "true" function of the maxillary sinus and the paranasal sinuses (PS) has been a controversial issue in the literature for decades, leading to many discussions and speculations. OBJECTIVE: This review briefly summarizes various theories on the possible physiology and functions of the maxillary sinus/PS that have been discussed over the centuries. MATERIALS AND METHODS: A literature search was conducted in PubMed using a combination of the search terms "physiology," "function," "maxillary sinus," and "paranasal sinuses." RESULTS: Current and scientifically evidenced theories are described. "Sinusology" is the science of the PS. The maxillary sinuses might simply serve to improve the respiratory function of the nose. A flow of inspiratory air does not occur. The maxillary sinuses are decisively involved in the production of nitrogen monoxide (NO) and thus in supporting the immune defense of the nasal cavity. The mucosa of the maxillary sinus continuously synthesizes NO and serves as a reservoir of NO. Other important functions are protection of the orbit and the brain in case of skull fractures, as well as weight reduction of the skull. CONCLUSION: The various theories about the function of the PS still raise many questions and their true function is yet not fully understood. Possible functions of the maxillary sinuses are local immune defense through the production of NO. The PS serve as a crumple zone for vital cerebral structures in the context of craniocerebral traumas.

Value of turbinoplasty in rhinosurgery - a controlled randomized study.

BACKGROUND: Turbinoplasty is a common procedure in patients with nasal obstruction and hypertrophy of the nasal turbinates. A general recommendation regarding the necessity of turbinoplasty in functional rhinosurgery is still missing. For the first time, the value of turbinoplasty in septo- and septorhinoplasty regarding patient satisfaction as well as objective data in rhinomanometry and acoustic rhinometry was analyzed in a prospective randomized controlled trial. METHODOLOGY: 73 patients with nasal obstruction due to septal deviation and / or a deviated nose were included in the study. After randomization, anterior turbinoplasty was or was not performed during septo- or septorhinoplasty. Pre- and postoperative rhinomanometry and acoustic rhinometry were accomplished. NOSE© and SNOT 20 questionnaires were completed by the patients before and 9 months after surgery. Additionally, the patients were asked about their subjective satisfaction. RESULTS: 81% of the patients were subjectively satisfied with the postoperative improvement of nasal breathing. There was a significant improvement in the values of NOSE© and SNOT 20 questionnaires with no relevant difference between the two study groups. Acoustic rhinometry and rhinomanometry showed values in MCA1 and 2, Vol 1 and Vol 2 as well as higher nasal flows with no statistically significant difference between the two study groups. CONCLUSIONS: Patient satisfaction after functional septo- and septorhinoplasty is high and does not seem to be affected by turbinate surgery. There was no statistically significant difference in the postoperative results regarding objective rhinological measurements with or without turbinoplasty. As extensive resections of the turbinates can have a negative impact on nasal physiology, the indication for turbinoplasty must be considered carefully.

[Negative effects of stripe conchotomy on intranasal conditioning]. / Negative Auswirkungen der Streifenconchotomie auf die intranasale Klimatisierung.

OBJECTIVE: Partial resection of the caudal part of the inferior turbinate including the head is still performed in rhinosurgery ("stripe conchotomy"). However, extensive resections of the turbinate affect nasal airflow and intranasal conditioning. The aim of this study was to determine the effect of partial resection of the inferior turbinate including its head on intranasal air flow as well as warming and humidification of the inspired air by means of computational fluid dynamics. MATERIALS AND METHODS: A bilateral, realistic nasal model was created based on the CT scan of a patient. A unilateral partial resection of the lower turbinate on the right side had been performed externally. A numerical simulation was performed to analyze intranasal air flow patterns, temperature, and humidity distribution of the inspired air. RESULTS: Due to the partial resection of the lower turbinate on the right side, the flow pattern was significantly altered compared to the opposite side. Resection leads to a centered and higher velocity in the inferior nasal meatus as well as to reduced heating and humidification of the inhaled air compared to the untouched left nasal cavity. CONCLUSION: Partial resection of the caudal part of the inferior turbinate may lead to disturbed intranasal conditioning of inspired air if performed too radically. Therefore, if possible, this procedure should be avoided and a more gentle mucosal procedure chosen.

