Publisher: Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie; Österreichische Gesellschaft für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Georg Thieme Verlag


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Georg Thieme Verlag

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Publications in this journal

  • Laryngo-Rhino-Otologie 09/2014; 93(9):588-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective:Accumulation of secretions in hypopharynx, aditus vestibule, and trachea is often found in cases of severe dysphagia and is considered a cardinal trait of high clinical and therapeutic importance. For the graduation of the severity level of accumulated secretions, a short version of the 4-point Murray secretion scale is available, which is also integrated into the protocol of the fiberoptic endoscopic evaluation of swallowing (FEES) according to the Langmore standard. This study aimed at the validation of the German translation of this short version in order to facilitate a uniform, standardized evaluation of the accumulation of secretions in dysphagic patients in the German language area. Material and Methods:For the examination of reliability and validity, a reference standard was defined by 2 dysphagia experts on the basis of 40 video files of the FEES examination, 10 videos for each of the severity grades. Afterwards, these videos were rated independently by 4 raters and re-rated in a new randomized order 2 weeks later. Results:Both the intra-rater reliability (τ>0,830***) and the inter-rater reliability (Kendalls W>0,890***) were highly significant and can be considered good. The same is valid for the correlation of ratings with the reference standard (τ=0,969***). Conclusions:The German translation of the short version of the 4-point Murray secretion scale is recommendable as a reliable and valid instrument for the graduation of the cardinal trait of oropharyngeal dysphagia and also as an evidence-based instrument for standardized use in the German language area.
    Laryngo-Rhino-Otologie 08/2014;
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    ABSTRACT: Background: Tinnitus is a widely spread symptom, which is perceived chronically by approximately 10% of the population. The vast majority of the tinnitus patients doesn´t feel impaired through the ear noise, but about 5-30% of the tinnitus patient are suffering in their everyday life. Whether severe distress is experienced cannot be explained by the quality of the ear noise itself (i. e. loudness or duration). Newer research tends to explain the difference in the experienced strain by the concept of acceptance. The aim of this study was to analyze the psychometric quality of a German Version of the "Chronic Pain Acceptance Ques-tionnaire" (CPAQ), namely the "Akzeptanzfragebogen bei chronischem Tinnitus" (AFCT) which has been adapted for tinnitus. Methods: 97 patients with chronic tinnitus have been tested at the start of an outpatient tinnitus group therapy. The following questionnaires were used: "Akzeptanzfragebogen bei chronischem Tinnitus" (AFCT) and "Tinnitusfragebogen" (TF). The structure of the AFCT was determined by a factor analysis. The reliability was evaluated by the estimation of the internal consistency (Cronbach Alpha). Results: Due to psychometric weakness and unclear factorial loadings 8 items have been removed. Out of the remaining 12 items the AFCT-12 has been developed. The AFCT-12 consists of 2 factors, which explain a variance of 54.9%. Both AFCT-12 and AFCT have a satisfactory reliability and validity. Conclusion: The results demonstrate that the AFCT-12 is a reliable and valid instrument to measure the acceptance of patients suffering from chronic tinnitus.
    Laryngo-Rhino-Otologie 08/2014;
  • Laryngo-Rhino-Otologie 08/2014;
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    ABSTRACT: The complex anatomy of the head and neck region requires the ability to raise a wide spectrum of pedicled and free flaps, to ensure optimal reconstruction of various defects by the reconstructive surgeon. The supraclavicular (island) flap, which has almost been buried in oblivion, provides excellent potential to reconstruct even bigger defects of the head and neck region, while causing minimal donor site morbidity at the same time. Its benefits lie in the reliable skin island and its wide arc of rotation, resulting in excellent cosmetic and functional outcomes.
