[Functional and audiological results of tympanoplasty type I using pure perichondrial grafts]. / Funktionelles und audiologisches Ergebnis der Tympanoplastik Typ I mit reinem Perichondrium.

BACKGROUND: There are very few studies analyzing the functional und audiological results of tympanoplasty type I using pure perichondrium. MATERIALS AND METHODS: Data of 80 randomly selected patients, who had tympanoplasty surgery between 1998 and 2008 with pure perichondrium were evaluated retrospectively. Average postoperative follow-up was 9 months. The preoperative- and postoperative status of tympanic membrane, air-bone gap (ABG) and influence of perforation size and perforation etiology on closure rate served as study parameters. RESULTS: The closure rate for tympanoplasty type I with pure perichondrium was 85% and the mean ABG reduction was 10.8±7.22 dB. Size and etiology of the perforation had no influence on operative results. CONCLUSIONS: Concerning closure rates pure perichondrium is very suitable for repairing tympanic membrane defects. Postoperative audiological results can be compared to other transplants, such as temporal fascia or combined cartilage-perichondrium grafts and the intraoperative handling and positioning seem to be more comfortable.

[Vestibular dysfunction after cochlear implant in adults]. / Vestibuläre Störungen nach Cochleaimplantat bei Erwachsenen.

BACKGROUND: According to the literature, clinical vertigo after cochlear implant (CI) occurs in 0.33-75%, a peripheral vestibular loss of function in 20-75%. MATERIALS AND METHODS: Between 2006 and 2009, 30 adults were implanted with a 22-channel Nucleus Freedom CI (41 operations). Cochleostomy was performed anterocaudal of the round window and the electrode inserted using the "off-stylet" technique into the scala tympani. RESULTS: Clinical vertigo occurred after 10/41 (24.4%) operations: acutely in 5/41 (12.2%), continuous in 1/41 (2.4%), delayed for 6-18 months in 5/41 (12.2%). In the calorimetry, 3/27 (11.1%) vestibular organs displayed a loss of function (p = 0.16). Three of 8 patients (37.5%) with clinical vertigo after surgery showed a loss of vestibular function (p = 0.08). CONCLUSION: Using the described techniques and materials, the risk of loss of vestibular function and the incidence of clinical vertigo can be minimized. Postoperative vertigo did not occur more often in patients with preoperative diminished vestibular function than in patients with normal findings. Therefore, preoperative vestibular function tests cannot be an indicator for the frequency of vertigo after CI. If one vestibular organ shows preoperative dysfunction, the non-affected normal vestibular organ should not be implanted.

[Outpatient diode laser tonsillotomy in children with tonsillar hyperplasia. Clinical results]. / Ambulant durchgeführte Diodenlasertonsillotomie bei symptomatischer Tonsillenhyperplasie des Kindes. Klinische Ergebnisse.

INTRODUCTION: The aim of this retrospective study was to present the postoperative development, therapy effectiveness, and parental satisfaction after an outpatient diode laser tonsillotomy in children with noninflammatory tonsillar hyperplasia. METHOD: The study included 183 children with noninflammatory tonsillar hyperplasia who were operated on between October 2004 and October 2006 (average age: 4 years and 7 months). All children underwent diode laser tonsillotomy in contact mode (812 nm, continuous wave, 13 W) with or without additional procedures (adenotomy, paracentesis, tympanic drainage). All surgeries were carried out under endotracheal anesthesia by two ENT physicians in private practice in an outpatient surgery center. The patients (n=82) of one of the physicians were given an oral antibiotic for the 7 days following the surgery (cefuroxime syrup), and all children were given standard pain medication after the surgery (ibuprofen syrup). The postoperative development, complications, or late complications, the recurrence frequency, the effectiveness of the treatment, and the parental satisfaction were assessed using the respective results of the follow-up exams (average follow-up period: 1 year) and a standardized parent questionnaire, completed on average 1 year and 8 months after the surgery. For data digitalizing and statistical analysis with SPSS the chi(2) test and the Wilcoxon test were used (p<0.05). RESULTS: Generally, patients experienced no or only very little pain, and there was no secondary bleeding after tonsillotomy. Occasionally, a conspicuous wound surface (2.9%), fever (2.3%), or reddened palatal arch (1.2%) were noted. There were no late complications such as scar tissue distortions on the soft palate or peritonsillar abscesses. The procedure's effectiveness with regard to snoring, obstructed respiration, apnea, lack of appetite, and susceptibility to infection was very good and the level of parental satisfaction very high. The postoperative development showed significant differences between the two groups (with and without oral antibiotic) concerning postoperative pain (point score: 0-3): in the antibiotics group there was no postsurgical pain (average point score: 0.1), and in the group without antibiotics there was slight postsurgical pain (point score: 0.5). CONCLUSION: Outpatient diode laser tonsillotomy for children with symptomatic tonsillar hyperplasia is a rather painless surgery method with a low perioperative risk, very high treatment effectiveness, and parental satisfaction. For this indication tonsillotomy is the therapy of choice. There were no differences in terms of postoperative development between the diode laser tonsillotomy compared to the literature of the more common CO(2) laser tonsillotomy.

