Prediction of Parkinson's disease subsequent to severe depression: a ten-year follow-up study.

Major depressive disorder (MDD) has been associated with an increased risk of subsequent Parkinson's disease (PD) in case-control and cohort studies. However, depression alone is unlikely to be a useful marker of prodromal PD due to its low specificity. In this longitudinal observational study, we assessed whether the presence of other potential markers of prodromal PD predicts the subsequent development of PD in MDD patients. Of 57 patients with severe MDD but no diagnosis of PD who underwent a structured interview, olfactory and motor investigation and transcranial sonography at baseline, 46 (36 women; mean age 54.9 ± 11.7 years) could be followed for up to 11 (median, 10) years. Three patients (2 women; age 64, 65 and 70 years) developed definite PD after 1, 7, and 9 years, respectively. The combined finding of mild asymmetric motor slowing, idiopathic hyposmia, and substantia nigra hyperechogenicity predicted subsequent PD in all patients who could be followed for longer than 1 year. Out of the whole study cohort, only the subjects with subsequent PD presented with the triad of asymmetric motor slowing, idiopathic hyposmia, and substantia nigra hyperechogenicity in combination with at least two out of four reportable risk factors (family history of PD, current non-smoker, non-coffee drinker, constipation) at baseline investigation. Post-hoc analysis revealed that additional rating of eye and eye-lid motor abnormalities might further improve the prediction of PD in larger cohorts. Findings of this pilot-study suggest that MDD patients at risk of subsequent PD can be identified using an inexpensive non-invasive diagnostic battery.

Microanatomy of the tympanic membrane in chronic myringitis obtained with optical coherence tomography.

A microscope-based optical coherence tomography (OCT) device was used to assess the microanatomy of the tympanic membrane in patients with chronic myringitis. A prospective study was designed for this purpose. OCT measurements of the tympanic membrane were done on 11 patients with myringitis with a microscope-based spectral domain OCT system. The in vivo findings were compared with those findings of a control group consisting of 36 patients with retraction pockets or atrophic tympanic membranes (n = 13), myringosclerosis (n = 12) and perforations (n = 11). In active chronic myringitis, the thickness of the tympanic membrane is increased compared to healthy membranes and to other pathological conditions of the tympanic membrane. Consistent changes of the microanatomy of the tympanic membrane were found in chronic myringitis with OCT. Serial OCT measurements revealed no biofilm suspicious findings in all patients with active chronic myringitis. Intraoperative and in vivo OCT measurements may help to detect microanatomical changes of the tympanic membrane in chronic myringitis and in other conditions of the tympanic membrane.

Would an endosteal CI-electrode make sense? Comparison of the auditory nerve excitability from different stimulation sites using ESRT measurements and mathematical models.

UNLABELLED: Regarding potential endosteal cochlear implant electrodes, the primary goal of this paper is to compare different intra- and extra-cochlear stimulation sites in terms of current strengths needed for stimulating the auditory nerve. Our study was performed during routine cochlear implantation using needle electrodes for electric stimulation and by visually recording electrically elicited stapedius reflexes (ESRT) as a measure for the stimulus transfer. Of course this rather simple setup only allows rough estimations, which, however, may provide further arguments whether or not to proceed with the concept of an endosteal electrode. In addition, a mathematical model is being developed. In a pilot study, intra-operative electric stimuli were applied via a needle electrode commonly used for the promontory stimulation test. Thus, stapedius reflex thresholds (ESRTs), electrically elicited via the needle from different points inside and outside the cochlea served as indicators for the suitability of different electrode positions towards the modiolus. Tests were performed on 11 CI-recipients. In addition, the extension of electrical fields from different stimulation sites is simulated in a mathematical cochlea model. In most patients ESRT measurements could be performed and evaluated. Thus an "endosteal" stimulation seems possible, although the current intensities must be higher than at intraluminal stimulation sites. Moreover, our model calculations confirm that the extension of electric fields is less favourable with increasing distance from the electrode to the ganglion nerve cells. In terms of hearing, the concept of an endosteal electrode should only be promoted, if its superiority for hearing preservation can be proven, e.g. in animal experiments. However, for other indications like the electric suppression of tinnitus, further research seems advisable. LEVELS OF EVIDENCE: N/A.