An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept.

Objective Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15-90 degrees). Results Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.

Treatment of ear keloids: algorithm for a multimodal therapy regimen.

Keloids are benign cutaneous lesions, arising from proliferating fibroblasts. Keloids of the ear may occur after trauma, surgery or helix piercings and are difficult to treat, since they tend to form recurrences. Guidelines suggest multimodal therapy; however, recurrence rates remain high and distinct algorithms for the combination of different modalities are missing. To unravel the most effective combination of therapeutic options for keloids of the ear, 38 patients with the diagnosis of an ear keloid were included in our cohort. In a prospective subgroup (B) of this cohort (n = 17), patients either underwent surgery using the "fillet technique" (a meticulous peeling of the keloid skin) and intra-lesional injections of triamcinolone 10 mg/ml every 4-6 weeks for 6 months, or they were additionally treated with a non-customized pressure device which was recommended for at least 16/24 h per day over 6 months. To further compare our results, the remaining 21 patients of our cohort, who were treated at our clinic before, were retrospectively evaluated concerning their recurrence rates. The mean follow-up was 48 months. The mean count of adjuvant steroid injections was two in all patients, four in subgroup B. The recurrence rate was 30% (13/38) in all patients (subgroup B 0/17). Aesthetic results were good to excellent in all non-recurrent cases. No patient treated with fillet technique showed recurrence (p < 0.001). However, we could not confirm a significant effect but a trend of repeated steroid injections for preventing recurrences (p = 0.099). The application of pressure using our non-customized clip also showed a clear trend towards preventing recurrences in cross-table analysis (p = 0.057). Although several studies on different treatment regimens for keloids of the ear exist, the effectiveness of a multimodal treatment regimen needs to be elucidated. Overall, the best results in preventing recurrences were achieved by combining three different treatments. However, the fillet technique was the only modality preventing recurrences of keloids in uni- and multivariate analysis. The application of pressure with a non-customized clip and repeated steroid injections also showed a positive trend but failed level of significance. Based on our data and the literature we recommend, when feasible, the combination of more than one therapeutic regimen, since relapse risk went down from single to dual and triple therapy from 40% (8/20) to 14.3% (2/14) to 0% (0/4), respectively in our cohort. The use of "fillet technique" was especially beneficial.

[Nasal turbinate surgery]. / Nasenmuschelchirurgie.

The nose forms the first 8 cm of the upper respiratory tract and is responsible for cleansing, humidification, and temperature control of the supplied air. This is also referred to as conditioning. The nasal valve region, formed by the head of the lower nasal concha, portions of the cartilaginous septum, and the upper lateral cartilage, is responsible for diffusing and accelerating the respiratory airflow. Prerequisite are regular mucociliary clearance and sufficient air passage. Hypertrophy of the lower nasal turbinate is one of the most common causes of symptomatic nasal congestion. In unclear cases, rhinometric procedures are available. In addition to conservative therapy of allergic or vasomotor rhinitis by specific immunotherapy or topical corticoids, numerous interventional procedures are available to reduce conchal tissue. All modern methods have a high degree of protection of the respiratory mucosa in common.

Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus.

Zenker's diverticulum is a common pathology in the transition zone of the posterior hypopharynx and esophagus. Surgical treatment is routinely performed by ENT and general surgeons. Besides the traditional open transcervical diverticulectomy, the introduction of transoral rigid treatment led to a paradigm change and is now the preferred treatment option for patients who are fit for general anesthesia. The implementation of interventional flexible endoscopy has opened another new micro-invasive approach for patients with high morbidity. Here, we present the potential utilization of a flexible, single port, robot-assisted, and physician-controlled endoscope system to facilitate transoral surgical access to the hypopharynx and upper esophagus. Transoral surgery of the hypopharynx and upper esophagus was performed in human cadavers (n = 5) using the Flex System (Medrobotics, Raynham, USA). Anatomical landmarks were identified, and posterior cricothyroid myotomy was performed with compatible flexible instruments in all cases. The approach to the hypopharynx and upper esophagus using the Flex system is feasible in a cadaveric model. Myotomy with a flexible tool and needle knife (from the perspective of treatment of Zenker´s diverticulum) was successful in all cases. Visualization of the surgical site with the system's HD camera is suitable and the flexible instruments meet the special needs of a micro-invasive transoral approach. Zenker´s diverticulum can be potentially treated with a transoral minimally invasive approach using a computer-assisted flexible endoscope system. This setup could be of advantage in patients with reduced mobility of the cervical spine to prevent open transcervical surgery. In our study, the Flex system enabled advanced visualization of the surgical site and extended intervention options, compared to standard flexible endoscopic treatment. However, general anesthesia is mandatory for the presented approach. Application in live patients with actual pathologies of the hypopharynx and upper esophagus will have to prove suitability for the treatment of Zenker's diverticulum. Further development of the system could include improved instrumentation and an adoption by other disciplines with challenging anatomy such as colorectal surgery.

