Reliability and Accuracy of Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population.

INTRODUCTION: Telemedicine is an increasingly prevalent component of medical practice. In otolaryngology, there is the potential for telemedicine services to be performed in conjunction with device use, such as with a nasolaryngoscope. This study evaluates the reliability of remote examinations of the upper airway through an iPhone recording using a coupling device attached to a nasopharyngolaryngoscope (NPL). METHODS: A prospective, blinded study was performed for pediatric patients requiring an NPL during an office visit. The NPL was performed using a coupling device attached to a smartphone to record the examination. A second, remote otolaryngologist then evaluated the recorded examination. Both otolaryngologists evaluated findings of anatomic sites including nasopharynx, oropharynx, base of tongue, larynx including subsites of epiglottis, arytenoids, aryepiglottic folds, false vocal cords, true vocal cords, patency of airway, and diagnostic impression, all of which were documented through a survey. Results of the survey were evaluated through inter-rater agreement using the κ statistic. RESULTS: Forty-five patients underwent an NPL, all of which were included in the study. The average age was 4.9 years. The most common complaint requiring NPL was noisy breathing (n = 16). The inter-rater agreement for overall diagnosis was 0.74 with 80% percent agreement, rated as "good." Other anatomic subsites with "good" or better inter-rater agreement were nasopharynx (0.75), oropharynx (0.75), and true vocal cords (0.71), with strong percentage agreement of 89%, 91%, and 87%, respectively. Both users of the adaptor found the recording setup to run smoothly. CONCLUSION: A telemedicine device for NPL use demonstrates strong diagnostic accuracy across providers and good overall evaluation. It holds potential for use in remote settings.

The Relation Between Otolaryngology-Specific Symptoms and Computed Tomography Findings in Ambulatory Care COVID-19 Patients.

OBJECTIVE: This study aimed to conduct a study to evaluate the relation between otolaryngology-specific symptoms and computed tomography findings in ambulatory care COVID-19 patients. PATIENT AND METHODS: The study was conducted with medical records of 987 (82%) patients with confirmed COVID-19 virus via real-time reverse transcription-polymerase chain reaction between March 11, 2020, and April 21, 2020. Patients were divided into 2 groups as computed tomography (CT)-negative and CT-positive groups considering the presence of the CT findings depicting COVID-19 disease. RESULTS: The mean age was significantly higher in CT-positive group than CT-negative group (41.53 ± 12.82 vs 36.61 ± 11.81, P < .001). Cough and shortness of the breath were observed with a significantly higher rate in CT-positive group than that of CT-negative group (44% vs 29.9%, P = .001 and 18.4% vs 9.7%, P = .002, respectively). CONCLUSIONS: In conclusion, advanced age, cough, and shortness of breath could be related to CT scan positivity.

Imaging features of mucopolysaccharidoses in the head and neck.

Ear, Nose and Throat (ENT) involvement by mucopolysaccharidoses is very common, affecting over 90% of patients, and occurs early in the course of the disease. Airway narrowing secondary to glycosaminoglycan deposition results in greatly increased morbidity, mortality and risk of anesthetic complications in these patients. Macroglossia, restricted mouth opening, tracheobronchomalacia, adenotonsillar hypertrophy along with other factors such as a short, rigid and unstable cervical spine, cardiac disease and increased susceptibility to respiratory infections result in a high perioperative mortality and morbidity. Imaging is most beneficial for evaluation of the airway, in particular in patients with obstructive symptoms and prior to intubation. We review the ENT manifestations of mucopolysaccharidoses including airway involvement, otological, oral and dental complications. 3-D reconstructions of the trachea, which is routinely captured on CT imaging of the spine, can be of great value for planning intubation in this patient population.