    Laryngo-Rhino-Otologie 08/2014;
  • Laryngo-Rhino-Otologie 08/2014;
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    ABSTRACT: Background: A validated instrument to measure patient-related outcome and quality of life in facial palsy is not available in German language. Methods: 2 appropriate questionnaires, the Facial Clinimetric Evaluation (FaCE) scale and the Facial Disability Index (FDI) were translated and validated according to international guidelines. The internal consistency of both German versions was assessed. The results of FaCE and FDI were correlated with results of the SF-36, the House-Brackmann scale and the Stennert index. Results: 122 facial palsy patients with a median duration of 4.7 months were included. FaCE and FDI showed good to very good psychometric characteristics with Cronbach's alpha values between 0.667 and 0.907. Both questionnaires were able to distinguish different degrees of facial palsy. The comparison to the SF-36 shows the highest correlation with the subscale social function. Discussion: The German versions of the FDI and FaCE are valid and should now be applied more frequently to assess the disease-specific quality of life in patients with facial palsy.
    Laryngo-Rhino-Otologie 08/2014;
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    ABSTRACT: Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by an excessive concern with a non-existing or slight defect in physical appearance. BDD patients frequently show impaired judgment regarding the psychiatric origin of their concerns and often seek aesthetic treatment to resolve their appearance concerns. The central position of the nose in the face makes the nose one of the most common areas of concern in patients with BDD. Thus, aesthetic rhinoplasty is suspected to be one of the most frequently requested and performed surgical procedures in this population. However, there is a growing consensus that BDD should be considered a contraindication for aesthetic rhinoplasty, as favourable outcome is unlike [1-5]. In order to prevent patients from undergoing unsatisfying surgery and in the context of the increasing importance of medico-legal arguments, the rhinoplasty surgeon should be familiar with BDD. This article provides a focused review of issues pertaining to BDD that are relevant to the rhinoplasty surgeon.
    Laryngo-Rhino-Otologie 08/2014; 93(8):507-13.
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    ABSTRACT: Objective: Studies on the surgical treatment of OSAS in adults have shown an improved outcome after targeted therapy by drug-induced sleep endoscopy (DISE). So far, only a few studies have focused on this method in children. The aim of this study is to evaluate the impact of DISE for children with obstructive sleep-disordered breathing and to determine the influence of DISE on treatment recommendations. Subjects and Methods: The medical records of children (n=25) who underwent polysomnography and DISE between 05/2012 and 12/2013 were retrospectively reviewed. The subjects were divided into an UARS (upper airway resistance syndrome)/mild OSAS group (AHI<5; n=10) and a moderate/severe OSAS group (AHI≥5; n=15). Results: The oropharynx was the most common site of obstruction. Prevalence of complete obstruction at the oropharynx was significantly higher in moderate or severe OSAS (p=0.02). The obstruction pattern of the velopharynx was significantly associated with the size of the adenoids (p=0.02), but tonsil and adenoid size were not related to the severity of OSAS. 71% of children with grade IV tonsils showed complete obstruction of the oropharynx. After DISE, the initial management plan changed in 5 patients (20%). Conclusion: DISE is a promising technique to identify sites of obstruction in children with OSAS and to guide treatment decisions. Further studies are needed to predict persistent OSAS based on this tool.
    Laryngo-Rhino-Otologie 07/2014;
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    ABSTRACT: Introduction: Within the last years transoral robotic surgery (TORS) with endoscopic visualization and surgery has gained importance in the resection of head and neck tumors and is an alternative to transoral laser microsurgery. The further development of transoral endoscopic systems should enhance the surgical options and reduce the surgery related morbidity. Thus, we evaluated a new flexible endoscopy system in cadaver -dissections. Methods: In March 2014 we performed all standard procedures of transoral tumor surgery in the oropharynx, hypopharynx and larynx in 3 fresh cadaveric specimens using the Medrobotics Flex(®) System. In a prospective study we analyzed exposure, -visualization, accessibility and resectability of the respective -anatomic regions. Results: All relevant anatomic structures of the pharynx and supraglottic region could be well exposed, visualized and accessed. Tonsillectomies and resections of the soft palate as well as the base of tongue could be performed easily. Supraglottic resections were possible with a good visualization. The piriform sinus could be exposed, and controlled tissue resections were possible-. The vocal cords were accessible and cordectomies could be performed. Conclusion: By combining a robot assisted flexible endoscope with flexible instruments the Flex system facilitates the visualization and accessibility of all relevant anatomic structures of pharynx and larynx. It is a promising system which now has to be further evaluated in clinical trials.