First use of flat-panel computed tomography during cochlear implant surgery : Perspectives for the use of advanced therapies in cochlear implantation.

BACKGROUND: Cochlear implantation in routine cases with normal anatomy is commonly performed without intraoperative image guidance. Revision cochlear implantation as well as surgery in malformations require not only a precise understanding of the underlying complex anatomy, but surgeons need to transform two-dimensional computed tomography (2D CT) scans into the surgical field and use this information for intraoperative surgical navigation. So far, information about the exact position of the electrode during insertion cannot be provided to the surgeon. Here, we present our first operative experience with cochlear implant surgery supported by intraoperative Dyna-CT technology, providing the surgeon with detailed views of the electrode location. METHODS: To prove the feasibility of the procedure, two cases of cochlear implantation were performed with intraoperative application of cone-beam CT acquired by a C-arm Dyna-CT system (Artis Zeego, Siemens Healthcare, Erlangen, Germany). Image reconstruction was performed intraoperatively in order to assess the correct positioning of the electrodes. RESULTS: Intraoperative Dyna-CT enabled clear visualization of the surgical anatomy and intracochlear electrode position. Dyna-CT technology can be applied with acceptable additional time requirements without adding too much complexity to the surgical procedure. CONCLUSION: Intraoperative data acquisition by Dyna-CT represents a suitable option for online surgical navigation during cochlear implant surgery. This imaging technology will push further advances in cochlear implant surgery and lateral skull base surgery, particularly if linked to intraoperative navigation.

Saline irrigations following sinus surgery - a controlled, single blinded, randomized trial.

BACKGROUND: Chronic rhinosinusitis (CRS) is a common health problem. If medical treatment fails, endonasal sinus surgery is a valuable treatment option. A thorough postsurgical treatment is needed including, among others, nasal saline irrigations (NSI). In this prospective, controlled, single blinded, randomized trial, we aimed to evaluate efficacy of nasal saline irrigations following endonasal sinus surgery in CRS-patients with nasal polyps. METHODOLOGY: We examined patient's nasal symptoms, general quality of life and postoperative condition of the mucosa. We also investigated whether or not NSI reduced the number of missed workdays after surgery (MWD). Patients were randomized into an irrigation and non-irrigation arm. RESULTS: Following treatment, mean nasal sum-score in the irrigation arm was 4.4 and in the non-irrigation arm it was 6.3. Accordingly, mean general sum-score in the irrigation arm was 2.5 and in the non-irrigation arm 4.8. Thus, nasal irrigation led to a more pronounced improvement of nasal and general symptoms than in the non-irrigation arm. No differences were observed in postoperative condition of mucosa or number of MWD. CONCLUSIONS: Nasal irrigation improves symptoms score after ESS in patients with CRSwNP.

[Autologous composite grafts from the cavum conchae for reconstruction of multilayer nasal defects]. / Das autologe Haut-Knorpel-Transplantat aus dem Cavum conchae zur Rekonstruktion mehrschichtiger nasaler Defekte.

