[The red tympanic membrane]. / Das rote Trommelfell.

An otoscopic red tympanic membrane is for the examiner a challenge. A short directed history, as well as a few functional examinations associated to a systematic otoscopy allow in most cases to make the otological diagnosis. The differential diagnosis for a red tympanic membrane is very large, including malformations, traumas, infections, and even tumors and other degenerative pathologies. The first diagnosis to think about is an infectious disease. On the other side, there are rare pathologies which, even for experienced examiners are quite seldom.

[Peracute suffocation emergency: what should be done?]. / Der perakute Erstickungsnotfall: Was tun?

Peracute obstructive dyspnea with imminent asphyctic death is a dramatic emergency. It is characterized by easily audible inspiratory stridor caused by severe stenosis. Several causes in the pharynx and larynx may be responsible. Pharmacotherapy is hardly effective, an intubation extremely difficult in extremis. In contrast emergency coniotomy offers a real chance to reopen the airways even to the surgically inexperienced. The technique for this intervention is described.

Diagnostic approach to primary ciliary dyskinesia: a review.

UNLABELLED: Primary ciliary dyskinesia (PCD) is a heterogeneous disease with impaired mucociliary transport leading to respiratory disorders, hearing impairment and male infertility. PCD can be diagnosed by clinical features together with functional and structural analysis of the cilia. To prevent bronchiectasis with a marked reduction in quality of life, early diagnosis is essential. The rarity of PCD and the costs of ultrastructural analysis of cilia require a rational diagnostic concept. We therefore reviewed the literature and compared clinical manifestations as well as functional and structural analyses of the cilia in 28 patients (23 children, 5 adults) investigated between 1990 and 1998. All were thoroughly examined for other possible diseases before biopsy, and ten patients (35.7%; eight children, two adults) were diagnosed as having PCD. From the literature review and our findings we conclude that ciliary investigation is indicated (a) in patients who remain suspected of having PCD despite thorough clinical examination and exclusion of other disorders such as cystic fibrosis, allergy, immunologic disorders and alpha1-antitrypsin deficiency; (b) in patients with situs inversus suffering from chronic and/or recurrent airway infections; and (c) in patients with neonatal respiratory distress syndrome of "unknown" cause (i.e. after exclusion of hyaline membrane disease, aspiration syndromes, neonatal pneumonia, and pneumothorax as well as cardiovascular and metabolic diseases). CONCLUSION: The combination of extensive clinical examination with functional and ultrastructural analysis of the cilia results in a high degree of accuracy in diagnosing PCD.

[Recurring tumors of the parotid gland with special reference to pleomorphic adenoma]. / Die Rezidivtumoren der Glandula parotis unter besonderer Berücksichtigung des pleomorphen Adenoms.

161 patients with parotid tumors seen between 1974 and 1980 are analyzed. A recurrence rate of 20% was found for both benign and malignant tumors. 76% of the recurrent tumors were judged to have been inadequately excised at the first operation. Pleomorphic adenomas had a recurrence rate of 25%. More than half these tumors exhibited multinodular patterns of recurrence. Therefore, a recurrent pleomorphic adenoma should not be reoperated upon for at least one year.

[Diagnosis of acoustic neurinoma (author's transl)]. / Zur Diagnostik des Akustikusneurinomes.

In conjunction with a competent medical history, the early diagnosis of acoustic neurinomas is based on the following clinical investigations: pure tone and speech audiometry, caloric testing for nystagmus, and Stenvers radiological examination of the petrous bone. In abnormal studies, audiometry consistently indicates a unilateral hearing loss which is often accompanied by a severe speech discrimination impairment. The caloric response of the affected side is significantly reduced in 90% of the cases. In the same per cent of cases, the Stenvers projection shows significant pathological findings. These include enlargement of the internal auditory meatus, absence of the crista transversa and atrophy of the roof of the internal auditory meatus. As a result of these studies, the possibility of an acoustic neurinoma can be excluded in 50% of cases. Only when these tests yield enough positive findings should more sophisticated studies, such as computerized tomography and meatocysternography, be considered.

[Venous tinnitus (author's transl)]. / Tinnitus venöser Genese

The etiology of venous tinnitus is discussed. The simple ligation of the internal jugular vein performed under local anaesthesia has resulted in the total disappearance of the hum in three cases.