[Optical coherence tomography in otolaryngology]. / Az optikai koherenciatomográfia alkalmazási lehetoségei a fül-orr-gégészetben.

Optical coherence tomography is an imaging technique based on coherence interferometry. It is used in many medical fields due to its non-invasive imaging capabilities with micrometer resolution. The aim of the authors was to review the applicability of the optical coherence tomography in otolaryngology. Literature data and their own studies show that optical coherence tomography is a reliable method for identifying and targeted biopsy of inflammated, pre-malignant or cancer tissue in human laryngeal and pharyngeal mucosa. Another emerging field for optical coherence tomography is diagnosis of middle ear diseases, especially stapes ankylosis and cholesteatoma.

Rigid confocal endoscopy for in vivo imaging of experimental oral squamous intra-epithelial lesions.

BACKGROUND: A rigid confocal endoscope has been developed to assess the oral squamous epithelium of mice and to determine sensitivity, specificity, and accuracy of this new technology. METHODS: This endoscope is connected to the commercially available Heidelberg Retina Tomograph (HRT). HRT is a device with a 670-nm diode laser designed to acquire topographical measurements of the optic nerve head. Real-time rigid confocal endoscopy is demonstrated by imaging the epithelial lesions of a mice model. Six-week-old male C57Bl/6 mice were randomly divided into a non-treated group (n = 10) and into a 4-nitroquinoline 1-oxide (4-NQO)-treated group (n = 50). In the 4-NQO-treated group, the mice obtained 4-nitroquinoline 1-oxide in the drinking water (100 microg/ml) to induce tumourigenesis in the mouse tongue. The 4-NQO-solution was diluted in the drinking water for mice. After an 8-16-week carcinogen treatment with 4-NQO (ad libitum), mouse tongues were dissected within 3 h after CO(2) overdose. After confocal microscopy of all lesions of the tongue, conventional histopathological investigation was performed. RESULTS: The inter-rater reliability for the two observers of the confocal microscopic findings was found to be Kappa = 0.59 (P < 0.001). The penetration depth varied in the healthy tissue of the underside of the tongue throughout this study and was measured between 104 and 240 microm. In keratotic lesions, the penetration depths were diminished and varied between 80 and 140 microm. Strong keratinization inhibits the evaluation of the epithelium. For differentiation between low-grade and high-grade squamous intra-epithelial lesions, a sensitivity and specificity of 73% and 88% was reached. CONCLUSIONS: The animal experiment with this non-invasive new technology indicates that this imaging technology facilitates the detection of pre-cancerous lesions of the underside of the oropharynx. Human studies on oropharyngeal and laryngeal lesions are needed to prove the applicability of this method in the field of otorhinolaryngology.

Normative data for a solution-based taste test.

The aim of our study was to study gustatory function in a large portion of the general population using liquid tastants, extending previous research. Further, we investigated the test-retest reliability of the test used. Data from 944 healthy subjects were used (498 women and 446 men, mean age 45 years; age range 5-90 years). For lateralized assessment of gustatory function, liquid taste solutions were used with different concentrations of each tastant (sweet 0.03, 0.1, 0.4, 2 g/mL sucrose solution; sour 0.01, 0.05, 0.1, 0.15 mL citric acid; salty 0.025, 0.075, 0.15, 0.36 mL sodium chloride solution; bitter 0.0002, 0.0005, 0.001, 0.01 mL quinine hydrochloride). A drop (approximately 20 µL) of liquid tastant was applied on the right side or on the left side of the anterior/posterior third of the extended tongue. The taste test had a good test-retest reliability r (304) = 0.78 (P < 0.001) for the total score and r (304) = 0.77 (P < 0.001) for the right-sided measures and r (304) = 0.75 (P < 0.001) for the left-sided measures, respectively. Gustatory sensitivity was found to decrease with age; women were more sensitive to gustatory stimuli than men. Irrespective of the sex-related differences, the total score at the 10th percentile was 28 in subjects younger than 15 years, 26.1 for ages from 16 to 35 years, 25 for ages from 36 to 55 years, and 24 for subjects older than 56 years of age. In conclusion, this test is recommended for clinical assessment of the ability to taste. The test provides reliable data, which is easy to handle, inexpensive, timesaving and can be self-made.