Head and neck manifestations of granulomatosis with polyangiitis: a retrospective analysis of 19 patients and review of the literature

Introduction: Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis characterized by a necrositing granulomatous inflammation of the upper and lower respiratory tracts and focal/proliferative glomerulonephritis. In more than 70% of the cases, the presenting symptoms are head and neck manifestations that are often misdiagnosed as infectious or allergic in etiology. Objective: The present study provides an analysis of head and neckmanifestations in a series of patients diagnosed with GPA. It also evaluates their medical and surgical treatment and provides a review of the relevant literature. Methods: A retrospective analysis of 19 patients diagnosed with GPA at a public tertiary care hospital between 2006 and 2017 was performed. Results: A total of 19 patients were included in the present study, and 16 of them presented head and neck manifestations. Sinonasal symptoms were the most common, affecting 56% of the patients, followed by laryngotracheal (31.25%) and ear (25%) symptoms. In 7 patients, sinonasal symptoms were the first manifestation of the disease (43.75%). Four patients underwent surgery at some stage of the disease. Conclusions: Head and neck involvement is common in GPA and may stand for the first or the onlymanifestation of the disease. The otolaryngologists play a central role in the diagnosis and long-term treatment of these patients, and they have to keep this pathology in mind when treating patients with ENT symptoms that do not respond as expected to the treatment (AU)

Manifestation of granulomatosis with polyangiitis in head and neck.

OBJECTIVES: Granulomatosis with polyangiitis is a rare autoimmune disease of the group of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Involvement of the ear, nose and throat (ENT)-region is only described in a few case series and case reports. The objective of this study is to systematically characterise the ENT-involvement in a large series of GPA patients. METHODS: GPA patients examined in the Department of Otorhinolayngology of the Christian-Albrechts-University of Kiel between 1990 and 2012 were included. Diagnosis was based on histological, serological and clinical parameters. GPA patients were examined in a standardised way based on the Ear Nose and Throat Activity Score (ENTAS) or its precursor. Medical history, ENT examination, diagnostic findings (ear, nose) and cranial radiology were documented cumulatively. RESULTS: A total of 230 GPA patients were included in this study. Over 95% of them showed ENT-involvement. 59% of the patients showed nasal obstructions, 57% a loss of smell. A hearing loss was diagnosed in 23% of the patients, 50% involvement in MR or CT scans and 15% showed laryngeal involvement. CONCLUSIONS: The data of the largest monocentric study presented here demonstrate a frequent ENT-involvement in GPA patients. Rhinological and ontological manifestations are most common.

[A german-wide inquiry about the significance of ultrasound in the head and neck area]. / Deutschlandweite Umfrage zur Wertigkeit der Ultraschalldiagnostik im Kopf-Hals-Bereich.

A german-wide inquiry was performed for the evaluation of diagnostic ultrasound, current applications and the significance in the head and neck area throughout 2013 and 2014. We focused on the integration of the ultrasound diagnostic in the ENT routine and compared the implementation of ultrasound in the practice and in the clinical setting. Furthermore the current concepts of standardization in sonographic documentation, training guidelines and assessment of clinical impact of the ultrasound were evaluated.

Does incidental mastoid opacification on computerized tomography necessitate referral to ENT?

OBJECTIVE: The prevalence of incidental temporal bone disease on magnetic resonance imaging has been widely reported in the medical literature. Despite this, there currently is little evidence regarding incidental otological disease on computerized tomography (CT). Thus, the study aimed to review the CT prevalence of asymptomatic adult ear disease and evaluate the appropriateness of ear, nose, and throat (ENT) referral following its discovery. STUDY DESIGN: Retrospective observational study of 468 CT scans. METHODS: All CT head scans performed between January 2015 and January 2016 containing the keyword mastoid in the radiological report initially were recruited for the study. Scans performed in the pediatric population following head trauma or for otological indications were excluded, leaving 468 eligible radiological images. The presence of prior otological disease or referral subsequently was established using electronic patient records. RESULTS: Mastoid and/or middle ear opacification was noted to be present in 62 patients (13%). Of these patients, 10 subsequently were found to have prior otological intervention or review. Following exclusion of these patients, the rate of incidental temporal bone disease was recorded as 11%. CONCLUSION: Data from this study suggests that incidental findings in an asymptomatic individual do not necessitate referral or further intervention. Furthermore, it is the author's recommendation that radiological findings be closely correlated with clinical examination to reduce false diagnosis and inappropriate referral to ENT. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2860-2865, 2017.

[Role of cone-beam computed tomography in diagnostic otorhinolaryngological imaging]. / A cone-beam komputertomográfia alkalmazása a fül-orr-gégészeti képalkotásban.

