Hemoglobin Absorption Spectral Imaging (H.A.S.I.): a novel optical staining technique for microlaryngoscopy.

PURPOSE: Optical image enhancement techniques are widely used in endoscopy to improve the visualization of blood vessels for diagnostic and therapeutic purposes. These techniques are monitor-based and therefore not available for direct microscopy. In this study, a novel optical microscope filter, Hemoglobin absorption spectral imaging (H.A.S.I.) was tested for use in microlaryngoscopy. METHODS: A novel dichroic filter was designed to improve contrast in small blood vessels by highlighting transmission in the spectrum range of hemoglobin absorption maxima. A surgical microscope equipped with the novel H.A.S.I. filter was installed in one operating room in our institution. 68 consecutive patients referred to our ENT department for endoscopy were examined using white light and the novel H.A.S.I. filter during microlaryngoscopy. Surgeons described the blood vessels of the vocal cords using a classification chart and assessed for suspected malignancy using both white light and H.A.S.I. RESULTS: 77 consecutive microlaryngoscopies were performed on 68 patients. 142 vocal cords were visualized in microlaryngoscopy and the blood vessels classified according to the chart. With white light, 152 blood vessel characteristics were documented and 157 with H.A.S.I. Notably, pathologies like benign horizontal blood vessel changes, leukoplakia, and vertical blood vessel changes like dots and loops were seen more frequently with H.A.S.I. Finally, seven lesions were treated by transoral laser microsurgery (TLM) with H.A.S.I. to test the practicability of the method for microlaryngoscopic laser surgery. CONCLUSION: This is the first study describing H.A.S.I. as an optical staining method for microlaryngoscopy. In our experience, the method was practical and improved the evaluation of vocal cord blood vessels. In some cases, the use of H.A.S.I. led to a change in diagnosis and treatment. Also, H.A.S.I. was found to be helpful in microlaryngeal laser surgery for demarcating resection margins. This is, to our knowledge, the first optical staining method integrated into a surgical microscope and can be conveniently used during microlaryngeal laser surgery and does not require further equipment.

History of the German-language ENT journals.

In 1864, the worldwide oldest journal in an area of the later established specialty of otorhinolaryngology was founded as the German Archiv für Ohrenheilkunde ("Archive of Otology") by its first editors Anton von Tröltsch (Würzburg), Adam Politzer (Vienna), and Hermann Schwartze (Halle/S.). Ear, nose, and throat (ENT) topics had previously been published in universal medical journals. In the next few decades, numerous journals in the field of ENT were founded, the eventful history of which is presented up to the present day. Particular attention is paid to the historical and personal context of the editors of newly founded magazines and their publishers. The journal landscape, which was changing through acquisitions and mergers of publishers, is described in detail. The merging of the specialties of otology and laryngo-rhinology in Germany, which lasted until the 1920s, had a profound influence on journal titles and contents. An attempt is made to present the most important titles in their historical development. All the important editors of the German ENT journals are mentioned, although it was not possible to include the names of the editors of the current journals, which are becoming more and more numerous. One chapter deals exclusively with the development of journal publishers. The inserted tables and figures will help to resolve some of the confusion caused by repeated similar names of journals by showing their historical development.

[History of the German-language ENT journals. German version]. / Geschichte der deutschsprachigen HNO-Zeitschriften.

In 1864, the worldwide oldest journal in an area of the later established specialty of otorhinolaryngology was founded as the German Archiv für Ohrenheilkunde ("Archive of Otology") by its first editors Anton von Tröltsch (Würzburg), Adam Politzer (Vienna), and Hermann Schwartze (Halle/S.). Ear, nose, and throat (ENT) topics had previously been published in universal medical journals. In the next few decades, numerous journals in the field of ENT were founded, the eventful history of which is presented up to the present day. Particular attention is paid to the historical and personal context of the editors of newly founded magazines and their publishers. The journal landscape, which was changing through acquisitions and mergers of publishers, is described in detail. The merging of the specialties of otology and laryngo-rhinology in Germany, which lasted until the 1920s, had a profound influence on journal titles and contents. An attempt is made to present the most important titles in their historical development. All the important editors of the German ENT journals are mentioned, although it was not possible to include the names of the editors of the current journals, which are becoming more and more numerous. One chapter deals exclusively with the development of journal publishers. The inserted tables and figures will help to resolve some of the confusion caused by repeated similar names of journals by showing their historical development.

