[Tonsil surgery in Brandenburg-trends between 2013 and 2017]. / Operationen an den Gaumenmandeln im Land Brandenburg ­ Entwicklungen von 2013 bis 2017.

BACKGROUND: The frequency of tonsil surgery in Brandenburg (BB) during the period from 2013 to 2017 is analyzed. Causes and possible consequences of the trends are discussed. MATERIALS AND METHODS: An OPS code-based survey is carried out in the 10 ENT hospitals in BB and using the data from the federal states (Federal Statistical Office). In addition, the respective heads of ENT departments are interviewed concerning the indication for tonsillectomy (TE). The average number of operations in 2013/2014 is compared to that in 2017 (BB) and 2016 (federal states). RESULTS: In 9/10 participating hospitals in BB, 10,302 operations were performed, thereof 58.4% as TE, 19.0% as tonsillotomy (TT), 13.7% as abscess tonsillectomy (abscess TE), and 8.9% other. In BB in 2017 in comparison to 2013/2014, because of the decrease in TE by 45.6%, a total of 21.1% less operations were performed, while TT and abscess TE increased by 32% and 18%, respectively. The average age at surgery was 28.1, 38.1, and 5.9 years for TE, abscess TE, and TT, respectively. The entire trend for Germany until 2016 on the basis of 395,674 cases reflects a decrease in TE (30.7%) and abscess TE (14%), while TT was performed 27.5% more often, resulting in a total decrease of 21.3%. The interviewed persons follow the "justifiable operation indications" of the German guideline from 2015 and adapted their previous practice. CONCLUSION: Our survey and results indicate that the massive decrease of TE in BB is associated with the "justifiable operation indications" of the 2015 German guidelines on inflammatory diseases of the tonsils. TE is mainly performed in adults. Therefore, research concerning conservative versus surgical treatment for recurrent tonsillitis is urgently needed for this age profile.

Determining Tarsus Curvature in Relation To Direction of Gaze Using Non-contact Ultrasound Video Assistance.

PURPOSE: Plastic surgery on the eyelids for the purpose of aesthetic or functional correction requires precise knowledge of lid anatomy. Changes in the tarsal curvature of the upper eyelid relative to line of vision are important, particularly when a surgical correction of paralytic lagophthalmos is undertaken. We used a computer-based image-processing algorithm to establish a relationship between changes in the curvature of the tarsus relative to the line of vision. MATERIAL AND METHODS: A dynamic, ultrasound examination of the upper eyelids of 100 participants (100 eyes) was performed transpalpebrally using a 7.5 MHz scanner with the patient looking straight ahead, away from and towards the midline of the body. A computer-aided examination of the upper eyelid tarsus was then performed, followed by the calculation of the radius of curvature of the tarsus relative to the line of vision in each position. RESULTS: Using regression of a Taylor polynomial, the shape of the tarsus was mapped by a quadratic function, and the change in tarsal curvature relative to line of sight could be demonstrated. CONCLUSION: With objective evidence of change in the tarsal curvature relative to the line of sight, this may influence the treatment of pathological changes in the upper eyelid.

Is there a need for a histological examination of the adenoid tissue after adenoidectomy?

OBJECTIVES: In Germany there is no uniform practice regarding the histological examination of removed tissue after an adenoidectomy. In addition, the unique benefits of routine histological examination of adenoid tissue cannot be ascertained from current literature due to varying opinion and evidence. METHODS: This study was approved by the Medical Association and Ethics Committee in Cottbus, Brandenburg, Germany. We evaluated the pre- and intra-operative examination findings (direct and indirect epipharyngoscopy, digital palpation, intraoperative macroscopic assessment and examination of removed tissue) and the histopathological findings of excised adenoid tissue. A statistical analysis of obtained results was undertaken thereafter. RESULTS: It was found that in all young patients included in the study, the histological results invariably represented lymphoepithelial hypertrophic mucosa with a varying inflammatory response, matching a clinical picture of adenoid vegetation and in keeping with the pre- and intraoperative investigations and findings. CONCLUSION: The characteristic history of adenoid vegetation in combination with a classic pre- and intraoperative clinical examination and an inconspicuous macroscopic examination of removed tissue, renders routine histopathological workup dispensable. On suspicion of deviant pathology a histopathological examination is recommended and should be undertaken.