[Process optimization in ENT: clinical pathways and central induction area]. / Prozessoptimierung in der HNO : Behandlungspfade und zentrale Einleitung.

INTRODUCTION: Owing to the rising costs in the health care system, it is now important to optimize processes through standardization and process consolidation. A lack of process consolidation in this area of operation or overly long durations of stay of patients in the hospital can lead to increased costs for the ENT department. The aim of this study was to examine whether process optimization could be achieved through close interdisciplinary networking with clinical pathways and central induction (CI). MATERIAL AND METHODOLOGY: In the 1-year periods before and after the implementation of CI, turnover times in the ENT department were retrospectively examined and 2,433 patients from the entire operative ENT spectrum were included. The average durations of stay before and after the implementation of the "septoplasty" pathway were additionally evaluated. RESULTS: ENT turnover times were significantly reduced after the introduction of CI. In comparison to the conventional anaesthesia process, the turnover times using CI were on average 10 min shorter. Furthermore, since the introduction of pathways, the duration of stay for ENT patients could be significantly reduced while simultaneously maintaining the quality of care. This process was statistically evaluated using septoplasty in nasal surgery as a typical example and the duration of stay was reduced from 5.85 days to 4.32 (a reduction of 26%) or 3.55 days (a reduction of 34%). CONCLUSIONS: The combination of CI and pathways is a suitable means to increase the clinical and economic effectiveness even when the new case-based flat-rate system is taken into consideration.

[Olfactory dysfunction: correlation of olfactory bulb volume on MRI and objective olfactometry]. / Riechstörungen: Korrelation von objektiver Olfaktometrie und volumetrischer Messungen des Bulbus olfactorius in der MRT.

PURPOSE: To define the role of olfactory bulb volume measurement by magnetic resonance imaging (MRI) for detecting olfactory dysfunction in comparison with objective olfactometry. MATERIALS AND METHODS: Thirty patients with suspected olfactory dysfunction (16 women, 14 men; mean age 52 years, range 20 - 79 years) were examined by MRI and objective olfactometry between January 2006 and January 2009. Olfactory bulb volumes were measured by two neuroradiologists using 3D MR data sets. The olfactory function was categorized as normosmia, hyposmia, and anosmia on the basis of objective olfactometry. Pearson correlation coefficients were calculated for objective olfactometry and olfactory bulb volumes on MRI. ROC analysis was performed to determine whether MRI bulb volumes can serve to predict anosmia or hyposmia. RESULTS: The bulb volumes measured by MRI ranged from 0 to 135.9 mm (3). Based on olfactometry, anosmia was present in 11 patients (total bulb volume of 15.7 +/- 23.3 mm (3)), hyposmia in 9 patients (total bulb volume of 50.0 +/- 25.5 mm (3)), and normosmia in 10 patients (total bulb volume of 110.7 +/- 21.5 mm (3)). There was good correlation (r > 0.9) between objective olfactometry and olfactory bulb volume on MRI. ROC analysis yielded a cut-off value of 32 mm (3) for anosmia, which had a sensitivity of 0.91 and specificity of 0.947. The cut-off value for olfactory dysfunction was 80.7 mm (3) (sensitivity 0.95; specificity of 0.9). CONCLUSION: The olfactory bulb volume determined by MRI is a suitable parameter for diagnosing complete or partial loss of the sense of smell.