BACKGROUND: Autologous transplants comprising skin and cartilage, so-called composite grafts (cgs), are an important reconstructive tool for multilayered defects of the nose. A cg from the auricular cavum conchae needs to fulfill both functional and esthetic demands. OBJECTIVE: This article illustrates the indications for and requirements of cgs, and also investigates graft healing and functional-aesthetic results. The current publication is a review article; the original data were published with the award of the 2014 APKO prize under the title "The auricle's cavum conchae composite graft in nasal reconstruction". MATERIALS AND METHODS: At the ENT department of Ulm University Medical School, multilayered defects of different nasal esthetic subunits are reconstructed with cgs. Based on these experiences, the authors report on long-term functional and esthetic results in the areas of the donor and recipient sites. CONCLUSION: Auricular cgs are versatile and reliable autologous transplants. The ease of harvesting, minimal donor site morbidity, and stable convex shape of these grafts render them ideal for reconstruction of multilayered nasal defects. Septal splints and custom-made prosthesis promote healing and prevent stenotic scarring.

Patient comfort following FESS and Nasopore® packing, a double blind, prospective, randomized trial.

BACKGROUND: The use of nasal packing after functional endoscopic sinus surgery (FESS) is often associated with pain and a feeling of pressure for patients. The aim of the present work was to investigate a modern wound dressing made of polyurethane (Nasopore®) that makes removal of the nasal packing unnecessary and is focussed on patient comfort. METHODOLOGY: Following bilateral FESS, after randomisation, one side was packed with Nasopore® while the other side was without packing as a control. The following parameters from 47 patients were determined daily in two centres from post-operative day 1 for the duration of the inpatient stay in a double-blinded setting: side-specific post-operative bleeding, nasal breathing and feeling of pressure as well as the general parameters sleep disturbance, headaches and general well-being. Which side patients considered subjectively the better was also recorded. RESULTS: No significant differences were determined between the two sides in terms of the rates of post-operative bleeding and nasal breathing. The feeling of pressure was slightly less on the side packed with Nasopore® on post-operative days 2 and 3. No trend could be observed regarding which side patients described as being subjectively better. CONCLUSION: There were only slight differences in patient comfort between the Nasopore® side and the control. Because the feeling of pressure in the midface was significantly less and there were no complications, this suggests there is greater patient comfort when using Nasopore® compared to using no nasal packing.

[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.

Chitinase enzyme activity in CSF is a powerful biomarker of Alzheimer disease.

OBJECTIVE: DNA damage accumulation in brain is associated with the development of Alzheimer disease (AD), but newly identified protein markers of DNA damage have not been evaluated in the diagnosis of AD and other forms of dementia. METHODS: Here, we analyzed the level of novel biomarkers of DNA damage and telomere dysfunction (chitinase activity, N-acetyl-glucosaminidase activity, stathmin, and EF-1α) in CSF of 94 patients with AD, 41 patients with non-AD dementia, and 40 control patients without dementia. RESULTS: Enzymatic activity of chitinase (chitotriosidase activity) and stathmin protein level were significantly increased in CSF of patients with AD and non-AD dementia compared with that of no dementia control patients. As a single marker, chitinase activity was most powerful for distinguishing patients with AD from no dementia patients with an accuracy of 85.8% using a single threshold. Discrimination was even superior to clinically standard CSF markers that showed an accuracy of 78.4% (ß-amyloid) and 77.6% (tau). Combined analysis of chitinase with other markers increased the accuracy to a maximum of 91%. The biomarkers of DNA damage were also increased in CSF of patients with non-AD dementia compared with no dementia patients, and the new biomarkers improved the diagnosis of non-AD dementia as well as the discrimination of AD from non-AD dementia. CONCLUSIONS: Taken together, the findings in this study provide experimental evidence that DNA damage markers are significantly increased in AD and non-AD dementia. The biomarkers identified outperformed the standard CSF markers for diagnosing AD and non-AD dementia in the cohort investigated.

[Surgery of the turbinates and "empty nose" syndrome]. / Nasenmuschelchirurgie und "Empty Nose" Syndrom.

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The wanted goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings and simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose they take care of climatisation, moistening and cleaning of the inhaled air. Thus a free nasal breathing means a decent quality of life as well. Regarding the multitude of different surgical techniques we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover there is a lack of prospective and comparable long-term studies which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation and therefore it is the method of choice today. Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The "empty nose" syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interferes with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in "empty nose" patients are presented.