[Invasive orbital aspergillosis: Rare but important differential diagnosis in the case of immunosuppression]. / Invasive Aspergillose der Orbita: Seltene, aber wichtige Differenzialdiagnose bei Immunsuppression.

Invasive aspergillosis originating from the paranasal sinuses is a rare disease that is associated with high mortality rates. We report on a 77-year-old patient with myelodysplastic syndrome and progressive left-sided proptosis persisting for 5 days. Antibiotic therapy and endonasal orbital decompression yielded insufficient improvement. Only upon application of complementary antifungal therapy was remission observed. Rapid diagnosis and treatment are essential in order to prevent life-threatening complications.

[Percutaneous dilatational tracheotomy or tracheostomy? Two case reports]. / Perkutane Dilatationstracheotomie oder Tracheostomie? 2 Kasuistiken.

In terms of numbers, percutaneous dilatational tracheotomy (PDT) is the most important tracheotomy technique since it is applied in surgical and nonsurgical disciplines. Where correctly indicated, PDT is a fast, economical and easily reversible procedure. Incorrect indication sometimes necessitates conversion of a PDT into a conventional surgical tracheostomy. In these cases scarring, wound infections and ambiguous anatomical structures can represent a surgical challenge. Where a long-term tracheotomy requirement is predicted, a surgical tracheostomy should be performed.

Neurological symptoms of leptomeningeal carcinomatosis as the primary manifestation of an adenocarcinoma of the nasal cavity and sinus: a case report and literature review.

Carcinomas of the nose and paranasal sinuses are rare solid head and neck tumours. With an incidence of 1-1.5/100,000 per year, they account for only 3% of all malignancies in the head and neck region. Sinonasal carcinomas are often adenocarcinomas. Hardwood dust is one possible triggering agent, although the latency period may extend to decades. Central nervous system complications arising from solid tumours of the head can be explained in terms of the close anatomical relationship between the two areas. However, leptomeningeal spread is rare. To our knowledge, this is the first report demonstrating cranial nerve deficits due to a leptomeningeal carcinomatosis as the primary manifestation of an adenocarcinoma of the paranasal sinus and the nasal cavity.

[Peritonsillar abscess - smoking habits, preoperative coagulation screening and therapy]. / Peritonsillarabszess - Analyse zu Rauchverhalten, präoperativer Gerinnungsdiagnostik und Therapie.

OBJECTIVE: Peritonsillar abscess (PTA) is a common problem in otorhinolaryngology. The pathogenesis, supporting factors and optimal therapy are matter of numerous investigations. We studied retrospectively smoking habits, preoperative coagulation screening and the applied therapy of PTA. MATERIAL AND METHODS: Data from 460 patients who underwent treatment for PTA between 2000 and 2009 at Dessau Medical Center were retrospectively analysed. RESULTS: The highest incidence of PTA was found in young men, the prevalence of nicotine consumption was clearly increased in relation to the general population. The therapy of first choice was abscess tonsillectomy. Even with preoperative pathological coagulation-parameters no increased risk of secondary bleeding was shown. CONCLUSIONS: The part of smokers of patients with PTA is increased in comparison to the correspondent population of same age. A routine preoperative coagulation screening has a low benefit relating to the prediction of the risk of secondary bleeding. Abscess tonsillectomy is a safe method and has proved itself in clinical daily routine.

[Significance of the sinus x-ray prior to septoplasty]. / Stellenwert der präoperativen Röntgendiagnostik der Nasennebenhöhlen vor Septumplastik.