Monitoring residual hearing during cochlear implantation by intra-operative brainstem audiometry.

OBJECTIVE: Aim of this paper is to prove the applicability of intra-operative recordings of auditory brainstem responses during cochlear implantation. METHODS: The clinical practicability of intra-operative monitoring of hearing thresholds (Notched-Noise BERA, Amplitude Modulation Following Response [AMFR]) is presented in the respective case. The recordings were performed prior to the cochlear implantation and were compared with those obtained during and after cochlear implantation. RESULTS: It is demonstrated that the patient's cochlear function can be monitored; residual hearing is available after surgery. CONCLUSION: The possibility of monitoring of hearing thresholds may add some security to the concept of electric-acoustic stimulation.

Changes of oral trigeminal sensitivity in patients after middle ear surgery.

OBJECTIVES: The specific aim of this study was to re-investigate the effect of chorda tympani damage on both trigeminal sensitivity and taste ability. STUDY DESIGN: Prospective study. METHODS: Capsaicin-impregnated filter paper strips (5 concentrations, 0.0001-1%) were used to measure trigeminal thresholds. The strips were placed on the anterior tongue for 10 seconds. Thresholds were estimated in two ways: 1) thresholds related to sensory perception and 2) intensity-related thresholds. The test was applied to 29 patients who underwent middle ear surgery (mean age, 49 yr; 16 females, 13 males). Results were compared with those of 63 healthy subjects (mean age, 40 yr; 36 females, 29 males). In addition to trigeminal thresholds, measures of gustatory function were also obtained using both the validated "taste strips" test kit and electrogustometry. RESULTS: For lateralized testing with capsaicin, significant differences were found between preoperative and postoperative thresholds and between the operated and nonoperated side, with thresholds being higher postoperatively on the operated side. The sensation-related thresholds from the operated tongue side exhibited a correlation with the corresponding postoperative electrogustometric thresholds. A higher degree of chorda manipulation was associated with higher postoperative capsaicin thresholds at the operated tongue side. CONCLUSION: Pain-related sensitivity of the tongue decreases after middle ear surgery, indicating that chorda tympani function also influences intraoral trigeminal sensitivity.

Noise exposure of the inner ear during drilling a cochleostomy for cochlear implantation.

OBJECTIVES: Inserting an electrode array into the cochlea may cause inner ear trauma, which has to be minimized, particularly in cochlear implant patients with substantial residual hearing. Another potential inner ear trauma has, to a large extent, been neglected so far: the acoustic trauma that can occur during cochleostomy using different techniques. In this study, the noise exposure of the inner ear during the drilling procedure was re-evaluated. In experiments on temporal bones, quantitative measurements of sound pressure level (SPL) were carried out while a cochleostomy for cochlear implantation was drilled. STUDY DESIGN: Experimental study. MATERIALS AND METHODS: Acoustic measurements during different drilling procedures were carried out on four human temporal bone preparations equipped with microphones attached to the round window. Special calibrations were carried out, which allowed determination of SPLs affecting the cochlea during the drilling procedure. RESULTS: The highest SPLs measured on the cochlea were recorded when a still-intact endosteal membrane was touched by the burr. The SPL exceeded 130 dB and reached a level almost comparable with the situation when the ossicular chain is touched by a running burr. CONCLUSIONS: In the drilling procedure for a cochleostomy, the inner ear may be affected by very high SPLs, particularly if the endosteal membrane is left intact and comes into contact with the running burr. Of course, the resulting SPLs depend on the drilling speed and the size and characteristics of the burr (larger burrs cause higher SPLs); however, we are of the opinion that the cochlear function is at risk, anyway, if special precaution is not exercised. Even when working with reduced drilling speed, the surgeon should be aware of the high risk in the form of an acoustic trauma, which may endanger residual hearing. Recommendations in terms of "soft surgery" are given in the paper (e.g., the use of microhooks instead of a drill to remove the very last shell of bone covering the cochlea).