[CO2-laser-assisted de-epithelialization of perforation margins of persistent tympanic membrane perforations. An alternative to conventional surgical procedures]. / Die CO2-Laser-assistierte Perforationsanfrischung bei persistierender Trommelfellperforation. Eine Alternative zu konventionellen operativen Vorgehensweisen.

INTRODUCTION: The standard treatment of persistent eardrum perforation is conventional surgical closure using myringoplasty or a tympanoplasty type I. In this study the valence of a modified, CO(2)-laser-assisted de-epithelialization of perforation margins was investigated. MATERIAL AND METHODS: A total of 44 patients with mesotympanal eardrum perforation (diameter 1-5 mm) were included in a partially retrospective and partially prospective study. The genesis of the eardrum perforations was partially traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under topical anaesthesia. Focussed, adjacent, single CO(2) laser pulses (1 watt, 0.05 s) were applied with the laser otoscope Otoscan (Lumenis, Yokneam, Israel) along the edge of the perforation until complete de-epithelialization. This was done to stimulate growth. Closure of eardrum perforation was monitored using an ear microscope and if this treatment was not successful after three attempts conventional surgical therapy was suggested. RESULTS: Complete eardrum closure occurred in 27 cases (61%), 17 patients (39%) had a residual perforation, of which 9 experienced a significant reduction of the perforation. There were no complications during and after the treatment. CONCLUSION: A closure rate of at least 61% (27/44) can be expected with a CO(2)-laser-assisted de-epithelialization of the perforation margins. This procedure can be performed under topical anaesthesia and is an economic, painless and facile alternative to conventional surgical treatment.

[Direct hearing aid provision by ENT specialists: Recommendations for prevention and treatment of complications after taking ear impressions]. / HNO-ärztliche Hörgeräte-Direktversorgung: Empfehlungen zur Vermeidung und Behandlung von Komplikationen bei der Ohrabdrucknahme.

In times of budgeting, rising costs and monetary losses, an increasing number of ENT specialists considers the hearing system sector due to the distinct undersupply and the expected demographic development to be a market of the future and appropriate to enlarge their field of competence. Exact prevalence of direct hearing aid provision by German otorhinolaryngologists as well as its complication rate are not well-known. Retrospectively, all patients were evaluated who presented at our department with complications in the context of outpatient direct hearing aid supply within the last 3 years. Inappropriate fitting contains the danger of malformed or displaced ear impressions with various injury patterns comprising the external auditory canal, tympanic membrane and ossicular chain. Practical advices for prevention of complications include the accurate modeling and placement of sufficient impression pads behind the second bend of the auditory canal, using an adequate type of impression material as well as performing the correct application procedures. Recommendations for diagnostic patterns and treatment of complications after taking ear impressions are presented, the differences between German "traditional" and "direct" hearing aid provision are critically discussed.

[The topical application of mitomycin C in the treatment of scar formation and stenosis in hollow organs of the head and neck: a field report]. / Die topische Applikation von Mitomycin C in der Behandlung von Stenosen und Narben in Hohlorganen in der Hals-Nasen-Ohrenheilkunde--Ein Erfahrungsbericht aus 10 Jahren.