Accurate diagnosis and preoperative planning in modern otorhinolaryngology is strongly supported by imaging with enhanced visualization. Computed tomography is often used to examine structures within bone frameworks. Given the hazards of ionizing radiation, repetitive imaging studies exponentially increase the risk of damages to radiosensitive tissues. The authors compare multislice and cone-beam computed tomography and determine the role, advantages and disadvantages of cone-beam computed tomography in otorhinolaryngological imaging. They summarize the knowledge from the international literature and their individual imaging studies. They conclude that cone-beam computed tomography enables high-resolution imaging and reconstruction in any optional plane and in space with considerably lower effective radiation dose. Cone-beam computed tomography with appropriate indications proved to be an excellent diagnostic tool in otorhinolaryngological imaging. It makes an alternative to multislice computed tomography and it is an effective tool in perioperative and postoperative follow-up, especially in those cases which necessitate repetitive imaging with computed tomography.

Temporal bone MRI with 3D-FIESTA in the evaluation of facial and audiovestibular dysfunction.

PURPOSE: To evaluate the clinical usefulness of magnetic resonance imaging (MRI) of the temporal bone using three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequences in patients with facial and audiovestibular dysfunction. METHODS: We retrospectively reviewed the MR images of 1263 patients who presented with hearing loss (n=429), peripheral facial palsy (n=96), tinnitus (n=341) or vertigo (n=397). There were 605 men and 658 women, with a mean age of 46.97±16.95 (SD) years (range: 2-83 years). Positive MRI findings that were responsible for clinical manifestations in individual patients were categorized according to the anatomic sites and etiologies of the lesions. RESULTS: Positive MRI findings possibly responsible for clinical manifestations were found in 232/1263 (18.37%) patients, including 86/429 (20.05%) patients with hearing loss, 21/96 (21.88%) patients with facial palsy, 62/341 (18.18%) patients with tinnitus, and 63/397 (15.87%) patients with vertigo. CONCLUSION: Although the use of MRI of the temporal bone using 3D-FIESTA shows positive findings in only 18.37% of patients, it provides important information in those with facial and audiovestibular dysfunction. However, for patients with normal MRI of the temporal bone, other etiological factors should be investigated in order to clarify or elucidate the cause of clinical manifestations.

[The application of the modern radiodiagnostic methods in otorhinolaryngology].

This paper highlights the problems and difficulties associated with the introduction of the modern radiodiagnostic methods including computed and magnetic resonance tomography into the otorhinolaryngological practice in this country. The approaches to addressing these problems and overcoming difficulties are proposed. The review of the diagnostic potential of various modalities is presented. The modern algorithms for the examination of the patients presenting with various diseases of the ears, nose, and throat are described with special reference to their diagnostic value.

Indications of cone beam CT in head and neck imaging.

CONCLUSION: Cone Beam Computed Tomography (CBCT) can be widely used in imaging of bony structures of the anterior and lateral skull base. Significant differences of applied dosages result from the different protocols of the various indications. OBJECTIVES: CBCT is increasingly being used in head and neck imaging. Until now, no precise knowledge about its dedicated usage existed. METHODS: All CBCT of 2012 and 2013 were analysed with regard to the technical parameters, the performance, and the indication for imaging. RESULTS: In total, 1862 patients were examined in 2012 and 2013. The top eight indications of the anterior skull were (1) chronic rhinosinusitis with disturbed nasal breathing (30.3%); (2) chronic rhinosinusitis (17.6%); (3) midfacial traumatology (13.7%); (4) disturbed nasal breathing (12.8%); (5) acute rhinosinusitis (7.9%); (6) polyposis nasi (6.3%); (7) search for focus (3.9%); and (8) persistent rhinorrhea (1.2%). For the lateral skull base, the top eight were (1) control after cochlear implantation (28.4%); (2) cholesteatoma (19.7%); (3) visualization of ear anatomy (8.7%); (4) chronic otitis media mesotympanalis (6.3%); (5) conductive hearing loss (5.1%); (6) suspected mastoiditis (4.8%); (7) pathology of external auditory canal (4.8%); and (8) otosclerosis (3.3%). Applied dosage for the anterior skull base was significantly lower than for the lateral skull base (2.90 mGy vs 5.92 mGy, p < 0.05); 2.4% and 3.6% of patients' images, respectively, had to be repeated.