Optical coherence tomography as an orientation guide in cochlear implant surgery?

CONCLUSION: With optical coherence tomography (OCT) it is basically possible to reveal parts of the cochlear morphology without opening its enveloping membranes. Thus, it may serve as a helpful guide for the surgeon to localize the scala tympani precisely before opening the fluid-filled inner ear to insert the electrode array. OBJECTIVE: To improve anatomical orientation in cochlear implant surgery before definitively opening the fluid-filled inner ear. The question was whether a new imaging technique, OCT, might provide information about the site of the underlying inner ear structures (scala tympani, scala vestibuli) and could, consequently, guide the surgeon towards the scala tympani. MATERIALS AND METHODS: In a preliminary study, OCT was carried out on human temporal bone preparations, in which a cochleostomy ('fenestration') was performed leaving the endosteum and the fluid-filled inner ear intact. OCT was applied via a prototype of a specially equipped operating microscope. The mode of OCT used in this context was spectral-domain (SD)-OCT. RESULTS: On scans, which can be read analogous to B-mode sonography, OCT provides information about structures on the inner surface of the partly exposed but still intact membranous cochlear lining - such as scala tympani or scala vestibuli.

Contact endoscopic comparison of morphology of human fungiform papillae of healthy subjects and patients with transected chorda tympani nerve.

BACKGROUND: The chorda tympani nerve (CTN) carries gustatory fibers from taste buds of fungiform papillae (fPap) of the anterior portion of the tongue. Accordingly, middle ear surgery with transection of the CTN may result in gustatory impairment. With use of contact endoscopy, the present study aimed to compare number and shape of fPap and subepithelial vessel formation in patients after CTN transection with that of healthy controls. MATERIAL AND METHODS: The number of fPap per square centimeter was obtained in addition to measures of gustatory sensitivity using electrogustometry and intensity ratings of natural taste stimuli. Data from 32 healthy subjects (mean age 40 yr; 16 female, 16 male) were compared with those from 14 patients whose CTN had been cut and partly resected during middle ear surgery because of cholesteatoma (mean age 38 yr; 7 female, 7 male). Middle ear surgery was performed by two of the authors. RESULTS: In healthy subjects, a higher fPap density was found on the tongue's tip compared with its edge; younger subjects had higher densities than older subjects. No sex-related differences were observed. Patients with transected CTN exhibited a significant decrease of taste function as measured with both natural and electric stimuli. In patients, we found significantly fewer and flatter fPap on the side of the tongue where surgery had been performed in comparison with the contralateral side. In addition, fPap density at the ipsilateral side was significantly lower compared with fPap density on the respective side in healthy controls. CONCLUSION: As established through contact endoscopy, the number of fPap decreases in relation to deafferentation and also in relation to the subjects' age, both of which are accompanied by a decreased gustatory sensitivity.

Laser scanning microscopy of the human larynx mucosa: a preliminary, ex vivo study.