INTRODUCTION: The antibiotic und antitumoral effect of Mitomycin C (MMC), a derivative of Streptomyces caespitosus, has been known since 1956. Besides its use as an adjunction in the treatment of breast, lung and prostate cancer, or as a second-line cytostatic drug for head and neck squamous cell carcinoma (HNSCC), since 1963, MMC has also been successfully used in the suppression of post-operative scar formation, particularly in the field of ophthalmology. This is due to its modulation of fibroblast activity, which enables decreased scarring and fibrosis. In this résumé, we wish to recapitulate our long years of experience in the topical application of Mitomycin C in the treatment of scar formation and stenosis in head and neck organs. PATIENTS AND METHODS: A retrospective analysis on the basis of clinical disease courses and findings (image documentation, questionnaires, pulmonary function tests) covering an examination period of 10 years, was performed on 40 patients with stenosising lesions and a mean age of 54 years. The fields of application included laryngeal, tracheal, oesophageal stenosis and stenosis of the external ear canal and the choane. RESULTS: After combined application of MMC and surgical intervention in cases of recurrent stenosising processes in head and neck organs, especially the larynx and the trachea, a sustained improvement was achieved in the pre-operative stenosis level as well as in the pre-operative, severely limited, forced inspiratory volume in 1 second (F1V1). CONCLUSION: The topical application of MMC appears to be an effective adjunction as a concept of treatment for stenosising, scar-forming lesions. This topical application, however, is not a substitute for correct diagnosis and appropriate surgical treatment. It must be regarded as a purely adjunctive manoeuvre. During the 10 years in which it was used, the clinical findings confirmed an enhancement in the containment of complex cases without the occurrence of any complications.

[Histiocytosis of Langerhans cells. Simultaneous manifestation in both mastoid cavities]. / Langerhans-Zell-Histiozytose. Simultane Manifestation in beiden Mastoidhöhlen.

Histiocytosis X (Langerhans cells) is a rare disease with different forms of manifestation in the head and neck, which mostly occurs in children. We report the case of a 52-year-old male patient from Saudi Arabia who presented in the out-patient department of the University Hospital Charité Berlin with therapy-resistant otitis externa. ENT examination additionally showed nasal polyps. A paranasal computed tomography scan revealed as an incidental finding a mass forming tumor in both mastoids with osseous destruction of the posterior cranial fossa. Histological evaluation of the suspected tissue revealed histiocytosis X in both mastoids. After exclusion of a systemic disease local low-dose radiotherapy with 9 Gy (3x3 Gy) of the mastoid cavities was administered.

The improvement of middle ear ventilation by laser ablation of the epipharyngeal eustachian tube: a prospective study.

A long-lasting dysfunction of the eustachian tube seems to be the etiologic origin for development of chronic otitis media (COM) with mesotympanic perforation, otitis media with effusion (OME), and chronic atelectasis of the middle ear. Surgical interventions in the middle ear generally treat the sequelae of the tube dysfunction but not the dysfunction itself. This prospective clinical study investigated how far fiber-guided laser ablation of the posterior half of the epipharyngeal tubal ostium led to better middle ear ventilation in the otologic disease patterns mentioned below. There were 38 adult patients included in the analysis. The patients in one group had a perforated tympanic membrane [COM before primary tympanoplasty (n = 14) or revision tympanoplasty (n = 5)]; the patients in a second group had an intact eardrum [OME resistant to therapy (n = 3), with an atelectasis of the middle ear (n = 2) or problems of pressure equalization with fast changes in ambient pressure (diving, flying) (n = 14)]. Laser ablation of the posterior half of the epipharyngeal tubal ostium was performed, generally with local anesthesia, if tubal function testing was pathologic (Valsalva maneuver, passive tube opening, tympanogram). In patients with COM the procedure was performed 8 weeks before the middle ear surgery. All patients were checked 8 weeks postoperatively and in the course of the following year. The intervention seemed to have had a positive effect on tube function in 68.4% of patients operated on (P = 0.001). In 26 of the 38 patients that had undergone operation, an improvement the results of tubal function tests could be seen in the postoperative follow-up. In the COM group the Valsalva maneuver improved in 14 of 19 patients (73.6%) (P = 0.001), and the passive tube opening improved in nine of 18 patients (50%). In the group with an intact eardrum the Valsalva maneuver improved in 13 of 18 patients (72.2%) (P = 0.001). The resulting condition remained stable after 1 year. None of the patients showed any complications as a result of the therapy. Minimally invasive shaping of the distal eustachian tube under topical anesthesia can be recommended for patients with the above-mentioned diagnoses who have pathologic middle ear ventilation. Especially prior to tympanoplasties, and especially in otologic revision procedures, where middle ear ventilation is a prerequisite for successful otologic surgery, the function of the eustachian tube can be optimized in 70% of the patients, particularly if there are pathological findings (tubal tonsil, narrow orifice of the tubal ostium, adenoids). The placement of permanent ear tubes in adults with recurrent OME can also be avoided by the procedure described. The resultant conditions remained stable for the next year. Patients with tympanic ventilation problems due to rapid pressure changes (flying, diving) can also benefit from this procedure.