[Interpretation of ultrasound findings in otorhinolaryngology. Salivary glands, paraganglioma, angioma, esophagus, hypopharynx, extra cranial vessels and temporomandibular joint]. / Interpretation von Ultraschallbefunden in der HNO-Heilkunde. Speicheldrüsen, Paragangliome, Angiome, Ösophagus, Hypopharynx, Halsgefäße und Kiefergelenk.

The second part of this continuing medical education article focuses on sonographic assessment of the salivary glands, cervical paraganglioma, angioma, esophagus, extra cranial blood vessels and the temporomandibular joint. The currently available minimally invasive therapeutic options (e. g. sialendoscopy, lithotripsy, therapeutic duct lavage and extracapsular dissection) for salivary gland disease presuppose a precise imaging modality. Modern ultrasound is able to meet this challenge, making additional imaging a rare necessity. Regions of the neck with a difficult topography (esophagus and hypopharynx) can often be successfully portrayed sonographically. Furthermore, ultrasound enables functional evaluation of swallowing in the cervical parts of the esophagus in dysphagia patients. In addition to the branchial cleft anomalies and lymph nodes discussed in part 1, paraganglioma, angiomatosis and neurogenic tumors are important differential diagnoses of solid lesions of the neck. Finally, venous and arterial alterations of the extracranial vessels of the neck relevant to clinical routine are depicted, as are pathological conditions of the temporomandibular joint relevant to the otorhinolaryngologist.

Patterns of cervicofacial infections: analysis of the use of computed tomography.

OBJECTIVE: The aim of this study was to determine which clinical, microbiological and radiological factors contribute to the need for repeated computed tomography (CT) imaging and surgical drainage. METHODS: In this retrospective study, medical records of all patients who underwent surgical drainage of cervicofacial infections between January 2006 and August 2010 at a London tertiary referral centre were analysed. Patients who underwent CT due to a clinical suspicion of deep cervicofacial infection were divided into two groups: (1) single CT only and (2) repeated CT imaging. These groups were then compared using Fisher's exact test. Patients requiring return to theatre for additional exploration and drainage of collection were also analysed. RESULTS: Four hundred and forty-five patients were admitted with cervicofacial infections, of whom 78 patients had a CT scan. The most frequent site of infection was the submandibular space, involving 54 % of patients. Among the patients who underwent repeated imaging compared to those who underwent a single CT scan, the parapharyngeal space was involved significantly more frequently (5/24 vs 2/54, p = 0.03), as was the presence of multiple-space infections (13/24 vs 15/54, p = 0.04) and osteomyelitis (4/24 vs 0/54, p = 0.007). Multiple-space infection was also more frequent in the group who required repeat visits to theatre as compared to those who had a single drainage (7/9 vs 23/69, p = 0.02). CONCLUSIONS: The majority of cervicofacial infections are managed without the need for CT scanning. Presence of infection in multiple cervicofacial spaces and in the parapharyngeal space and presence of osteomyelitis result in persistent sepsis necessitating repeat imaging and drainage.

Infecciones por Streptococcus anginosusen otorrinolaringología: revisión de 9 casos clínicos / Infections caused by Streptococcus anginosusin otolaryngology: review of 9 clinical cases

Introducción: El Streptococcus anginosus (SA) es un habitante común de la cavidad oral y tracto gastrointestinal, y puede ser un patógeno agresivo causante de abscesos en varios sitios del cuerpo. Aparentemente, su rol en infecciones de cabeza y cuello está adquiriendo cierta notoriedad y no está claramente reportado en la literatura. Objetivo: El objetivo del presente estudio fue evaluar las implicancias clínicas de estas infecciones en otorrinolaringología. Material y método: Estudio retrospectivo de todos los pacientes diagnosticados microbiológicamente con infecciones causadas por Streptococcus anginosus, tratados en el Servicio de Otorrinolaringología del Hospital Barros Luco-Trudeau entre los años 2007 a 2012. Se describen las características clínicas, microbiológicas y el manejo de los pacientes. Resultados: La muestra estuvo constituida por 9 casos, 3 hombres y 6 mujeres, con una mediana de edad de 52 años (rango 6-70). Los sitios de infección fueron: absceso periamigdalino (2 casos), un absceso peritraqueostoma, un absceso submandibular, un absceso submentoniano, un absceso parafaríngeo con extensión retrofaríngea y mediastino, un caso de absceso cerebral frontal secundario a sinusitis frontal complicada, un caso de otitis media crónica activa, y un caso de sinusitis maxilar crónica. Discusión: El SA ha sido reportado como un agente causal de infecciones potencialmente graves en cabeza y cuello. Su identificación requiere de consideraciones especiales para el cultivo, y al ser un microorganismo común puede ser confundido e informado como S viridans o Streptococcus anaeróbico. Es importante reconocer al SA como un patógeno a considerar en infecciones de cabeza y cuello.