INTRODUCTION: There is still disagreement concerning the significance of sinus x-ray prior to septoplasty: according to the previous guidelines for Diagnostic and Therapy of the German Society for Oto-Rhino-Laryngology and head and neck surgery in 1996, a sinus x-ray prior to septoplasty was seen as "necessary." According to the guidelines from 2010, a suitable radiology imaging is just "optional." In the present study, we analyzed the significance of a sinus x-ray to exclude a chronic sinusitis prior to septoplasty. PATIENTS AND METHODS: A total of 96 patients were included in this study. All were admitted to the hospital by an ENT specialist for septoplasty with conchotomy. The preoperatively performed sinus x-ray was evaluated with regard to an already existing sinusitis. These results were correlated with the patients' anamnesis and the nasal endoscopic view. RESULTS: A sinus x-ray (occipitomental) was obtained in all 96 patients. No pathological result was observed in 82 patients, while 14 patients showed pathology in the paranasal sinus. After a detailed appraisal of the sinus x-ray with pathology, 7 patients with pathological findings in the paranasal sinus remained. In the other 7 patients, the statement was false positive. In only 3 patients was a CT image obtained, which resulted in modification of the surgical procedure. CONCLUSION: Our findings show that a routinely performed sinus x-ray is not necessary prior to septoplasty. If there is reasonable suspicion for pathology in the paranasal sinus, radiological imaging is necessary, whereby a CT scan should be performed.

Balloon dilatation of the Eustachian tube: postoperative validation of patient satisfaction.

OBJECTIVES: The Eustachian tube is responsible for ventilation, protection and drainage of the middle ear. Dysfunction of the Eustachian tube can lead to impairments ranging from inadequate pressure equalisation in the middle ear and pneumatised mastoid process to cholesteatoma. Conventional surgical interventions for chronic tube dysfunction have not brought resounding clinical success. However, the 'Bielefelder Balloon dilatation' constitutes a new and, judging from early results, very effective treatment for chronic tube dysfunction. Proof of the efficacy of the surgical procedures is provided by objective clinical factors, but for quality assurance, the assessment of the subjective quality of life of patients must also be taken into account. To measure health-related quality of life, standardised questionnaires are used which have been tested for reliability, validity and sensitivity. METHODS: A total of 30 patients were included in the study. The patient survey was conducted retrospectively, and validation of patient satisfaction was carried out with the Glasgow Benefit Inventory (GBI). RESULTS: GBI analysis revealed significant improvements in the total score as well as in general and physical health. CONCLUSIONS: The Bielefelder Balloon dilatation is a new and safe treatment for chronic tube dysfunction, which had a significant positive influence on the postoperative quality of life of our patient cohort.

[Bilateral bisphosphonate-associated osteonecrosis of the external ear canal : a rare case]. / Beidseitige bisphosphonatassoziierte Osteonekrose des Gehörgangs : Ein seltener Fall.

Osteonecrosis of the mandible is a well-known and dreaded complication after the administration of bisphosphonates. Only a few cases of bisphosphonate-associated osteonecrosis of the external ear canal have been described. Especially after long-lasting bisphosphonate therapy, for example in patients with multiple myeloma, an ulceration of the floor of the bony external auditory canal should be treated surgically and be distinguished from radioosteonecrosis, malignant external otitis, or carcinoma of the external ear.

[Thrombosed aneurysm of the subclavian vein]. / Thrombosiertes Aneurysma der Vena subclavia.

Progressive growth of a thrombosed aneurysm in the venous neck vessels represents an important differential diagnosis in solitary cervical swelling. We report the case of a 72-year-old woman with a 4-month history of left cervical, supraclavicular swelling. CT showed a cystic tumour with a maximum diameter of 4.8 cm at the left jugulobrachial venous arch. Surgical removal revealed a firm elastic tumour, which arose from the subclavian vein. Histological analysis showed a thrombosed venous vessel.

[Bilateral peritonsillar abscess with lymph node abscess in a infant. A rare case]. / Beidseitiger Paratonsillarabszess mit Lymphknotenabszedierung bei einem Säugling. Ein seltener Fall.

Peritonsillar abscess (PTA) comprises approximately 30% of soft tissue head and neck abscesses. Bilateral occurrence in infants is rare. The present case demonstrates a bilateral peritonsillar abscess with a lymph node abscess in a 10.5-month-old infant without the typical clinical findings of PTA. This report highlights the importance of including peritonsillar abscesses in the differential diagnosis of abscess-forming cases of lymphadenitis colli refractory to therapy, even if the classical symptoms are absent. In individual cases, the indication for image-guided procedures to establish the diagnosis of PTA should be made generously.