[The risk of damaging the round window by CO2 laser myringotomy. A morphological experimental analysis of 61 human petrous bone specimens]. / Die Gefährdung des runden Fensters bei der CO2-Laser-Parazentese. Eine morphologisch-experimentelle Analyse an 61 humanen Felsenbeinen.

INTRODUCTION: In CO2 laser myringotomy, a self-healing perforation is typically created in the lower anterior quadrant. A prominent anterior meatal wall may cover that quadrant and necessitate dorsal perforation of the eardrum. This study orientationally assessed the risk of damaging the round window membrane (RWM) when applying the laser in dorsal eardrum areas. MATERIALS AND METHODS: The round window was exposed by otomicrosurgery in 61 human petrous bone specimens. CO2 laser myringotomy was previously performed with twice the standard power (25 W, 180 ms, 2.2 mm) in the lower posterior quadrants of 25 specimens, the beam being applied directly to the round window niche in five specimens, and the effect of the laser radiation was documented. The RWM was subsequently exposed in all petrous bones, and the angle correlation of the membrane to the direction of the laser beam was digitally measured. RESULTS: The laser did not damage the membrane of the round window in any of the cases. The angle between the RWM and the external auditory meatus was below 30 degrees in 97% of the petrous bones and thus had a nearly parallel course. CONCLUSION: Localization of the window caudodorsal to the meatal wall, bone overhanging the membrane, mucosal duplications, and membrane alignment nearly parallel to the laser beam make it virtually impossible to reach this membranous structure with the CO2 laser.

Persistent cerebrospinal fluid rhinorrhea by intrasphenoidal encephalocele.

The case of a 60-year-old man with a 6-month history of cerebrospinal fluid (CSF) rhinorrhea is presented. Computed tomography (CT) and magnetic resonance (MR) imaging revealed an intrasphenoidal mass extending through a bony defect of the roof of the left sphenoid sinus. Transnasal surgical repair was performed; intraoperatively the mass was identified as an intrasphenoidal encephalocele. The pathogenesis of this anomaly is analyzed, the clinical findings and the operative treatment are described, and the literature is reviewed.

[Topical immunomodulation. A milestone for the treatment of therapy-resistant noninfectious chronic external otitis?]. / Topische Immunmodulation. Ein Meilenstein in der Behandlung der therapieresistenten nichtinfektiösen chronischen Otitis externa?

BACKGROUND: Recurrent exacerbation of chronic external otitis represents a special challenge for the attending physician. The goal of our study was to evaluate the effectiveness of novel topical immunomodulators acting through an anti-inflammatory, nonsteroidal mechanism. PATIENTS AND METHODS: In a prospective study, in 33 patients an ear wick containing tacrolimus ointment (Protopic 0.1%) was inserted every 2-3 days. Altogether, the wick was changed three times. Therapeutic outcomes were assessed by reexaminations, video-otoscopy, and a standardized findings sheet. RESULTS: Twenty-eight patients showed significant improvement of clinical symptoms, with 13 of them showing complete healing (follow-up 10-22 months). Relapses (15 cases) were associated with significantly extended symptom-free intervals and reduced numbers of further recurrent episodes. CONCLUSIONS: Because of the safe and successful anti-inflammatory effects, topical immunomodulators represent a new alternative in chronic inflammatory stages of otherwise therapy-resistant external otitis.

[Treatment of chronic tube dysfunction. Use of the tube conductor]. / Therapie chronischer Tubenfunktionsstörungen. Einsatz des Tube conductor.