Introduction: Streptococcus anginosus (SA) is a common inhabitant of the oral cavity and gastrointestinal tract, and can be an aggressive pathogen causing abscesses in various body sites. Apparently, its role in head and neck infections is gaining some notoriety that it is not clearly reported in the literature. Aim: The aim of this study was to evaluate the clinical implications of this infections in otolaryngology. Material and method: A retrospective case series study of all patients diagnosed microbiologically with Streptococcus anginosus infections treated at the Department of Otolaryngology, HospitalBarros Luco-Trudeau from 2007 to 2012. We describe the clinical and microbiological features, and treatment of each patient. Results: The sample consisted of 9 patients, 3 men and 6 women, with a median age of 52 years (range 6-70). The sites of infection were: peritonsillar abscess (2 cases), peritracheostomy abscess, submandibular abscess, submental abscess, parapharyngeal abscess with retropharyngeal and mediastinal extension, a case of frontal brain abscess secondary to frontal sinusitis, a case of otitis chronic active half, and one case of chronic maxillary sinusitis. Discussion: SA has been reported as a causative agent ofpotentially serious infections in the head and neck region. Their identification requires special considerations for growing, and because of being a common microorganism may be confused and informed as Streptococcus viridans or anaerobic streptococcus. It is important to recognize SA as a relevant pathogen in head and neck infections.

[Imaging quality and dosage in ENT--what do we really need?]. / Dosisreduktion unter Betrachtung der erforderlichen Bildqualität--Wie viel Dosis braucht ein Bild?

BACKGROUND: Today, imaging of nose, paranasal sinuses and temporal bone by CT is standard in preoperative diagnostics. The need of reduction of applied dosage leads to the necessity of research in necessary imaging quality. Therefore this paper deals with new developed anatomical checklists and the analysis of imaging quality on anterior and lateral skull base. MATERIAL AND METHODS: With 3 human complete heads over 400 examinations were performed on one cone beam CT device under varying x-ray-tube adjustments. 31 anatomic parameters were evaluated (Excellent, well, poor, not evaluable) for every data set. A summation score was built for every examination. RESULTS: As well for paranasal sinuses as for temporal bone a constant excellent imaging quality could be seen in high dosages. Certainly, in low dosages a reduction of imaging quality was detected. The optimal range (all parameters visualized well as average) could be evaluated for paranasal sinuses between 2,0 and 3,0 mGy and between 3,0 and 4,0 mGy for temporal bone. So, a reduction of 70-80% in comparison to highest adjustments of today is possible and realistic. In comparison to standard protocols, a reduction of about 50% can be reached. CONCLUSION: The possibility of dose reduction by discussion of the necessary imaging quality from clinical point of view could be shown.

[Primary mucosal tuberculosis of head and neck region: a clinicopathologic analysis of 47 cases].

OBJECTIVE: To study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region. METHODS: Forty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains. The clinical and pathologic features were analyzed with review of the literature. RESULTS: The patients included 26 male and 21 female, with mean age 47.1 years (range 14-84 years). There were three sinonasal TB, 19 nasopharyngeal TB, two oropharyngeal TB, 18 laryngeal TB, four middle ear TB, one salivary gland TB and one laryngeal TB complicating laryngeal cancer. The initial symptoms were nasal obstruction, mucopurulent rhinorrhea, epistaxis, snoring, hoarseness, dysphagia, odynophagia, serous otitis, hearing loss, tinnitus, and otalgia. Physical examination result was variable, from an apparently normal mucosa, to an evident mass, or a mucosa with an adenotic or swollen appearance, ulcers, leukoplakic areas, and various combinations thereof. CT and MRI findings included diffuse thickening, a soft-tissue mass, calcification within the mass and bone destruction resembling malignancy. Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells. Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases. Follow-up data were available in 42 patients. CONCLUSIONS: Primary TB arising in the head and neck mucosa is rare. It may mimic or co-exist with other conditions. The characteristic histopathology is a granuloma with central caseous necrosis and Langhans'giant cells. Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.