OBJECTIVE: Laser scanning microscopy (LSM) supplies in vivo information from epithelia up to depths between 0.1 to 0.5 mm. The aim of this ex vivo prospective pilot study was to investigate the potential use of LSM for the diagnosis of laryngeal cancer and its precursors. METHODS: Forty-three larynx specimens of 26 patients (age 35-61 years, mean age 51.9+/-9.5 years; 7 women and 19 men) with laryngeal lesions were investigated with LSM. The LSM findings were compared with histopathologic sections. The following criteria were used for characterization of cancerous lesions: enlarged nuclei, enlarged cells with variable shapes, cluster of cells, increased nucleus/cytoplasm ratio, irregular cell architecture, and loss of cellular junctions characterized by lack of visualization of the cell membrane. RESULTS: LSM enables the visualization of epithelium up to the basement membrane, Reincke space, the subepithelial vessels, and the fibers of the subepithelial space. In contrast to the squamous epithelium, the respiratory epithelium bears kinocilia. The beat of the cilia and the directed mucous transport can be observed ex vivo. With the use of the presented malignancy criteria, a sensitivity of 72.7% and a specificity of 82.9% for differentiation of dysplasia and benign laryngeal lesions from cancer were reached. CONCLUSIONS: LSM in an ex vivo manner supplies microscopic images up to the subepithelial space. LSM could represent a new technology in laryngology to visualize larynx epithelia. In the next step, in vivo LSM will be applied to evaluate laryngeal lesion in vivo.

Positioning Accuracy in Otosurgery Measured with Optical Tracking.

OBJECTIVES: To assess positioning accuracy in otosurgery and to test the impact of the two-handed instrument holding technique and the instrument support technique on surgical precision. To test an otologic training model with optical tracking. STUDY DESIGN: In total, 14 ENT surgeons in the same department with different levels of surgical experience performed static and dynamic tasks with otologic microinstruments under simulated otosurgical conditions. METHODS: Tip motion of the microinstrument was registered in three dimensions by optical tracking during 10 different tasks simulating surgical steps such as prosthesis crimping and dissection of the middle ear using formalin-fixed temporal bone. Instrument marker trajectories were compared within groups of experienced and less experienced surgeons performing uncompensated or compensated exercises. RESULTS: Experienced surgeons have significantly better positioning accuracy than novice ear surgeons in terms of mean displacement values of marker trajectories. The instrument support and the two-handed instrument holding techniques significantly reduce surgeons' tremor. The laboratory set-up presented in this study provides precise feedback for otosurgeons about their surgical skills and proved to be a useful device for otosurgical training. CONCLUSIONS: Simple tremor compensation techniques may offer trainees the potential to improve their positioning accuracy to the level of more experienced surgeons. Training in an experimental otologic environment with optical tracking may aid acquisition of technical skills in middle ear surgery and potentially shorten the learning curve. Thus, simulated exercises of surgical steps should be integrated into the training of otosurgeons.

Confocal microscopy of the peripheral gustatory system: comparison between healthy subjects and patients suffering from taste disorders during radiochemotherapy.

OBJECTIVES: Laser-scanning microscopy (LSM) was used to compare taste buds and epithelia of fungiform papillae of healthy subjects with those of patients suffering from taste disorders during/after radiochemotherapy (RCT). Aim of the study was to investigate effects responsible for taste loss at a microscopic level. STUDY DESIGN: Prospective study. METHODS: Data from 12 healthy subjects (mean age 52.4, SD 9.5 years) were compared with those of 12 patients (mean age 54.7, SD 8.5 years) with head and neck cancer suffering from taste disorders during RCT. Four parameters from LSM were selected for analysis: 1) distance between the pore of the taste buds of fungiform papillae and the crest of the papillary vessels; 2) epithelial cells of each taste bud at 34 mum; 3), cell density, and 4) area of the taste pore at 4 mum. These data were correlated to measures of gustatory sensitivity obtained with both the validated "taste strips" test kit and electrogustometry. RESULTS: Patients complaining from taste disorders during RCT exhibited a significant decrease of taste function assessed with both natural and electric stimuli. In these patients, we found thicker epithelia and smaller areas of the taste pores compared with healthy subjects. In 30% of those patients, no taste pores were detectable; in deeper sections, however, normal taste buds were present. CONCLUSIONS: In conclusion, in RCT patients with taste disorders, LSM indicates changes of epithelia of fungiform papilla but no changes of the taste bud structure. Damage of the chorda tympani nerve by scattered rays, direct or indirect mucotoxic effects of chemotherapeutic agents, and covering of taste pores by epithelial cells are likely reasons for taste loss during RCT.