Treatment of otosclerosis with a superelastic nitinol piston: first results.

Stapedotomy with implantation of an alloplastic prosthesis is a well-established therapy for the treatment of otosclerosis. Since the middle of 2008, a new Nitinol prosthesis with memory function and superelastic properties has been available which is expected to make fixation on the long process of the incus much easier. The advantage of this prosthesis is that heat-induced wire crimping is no longer necessary and damage to the incus caused by heat is avoided. Since May 2008, laser-assisted stapedotomy with implantation of a Nitinol prosthesis was performed in 21 patients suffering from otosclerosis. The prostheses used for all patients had a size of 4.5 mm × 0.4 mm. The patient collective consisted of 14 women and 7 men with a mean age of 53.4 years. Pre- and postoperatively, an ENT examination was carried out followed by an audiological evaluation of the hearing result. In addition, the properties of the prosthesis ("proper fitt", "handling", and "overall rating") were evaluated intraoperatively by means of a test protocol. The Nitinol prosthesis was implanted successfully in all 21 patients. The mean air-bone gap for the frequencies from 0.5 to 4 kHz was 9.83 dB postoperatively. Intraoperatively, the fit of the prosthesis was rated as "good to very good", the handling as "good" and the overall rating of the system was "good to very good". Our patient collective showed good postoperative hearing results. Due to simple intraoperative handling, especially placing the Nitinol prosthesis in position, the critical work step of crimping is no longer necessary.

[Surgical treatment of paralytic lagophthalmos]. / Chirurgische Korrektur des paralytischen Lagophthalmus.

Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20-35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.

[Evaluation of quality of life following prosthetic replacement of the auricle]. / Untersuchungen zur Lebensqualität nach epithetischem Ohrmuschelersatz.

INTRODUCTION: The assessment of quality of life (QOL) of patients is becoming increasingly important in the evaluation of the quality of care. Therefore, we examined the quality of life of patients treated with prostheses following loss of an auricle using a questionnaire. PATIENTS AND METHODS: Of 18 patients (14 male, 4 female), 10 had lost an auricle due to a neoplasm, 2 traumatically, while 6 patients showed a congenital lack of an auricle. In order to measure the subjective quality of life we used a questionnaire compiled by the WHO (WHOQOL-BREF); we used a self-designed questionnaire for questions relating to the prostheses. RESULTS: Analysis of the data of all patients with prostheses in comparison with the age-based general population showed a lower score value for quality of life, indicating a poorer quality of life. However, none of the differences were statistically significant. Patients with neoplasms achieved higher values compared with the age-based standard value; in contrast, the other patients showed lower values in nearly every respect. The gender-related analysis of the results showed a poorer quality of life for females than for males. CONCLUSION: The reason for an auricle defect as well as patient gender influenced the subjective quality of life following prosthetic surgery. The overall acceptance of auricular prostheses can be considered good, especially among patients suffering from neoplasms. In order to be able to evaluate the results and compare the different working groups more sufficiently it would be desirable to use standardized test procedures and a larger patient collective.

[Unusual case of oesophageal foreign body as part of a self-harm syndrome]. / Ungewöhnlicher Osophagusfremdkörper im Rahmen eines Autoaggressionssyndroms.