    Laryngo-Rhino-Otologie 07/2014;
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    ABSTRACT: Hintergrund: Sekretansammlungen im Hypopharynx, Aditus laryngis und der Trachea finden sich häufig bei schweren Schluckstörungen und bilden damit ein Kardinalmerkmal von hoher klinischer und therapeutischer Relevanz. Zur Einteilung des Schweregrads akkumulierter Sekrete bietet sich die Verwendung der Kurzversion der Vier-Punkte-Sekretbeurteilungsskala nach Murray an, so wie sie im Protokoll für die fiberoptisch endoskopische Evaluation des Schluckvorganges (FEES) nach Langmore integriert zu finden ist. Ziel dieser Studie war die Validierung der deutschen Übersetzung dieser Kurzversion, um eine einheitliche und standardisierte Bewertung von Sekretansammlungen schluckgestörter Patienten im deutschen Sprachraum zu erreichen. Material und Methoden: Zur Reliabilitäts- und Validitätsüberprüfung wurden von zwei Dysphagieexperten 40 Videosequenzen von FEES-Untersuchungen, zehn pro Schweregrad, als Referenzstandard definiert und von vier Ratern unabhängig voneinander beurteilt. Ein Re-Rating erfolgte in neuer Randomisierung im Abstand von zwei Wochen. Ergebnisse: Die Intrarater-Reliabilität (τ > 0,830***) und die Interrater-Reliabilität (Kendalls W > 0,890***) zeigten sich sehr gut und hochsignifikant, wie auch die Korrelation mit dem Referenzstandard (τ = 0,969***), so dass auch die Übereinstimmungsvalidität als sehr gut zu werten ist. Schlussfolgerungen: Die deutsche Fassung der Kurzversion der Vier-Punkte-Sekretbeurteilungsskala nach Murray ist als reliables und valides Instrument zur Graduierung des Kardinalmerkmals einer oropharyngealen Schluckstörung und auch als evidenzbasiertes Instrument empfehlenswert zur einheitlichen Verwendung im deutschen Sprachraum.
    Laryngo-Rhino-Otologie 07/2014; 93:1-4.
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    ABSTRACT: Inducible Laryngeal Obstruction vs. Bronchial -Asthma Background: Inducible laryngeal obstructions (ILO) represent paroxysmal and sometimes severe dyspnea caused by different factors. Symptomatically ILO resembles bronchial asthma and is therefore often misdiagnosed. In the following 3 cases regarding a special type of ILO, the exercise induced laryngeal obstruction (EILO) will be presented. It will also be demonstrated, how EILO can be diagnosed and differentiated from bronchial asthma. Method: Laryngeal symptoms were provoked by spiroergometry (treadmill or bicycle) and inspected by laryngoscopy. Results: Symptoms could be provoked in all of the 3 patients by either treadmill or bicycle spiroergometry. When a stridor occurred, usually 1.5-2 min after the anaerobe threshold had been exceeded, spiroergometry showed a decline or plateau of carbon dioxide emission and oxygen intake. Laryngoscopy revealed adduction of the vocal cords during inspiration occa-sionally with a collapse of supraglottic structures towards the endolarynx. Discussion: This article is the first to report that EILO can be distinctly depicted by spiroergometry. The decline or plateau in oxygen and carbon dioxide curves in coordination with the onset of stridor, approximately 1.5-2 min after the anaerobe threshold had been exceeded, was found to be reproducible in all cases. Furthermore, endoscopy immediately following peak exhaustion represents a practical tool for the identification of EILO.·
    Laryngo-Rhino-Otologie 07/2014;
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    ABSTRACT: Laryngeal Adductor Reflex Background: A rapid closure of the vocal folds is necessary, whenever foreign materials or food particles penetrate into the larynx. Otherwise a passage of these particles into the trachea or the lower respiratory tract would be imminent. An aspiration could mechanically block the respiratory tract and cause severe dyspnoea or cause aspiration pneumonia. Method: For this systematic review a selective literature research in PubMed and Scopus using the keywords "laryngeal adductor reflex" and "vocal fold closure" has been carried out. Results: Apart from the oesophago-glottal and pharyngo-glottal closure reflexes, the laryngeal adductor reflex (LAR) has been investigated in particular. The LAR qualifies as a reflectory laryngeal adductor mechanism and involves early, presumably di- or oligosynaptic ipsilateral LAR1 as well as late polysynaptic ipsi- and contralateral LAR2 components. In clinical routine diagnostic settings of dysphagia, LAR is only assessed qualitatively and usually triggered by air pulses or tactile stimulation. Discussion: Dysphagiologists often find that not only the laryngeal sensibility in general is impaired, but especially the protective laryngeal adduction mechanism, which results in a higher risk of aspiration. Thus, it appears mandatory to test the LAR not only qualitatively but also quantitatively. Unfortunately a valid and reliable method that can be employed in clinical practice has not yet been put forward.