An "endosteal electrode" for cochlear implantation in cases with residual hearing? Feasibility study: preliminary temporal bone experiments.

BACKGROUND: Over the years, an increasing number of patients with some degree of residual hearing have received cochlear implants. In these cases, the marginal benefit provided by hearing aids alone is not sufficient; however, as experience has already shown, when hearing aids are used in combination with a cochlear implant, more benefit may be obtained. As a prerequisite, this requires that residual hair cell function must remain intact postoperatively. One of the European pioneers of cochlear implants, Ernst Lehnhardt, questioned whether residual hearing might better be preserved if the implanted electrode permits the fluid-filled inner ear space to remain intact. Subsequently, he proposed insertion of a very flat electrode array design into the extraluminal space between the spiral ligament and the bony cochlear wall (endosteum). OBJECTIVE: Our study aimed to determine whether it is feasible to insert an endosteal electrode model intracochlearly but extraluminarily, anatomically, and ultimately surgically and to determine the impact on surrounding intracochlear structures. METHODS: Insertion of two silicon models of an endosteal electrode were carried out in 15 human temporal bones. Histologic examination of the temporal bones after electrode insertion was performed on both fresh and fixed specimens to determine whether the desired anatomic site of insertion was achieved. In combination with light reflected and electron microscopic techniques, the extent to which the surrounding structures were impacted was also examined. RESULTS: Successful insertion of the prototype silicon endosteal electrodes was performed intracochlearly and extraluminarly in 11 of the 15 temporal bone specimens, confirming the anatomic feasibility of insertion into the crevice between the spiral ligament and endosteum. CONCLUSIONS: On the basis of the anatomy of the human temporal bone, insertion of an "endosteal electrode" is feasible. Subsequently, in vivo animal studies are needed to determine the physical effects of insertion of an endosteal electrode design prototype upon the functionality of the surrounding intracochlear structures and in particularly the ability to preserve hearing function.

Fixation of the stapes footplate in children: a clinical and temporal bone histopathologic study.

OBJECTIVE: To clarify the anatomic characteristics, cause, and surgical outcomes relating to fixation of the stapes footplate in children. STUDY DESIGN: Retrospective case review and four-center histopathologic study of temporal bones. SETTING: Tertiary referral center. PATIENTS: We reviewed charts and histologic specimens from 12 children, aged 7 to 13 years, who underwent surgery for footplate fixation. We also studied stapes footplates in 288 temporal bones from 181 children ranging from newborn (20-44 weeks of gestation) to 13 years of age. MAIN OUTCOME MEASURE: Anomalies of the stapes footplate in children. RESULTS: The average age of diagnosis of hearing loss was 6.6 years. Criteria for a diagnosis of otosclerosis were progression of a conductive hearing loss and an intraoperative finding of fixation of the anterior stapediovestibular joint in five patients. In contrast, a nonhomogeneous, thickened, fixed footplate and the absence of an annular ligament were indicators of congenital fixation in six children. In one child, there was neither new bone from the otic capsule nor any obvious otosclerotic foci. In the temporal bone study, 17 of 181 (9.4%) children had anomalies of the stapes footplates, with ankylosis in 4 (2.2%). In two subjects (1.1%), there was an otosclerotic focus not in contact with the stapes footplate. CONCLUSION: Children younger than 6 years with various congenital anomalies are more likely to have congenital footplate fixation, which will present intraoperatively as a thickened footplate with a partial or absent annular ligament. Children older than 6 years with progressive conductive hearing loss are more likely to have otosclerosis, which presents as fixation of the anterior stapediovestibular joint. The difference in surgical outcomes is probably related to different degrees of footplate abnormality.