[Training Curriculum for the Certificate "Diagnostics and Therapy of Oropharyngeal Dysphagia, including FEES", of the German Society for Phoniatrics and Pedaudiology and the German Society for Otolaryngology, Head and Neck Surgery]. / Ausbildungscurriculum zum Zertifikat "Diagnostik und Therapie oropharyngealer Dysphagien, inklusive FEES" der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie und der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie.

BACKGROUND: In Germany, about 5 million people of all ages suffer from dysphagia. Due to demographic change and improved medical care, the incidence of swallowing disorders is expected to increase. Dysphagia is associated with an increased morbidity and mortality and leads to a considerable financial burden on the health systems. The two most common causes of dysphagia are neurological disorders and head and neck cancer. Diagnostics and therapy have developed continuously over the past decades. In particular, the flexible endoscopic evaluation of swallowing (FEES) has become an established part of dysphagia diagnostics. RESULTS: The certificate "Diagnostics and Therapy of Oropharyngeal Dysphagia, incl. FEES" was developed by the German Society for Phoniatrics and Pedaudiology (DGPP) and the German Society for Otolaryngology, Head and Neck Surgery (DGHNO KHC) in cooperation with the German Professional Association for Phoniatrics and Pedaudiology and the German Professional Association of Otolaryngologists.It consists of three parts: the modules (A, B and C), the indirect supervision and a practical examination. Structure, detailed contents and requirements for obtaining the certificate are described in the following article. The qualification of the lecturers and auditors are also defined. CONCLUSION: The systematic training serves the quality assurance and establishment of standards in the diagnostics and therapy of oropharyngeal dysphagia in the area of phoniatrics and ear, nose and throat medicine.

Tracheobronchoscopy and esophagoscopy in current ear-nose-throat practice: an update.

Rigid and flexible bronchoscopies and upper aerodigestive endoscopy are important diagnostic and therapeutic tools in ENT. The use of flexible upper aerodigestive endoscopy allows simultaneous percutaneous endoscopic gastrostomy (PEG) placement. Based on a similar study analyzing endoscopies performed in 1995, an anonymous questionnaire was developed by the Arbeitsgemeinschaft Endoskopie of the German Society of Oto-Rhino-Laryngology Head and Neck Surgery to determine current trends in the use of bronchoscopy and upper aerodigestive endoscopy. Questionnaires were sent to 165 different ENT institutions in Germany. 57 questionnaires were evaluated. 4,294 rigid and 3,965 flexible bronchoscopies were performed as well as 8,897 rigid and 2,211 flexible upper aerodigestive endoscopies. These results are shown according to the size (number of beds) of the performing institutions. Foreign body removals and PEG placements were also analyzed and compared with previous studies. In conclusion, the survey shows that the total number of procedures performed is comparable to the number performed in 1995. There is, however, a considerable increase in the number of flexible procedures performed, especially in upper aerodigestive endoscopies. It is commendable that all 57 institutions provide PEGs for their patients. However, only about one-fifth of these is placed by the treating ENT, despite the fact that panendoscopies provide an ideal setting for the performance of this procedure. An improvement of this situation would be desirable.

Selective indication for positive airway pressure (PAP) in sleep-related breathing disorders with obstruction.

Positive airway pressure (PAP) is the therapy of choice for most sleep-related breathing disorders (SRBD). A variety of PAP devices using positive airway pressure (CPAP, BiPAP, APAP, ASV) must be carefully considered before application. This overview aims to provide criteria for choosing the optimal PAP device according to severity and type of sleep-related breathing disorder. In addition, the range of therapeutic applications, constraints and side effects as well as alternative methods to PAP will be discussed. This review is based on an analysis of current literature and clinical experience. The data is presented from an ENT-sleep-laboratory perspective and is designed to help the ENT practitioner initiate treatment and provide support. Different titration methods, current devices and possible applications will be described. In addition to constant pressure devices (CPAP), most commonly used for symptomatic obstructive sleep apnoea (OSA) without complicating conditions, BiPAP models will be introduced. These allow two different positive pressure settings and are thus especially suitable for patients with cardiopulmonary diseases or patients with pressure intolerance, increasing compliance in this subgroup considerably. Compliance can also be increased in patients during first night of therapy, patients with highly variable pressure demands or position-dependent OSA, by using self-regulating Auto-adjust PAP devices (Automatic positive airway pressure, APAP). Patients with Cheyne-Stokes breathing, a subtype of central sleep apnoea, benefit from adaptive servo-ventilation (ASV), which analyzes breathing patterns continually and adjusts the actual ventilation pressure accordingly. This not only reduces daytime sleepiness, but can also influence heart disease positively. Therapy with positive airway pressure is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because therapy is generally applied for life, the optimal PAP device must be carefully selected, taking into account side effects that influence compliance.