BACKGROUND: Chronic tube dysfunction plays a major part in the development of chronic otitis media. Owing to the complex structure of the Eustachian tube, the development of successful therapeutic approaches to the treatment of tube function disorders is still difficult even today. The application of a gold tube wire (tube conductor) was reported in 1991, but no studies have yet been performed on the postoperative success rates achieved with tube conductors. MATERIAL AND METHODS: In a retrospective study, the data relating to 125 patients who were operated on from 1996 to 1999 for treatment of different forms of chronic otitis media and also underwent transtympanic tube conductor implantation to improve tube ventilation disorder were evaluated. Data on pre- and postoperative tube function were available for 96 patients after a mean follow-up period of 18 months. RESULTS: All tube implantations were achieved without complications. Tube function normalized in 8 patients (8.3%), while the tube ventilation disorder remained unaffected in 88 patients (91.7%). A total of 23 (18.4%) tube conductors have so far been removed. The reasons for removal include persistent tube ventilation disorder, dislocation of the tube conductor in 7 patients (5.6%) and granulation around the tube wire in 7 cases (5.6%). CONCLUSIONS: The chronic tube ventilation disorder was improved by implantation of a tube conductor in only 8.3% of the patient population investigated. We are therefore of the opinion that this is not a suitable treatment for chronic tube ventilation disorders. The development of new, effective therapeutic approaches to the treatment of chronic tube ventilation disorders remains a priority.

[Differential diagnoses of acute bilateral hearing loss in a patient with metastatic bronchial carcinoma]. / Differenzialdiagnosen einer beidseitigen akuten Hörminderung bei einem Patienten mit metastasierendem Bronchialkarzinom.

The first symptom of an acoustic neuroma in about 50% of the patients is hearing loss, which occurs suddenly in about 5-10% of cases. Acute progressive hearing loss is associated with a broad spectrum of differential diagnoses. Cerebellar and hepatic metastases from a bronchial carcinoma were previously diagnosed in the case presented here, and the most probable causes of the progressive hearing loss, e.g. idiopathic sudden deafness, infection and tumor-associated factors, were considered and diagnostically analyzed. The discussion ultimately focused on the clinical and radiological signs of bilateral acoustic neuroma. The patient's history and clinical findings yielded no indication of neurofibromatosis (type 1/2). Nevertheless, the constellation of findings suggests that the bilateral hearing loss was caused by a bilateral acoustic neuroma.

Photodynamic effect of argon and diode laser on cholesteatoma cell cultures after intravital staining with absorption enhancers.

Chronic epitympanic otitis media, or chronic suppurative osteitis, is a destructive form of chronic middle-ear inflammation. The therapy of choice is complete surgical removal of the squamous epithelium from the middle ear. It is often impossible to inspect all areas of the middle ear with the posterior canal wall intact. Not all recesses can be reliably monitored with the microscope, particularly in the area of the antrum and hypotympanum. Residual squamous epithelium here causes frequent recurrences following cholesteatoma surgery. This study examines the effect of argon and diode lasers on cholesteatoma tissue. The aim is to develop a laser treatment selectively directed against cholesteatoma cells that can be performed after cholesteatoma surgery to eliminate any residual squamous epithelium. Intraoperatively harvested monolayer-cultured cholesteatoma cells stained in vivo with various absorption enhancers served as the in vitro examination model. Argon (499 nm) and diode lasers (810 nm) were applied since their irradiation has an appropriate tissue penetration depth and is absorbed by various chromophores such as neutral red (475-500 nm), fluorescein (488 nm), and indocyanine green (790-810). Intracellular staining of cultured cells increased the optical density at the wavelength corresponding to the dye. Neutral red damaged 50-60% of cultured cells merely by intracellular accumulation at high concentrations. An additive cell destruction of about 30% was achieved by also applying argon laser irradiation. Fluorescein diacetate caused no appreciable stain-induced damage to cultured cholesteatoma cells. Argon laser irradiation destroyed up to 60% of the cultures. Indocyanine green resulted in only minor damage to cultured cells. The diode laser destroyed up to 60% of the irradiated cells. Selective staining of cholesteatoma cells was not achieved with any of the dyes examined. Thus, other stained tissue could be damaged. Staining and subsequent laser irradiation destroys up to 60% of cultured cholesteatoma cells. Unstained irradiated cells are not affected. Indocyanine green and fluorescein are nontoxic and may thus be used as absorption enhancers. The diode and argon lasers appear to be basically suitable. Cell staining is not selective, i.e., other tissues would also be stained and damaged. To avoid such unwanted damage, it would be desirable to couple the chromophore to a specific antibody that binds only to cholesteatoma cells.