[Testing the sense of smell using validated procedures]. / Die Prüfung des Riechvermögens mit validierten Verfahren.

There is a growing interest into the investigation of smell disorders in both research and clinical practice. For psychophysical ("subjective") investigations related to the sense of smell a variety of test kits are available, namely the various "Sniffin' Sticks" kits, the UPSIT (University of Pennsylvania Smell Identification Test) or the CCSIT (Cross-Cultural Smell Identification Test). Recording of olfactory evoked potentials (OEPs) and respiration olfactometry can be used for diagnosing smell dysfunctions in a more objective way.

[Testing the sense of taste using validated procedures]. / Die Prüfung des Schmeckvermögens mit validierten Verfahren.

Psychophysical tests related to the sense of taste are usually less complex than those of the sense of smell. In addition to global tests a regional examination of the sense of taste might be indicated to search for nerve lesions. There are numerous validated psychophysical tests available based on the administration of liquid or solid substrates. The use of electrical currents (electrogustometry) is especially feasible for a rapid regional testing. The registration of gustatory event-related potentials to objectify results from psychophysical examination is possible although limited to a few centers world-wide.

Comparative Study between the Surgeon's Intraoperative Evaluation and Histopathology for Diagnosis of Laryngeal Lesions.

Objective. To compare the surgeon's evaluation and histopathology for diagnosis of laryngeal lesions. Material. A clinical survey was distributed to laryngeal surgeons, ENT clinicians, and students in 2013 at the Department of Otorhinolaryngology in Rostock. Participants were asked to anonymously identify laryngeal pathologies and to assess the severity of the lesion starting from hyperplasia and inflammation over moderate dysplasia to early laryngeal cancer. Images of similar clinical laryngeal lesions were demonstrated in a multiple-choice modus to assess the surgeon's intraoperative evaluation. The questionnaires were digitally processed and evaluated. The results were correlated with histopathology and compared between experienced laryngeal surgeons, clinicians inexperienced in laryngeal surgery, and medical students from the Medical Faculty of the University of Rostock. Results. Sensitivity and specificity varied among the various groups, being highest in experienced laryngeal surgeons. In this group, sensitivity, specificity, positive and negative predictive value, and accuracy were 85%, 56%, 44%, 90%, and 65%, respectively. In 4% and 31%, laryngeal disease was underdiagnosed and overdiagnosed, respectively. In this group, Kappa statistics resulted in Kappa 0.32 (P < 0.001). Conclusion. This clinical survey clearly demonstrates that conformity between histopathology and evaluation of the laryngeal lesion depends on the surgeon's experience.

Conservative management of post-intubation tracheal tears-report of three cases.

Iatrogenic tracheal rupture is a rare complication after intubation. We present three patients with tracheal tears. In all of these patients, a common finding was a lesion of the posterior tracheal wall with postoperative subcutaneous and emphysema as the first clinical sign of the rupture. Diagnosis and follow-up were based on clinical and endoscopic findings and chest computed tomography (CT) scans. In our cases with progressive subcutaneous and mediastinal emphysema or dyspnea, we performed a tracheotomy and bypassed the lesion with a tracheostomy tube to avoid an increase in air leakage into the mediastinum. Under broad-spectrum antibiotic therapy, no mediastinitis occurred and all patients survived without sequelae. Closure of tracheostomy was scheduled for 1-2 months after tracheal injury. Analysis of surgical and anesthesiological procedures revealed no abnormalities and the accumulation of tracheal injuries was considered as accidental. We found that in clinically stable patients with spontaneous breathing and with no mediastinitis, a conservative management of tracheal tears is a safe procedure.