INTRODUCTION: Foreign bodies in the oesophagus represent a frequent emergency situation in ENT medicine. Usually the cases involve lumps of meat, bones, shards of glass, bottle tops, batteries or dentures. We would like to report about an unusual foreign body found in the oesophagus. PATIENT: A 45-year-old patient presented himself in our interdisciplinary casualty department where he claimed to have swallowed a butter-knife that morning as a bet. The ENT examination showed no abnormal findings. The thorax X-Ray revealed a 14 cm-long foreign body in projection to the oesophagus, which matched the knife. Following consultation with the thorax surgeon, a rigid oesophagoscopy was conducted under endotracheal intubation and the knife was easily removed using tongs. Archive searches conducted in the meantime showed that foreign bodies had been removed from the patient on numerous occasions by fellow surgeons either laparoscopically or via open surgery. As a result, the patient was transferred to the psychiatric ward with unimpeded swallowing reflex with a suspected self-harming syndrome. DISCUSSION: As an ENT emergency, a foreign body in the oesophagus generally requires intervention because of the risk of complications such as perforation or pressure-induced necrosis of the oesophagus wall with resulting mediastinitis. Suitable instruments are the flexible oesophagoscope, the rigid oesophagoscope under anaesthesia or transcervical/transthoracic removal. The choice of procedure crucially depends on the type and localisation of the foreign body in the oesophagus. Particularly in cases of unusual foreign objects or repeated foreign object ingestion, it should be considered whether a psychological illness could be the cause and whether the introduction of appropriate therapy could be expedient.

[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.

[Is postoperative antibiotic treatment mandatory after abscess tonsillectomy]. / Ist eine begleitende Antibiotikatherapie nach Abszesstonsillektomie erforderlich?

BACKGROUND: Peritonsillar abscess (PTA) is a common and serious complication of acute exudative tonsillitis. We wanted to answer the following question: Are postoperative antibiotics mandatory after abscess tonsillectomy? PATIENTS AND METHODS: In an epidemiological observational study, 283 patients (98 females and 185 males, age range 2-72 years) were treated with abscess tonsillectomy for PTA. For a prospective randomized multicenter study, 105 patients were divided into two groups; one group was treated postoperatively with benzylpenicillin, and antibiotics were omitted in the control group. We evaluated postoperative pain scores, swallowing disorders, and well-being. Additionally, laboratory parameters such as C-reactive protein, leukocytes, and antistreptolysin titer were measured, and blood cultures were collected. RESULTS: Male patients in the 2nd-4th decades of life were predominantly affected, mostly in the summer. For the patients in the two groups, we assessed no significant differences in either the subjective or the laboratory parameters. The blood cultures showed no evidence of bacteremia. CONCLUSIONS: We conclude that immediately performed abscess tonsillectomy is an effective and safe treatment for PTA. No higher complication rate was found when additional antibiotic treatment was not used. Because of the small number of cases, the results can be regarded only as a tendency, not as a general recommendation.

[Integrated intensive treatment of tinnitus: decrease of the tinnitus-related distress during a one-year follow-up study]. / Integrierte Tinnitusintensivbehandlung: Verringerung der tinnitusbedingten Belastung während einer 1-Jahres-Katamnese.

AIM OF THE STUDY: The therapy of the chronic tinnitus is aimed at improving the way patients cope with their tinnitus and at reducing the tinnitus-related distress. The present study investigated the changes of psychometric parameters that occurred in patients with chronic tinnitus after 7-days outpatient multidisciplinary therapy. The changes were monitored for up to 1 year in order to evaluate the long-term efficiency. METHODS: Main emphasis of the intensive tinnitus therapy applied was placed on tinnitus habituation and on teaching the patients how to apply coping strategies. The main elements of the multimodal concept included progressive muscle relaxation according to Jacobson, physiotherapy, educative seminars, training of selective attention and, lastly, the change of judgment, attitude and behaviour towards tinnitus. Psychometric parameters and tinnitus-related distress were assessed prior to and after the therapy (at 3, 6 and 12 months) using the tinnitus questionnaire (TQ) according to Goebel and Hiller. Furthermore, subjects waiting for therapy (waiting list) were recruited to the control group and compared with the therapy group which had received therapy 3 months earlier. RESULTS: The therapy group showed a significant reduction of the TQ total score after 3 months as compared to the control group. Moreover, we observed a long-term, progressive positive outcome during the one-year follow-up. The TQ total score was reduced by 10.9 points. There was an obvious decrease of the emotional and cognitive distress as well as of the intrusiveness of tinnitus, as per evaluation of TQ subscales. CONCLUSIONS: The outpatient intensive multidisciplinary tinnitus therapy with long-term aftercare has proved to be an effective method in the treatment of patients with chronic tinnitus. The outpatient setting enables the instant implementation of strategies learned during therapy in the patients' everyday life.