[The NEN (Nicolet Electronic Naviation System) ENT navigation system. Initial clinical application]. / Das NEN-HNO-Navigationssystem. Erste klinische Anwendung.

BACKGROUND: Intraoperative computer navigation will soon play an important role in procedures performed on the anterior and lateral skull base. Electromagnetic systems compared to optical systems offer some advantages such as small hardware dimension and free unimpaired mobility of the surgeon. PATIENTS AND METHODS: The NEN navigational system (Nicolet Electromagnetic Navigation System) was used in 22 patients who underwent microscopic/endoscopic surgery for polypoid rhinosinusitis. It is the prototype of a new system, which localizes the surgical probe via the measurement of pulsed electromagnetic DC fields. This system was modified for the needs of head and neck surgery. Preoperative imaging data consisted of an axially oriented spiral computed tomography (CT) resulting in a slice thickness of 1 mm with a radiation dose slightly higher than a routine coronary CT scan of the paranasal sinuses. RESULTS: The data acquired during clinical application was used to optimize navigation accuracy. The number and positions of the markers were gradually modified and improved. Six markers including the volume of the paranasal sinus system (three non-coplanar frontal markers, one on each of the mastoid processes and one median marker on parietooccipital junction) offered the best navigation precision. Additionally, all surgical instruments measured as ferromagnetic, i.e., nasal specula, were replaced by titanium instruments. An adapter affixed to the maxilla-designed to hold a second sensor used to track the patient's head was developed. With these modifications, it was possible to improve navigation accuracy to 1.5 mm in the plane of the sphenoid bone while retaining free head movement of the patient. CONCLUSION: For routine procedures such as microscopic/endoscopic endonasal sinus surgery, the systems have to be cost effective and easy to operate.

[Duration of middle ear ventilation after laser myringotomy with the CO2 laser otoscope Otoscan]. / Dauer der Paukenbelüftung nach Lasermyringotomie mit dem CO2-Laserotoskop Otoscan.

BACKGROUND: The most important principle in treating secretory otitis media (SOM) is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this via a self-healing perforation whose diameter essentially determines the duration of transtympanic ventilation. PATIENTS, METHODS: In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a homogeneous patient collective comprising 81 children (159 ears) suffering from SOM. The tympanic intervention was combined with an adenoidectomy or a CO2 laser tonsillotomy and therefore performed under general insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12-15 W and a pulse duration of 180 ms. RESULTS: None of the children showed postoperative impairment of inner ear function. Otomicroscopic and videoendoscopic monitoring documented the healing process. The mean closure time was found to be 16.35 days (8-34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later the laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes (1.6%) examined showed atrophic scar formation, one (0.8%) a perforation with a diameter of 0.5 mm. In 19 ears (14.7%) there was a recurrence of SOM within the observation period. CONCLUSIONS: Laser myringotomy competes with ventilation tube insertion in the treatment of SOM. It may be an useful alternative in the surgical management of secretory otitis media.

[Enlarged ventricular sacculus in laryngeal carcinoma--in increased risk in tumor surgery]. / Der vergrösserte ventrikuläre Sacculus beim Larynxkarzinom--ein erhöhtes tumorchirurgisches Risiko.

The case of a 60-year-old female patient with a supraglottic larynx carcinoma (T3N2CM0) and bilateral enlargement of the laryngeal sacculus is presented. On one side, the sacculus opened atypically into the left vestibular fold. The sacculus is a physiologic part of the roof of Morgagni's ventricle, the size of which can vary greatly. These canal-like structures can be the point of origin of cysts, laryngoceles, mucoceles, and pyoceles. Laryngoceles are present in about 5% of larynx carcinomas; their cause is not precisely known. Frequently, a computer tomogram suggests the coincidence of larynx carcinoma and laryngoceles or a large laryngeal sacculus. In oral panendoscopy, these ventricular distensions are difficult to detect even using 70 degrees rigid endoscopes. A planned supraglottic partial resection must take into account early tumor growth along the performed canals in the preepiglottic space. In this patient, a laryngectomy was performed due to the bilateral involvement of the vocal process and the anterior commissure.