Reliability of shear wave ultrasound elastography for neck lesions identified in routine clinical practice.

PURPOSE: To evaluate the reliability of shear wave ultrasound elastography (SWE) in the neck. MATERIALS AND METHODS: 176 neck lesions (40 thyroid, 56 lymph nodes, 46 salivary, 34 miscellaneous) identified in a routine US clinic underwent SWE by one or two blinded radiologists. For this study, SWE required the operator to acquire three 10 second dynamic colour-coded SWE cineloops per lesion, select one static image per cineloop, and place circular regions-of-interest within the entire lesion and stiffest part to generate 3 SWE measurements per static image. For logistical reasons, one radiologist evaluated all 176 lesions and the other evaluated 58 lesions. Both radiologists also reviewed 27 archived cineloops independently to assess SWE excluding practical technique. Reliability was assessed using intraclass correlation coefficients (ICCs) concordance correlation coefficients (CCCs) and coefficients of repeatability (CORs). RESULTS: Test-retest ICCs for the radiologist evaluating 176 lesions were 0.78 - 0.85 (fair-excellent agreement), CCCs were 0.85 - 0.88 (substantial agreement), and CORs were 14.9 - 36.1 kPa. For both radiologists evaluating 58 lesions, intra-rater and inter-rater ICCs were 0.65 - 0.78 and 0.72 - 0.77 respectively. For SWE excluding practical technique, inter-rater ICCs were 0.97 - 0.98 (excellent agreement). ICCs differed according to tissue, being higher in thyroid lesions than lymph nodes (p < 0.001), and higher in benign than malignant lesions (p values < 0.001). CONCLUSION: Intra- and inter-rater reliability of SWE is fair to excellent according to ICCs. SWE reliability is influenced appreciably by acquisition technique. Nevertheless, CORs for SWE are not negligible. To determine whether these results are acceptable clinically, further research is required to establish SWE stiffness values of normal and pathological tissues in the neck.

Safer radiologic imaging of otolaryngologic disease in children.

The use of medical imaging is commonplace in children with otolaryngologic disease, with a not insignificant and increasing exposure to ionizing radiation from such diagnostic imaging. Radiation exposure imparts potential cancer risk, particularly in children, who have long life expectancies and are more sensitive to the adverse effects of ionizing radiation. We summarize these issues, with a focus on computed tomography (CT) in children. The otolaryngologist plays a key role optimizing the use and minimizing the risk of diagnostic imaging in children by ordering the correct test at the best time for the right reasons. In concert with radiology colleagues and informed parents, we can improve the safety of radiologic imaging for the children we diagnose and treat.

[Indications of intraoperative ultrasound in head and neck surgery]. / Indikationen für den intraoperativen Ultraschall bei Eingriffen im Kopf-Hals-Bereich.

BACKGROUND: A possible use of B-scan sonography arises from the difficulty in transferring information by means of imaging to the intraoperative situation, which is now possible with navigation systems in complicated surgical procedures in the field of otolaryngology. A solution to this problem offers the intraoperative use of ultrasonography for orientation in soft tissue surgery. PATIENTS AND METHOD: A prospective study involving 115 patients in total entailed scanning with a small part linear and fingertip probe with either 10 and 7.5 MHZ. An ultrasound endoscope featuring a 7.5 MHZ convex probe was used to image endolarygeal processes. RESULTS: Indications included panendoscopies, parotidectomies, submandibulectomies, lymph node exstirpations and abscess incisions. The colour doppler sonography was used in reconstructive surgery involving microvascular transplants. The display of soft tissue tumours provided information about tumour size as well as demarcation or infiltration of neighbouring structures. The fingertip probe and the ultrasound endoscopy served to evaluate areas that were morphologically difficult to access. After clamping the radial artery when harvesting the forearm flap, a sufficient perfusion of the thumb and later the sufficiency of the vascular anastomosis could be verified. CONCLUSION: The intraoperative use of sonography is an inexpensive non-invasive procedure that can be performed by the surgeon himself and allows quick and reliable orientation during difficult operations.