    Laryngo-Rhino-Otologie 07/2014; 93(7):446-449.
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    ABSTRACT: Idiopathic subglottic stenosis is causing a narrowing of the central airway at the laryngotracheal junction. Etiology is remaining unclear at large. There is a marked preponderance for women in the fertile age, an association to estrogene or progesterone metabolism remains doubtful. Suggested treatment varies from repeated endoscopic interventions to primary open resection. Therapy selection in this heterogeneous condition should be based on the individual patient situation as well as surgeon's expertise. This complex entity is prone to complications and should preferably be managed in a referral center.
    Laryngo-Rhino-Otologie 07/2014; 93(7):474-484.
  • Laryngo-Rhino-Otologie 07/2014; 93(7):471-473.
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    ABSTRACT: Penetrating Injuries of the Head and Neck Region - A Potentially Life Threatening Situation Background: Cuts, stabs and gunshot wounds in the head and neck region are potentially life-threatening because of the high risk of vascular lesions. A consistent emergency management is usually based on an operative exploration of the wound with effective reconstruction of viable structures. Patients and Methods: Various penetrating injuries of the head and neck region are described in 11 cases with respect of age, gender, course of events of injury, type of injury, involved structures, diagnostic and operative procedures and outcome and compared with current literature and guidelines. Results: In 10 of 11 patients, in the context of an interdisciplinary emergency room management, CT angiography was performed following clinical examination. A surgical exploration and wound treatment was performed in 9 of these patients. The common carotid artery, the external carotid artery and large venous blood vessels of the neck were injured in 2 cases respectively. None of the patients deceased or suffered permanent damage. Conclusion: The outcome of deep head and neck lesions with relevant vascular trauma is determined by a rapid and interdisciplinary approach. A rapid, systematic and interdisciplinary approach in specialized trauma centers has a significant role in ensuring that patients with penetrating wounds in the head and neck -region rarely die due to their serious injury or their consequences.
    Laryngo-Rhino-Otologie 06/2014;
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    ABSTRACT: Topical Application of Tranexamic Acid to Prevent Post-tonsillectomy Haemorrhage Background: Haemorrhage after tonsillectomy (TE) is a frequent and possibly major complication. The aim of the present study was to examine, if the rate of haemorrhage after tonsillectomy could be reduced by the topical application of Tranexamic acid (TXA) postoperatively. Material and Methods: Between November 2011 and April 2013, all patients (n=246) received TXA postoperatively to prevent haemorrhage after TE. The patients were instructed to dilute 1 ampulla of TXA in 300 ml of tap water (concentration 0.2%) from postoperative day 5-10 and to gargle or spray the tonsillar fossae 5-6 times daily. The study group was compared retrospectively with a control group of patients undergoing TE with-out postoperative application of TXA from December 2010 to November 2011 (n=248). Results: The overall rate of postoperative haemorrhage was 19% and 22% in the study and control group, respectively. The rate of postoperative bleeding that needed surgical intervention was at 8.9% and 11.3% in the study and control group, respectively. Topical application of TXA did not significantly reduce the rate of postoperative haemorrhage after TE. Conclusion: Topically applied TXA did not reduce postoperative haemorrhage after TE. However, a slight tendency to less bleeding which needed surgical intervention was found in pa-tients older than ≥ 12 years.
    Laryngo-Rhino-Otologie 06/2014;
  • Laryngo-Rhino-Otologie 06/2014; 93(6):364-5.
  • Laryngo-Rhino-Otologie 06/2014; 93(6):398-400.
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    ABSTRACT: Adipose-derived Stromal Cells (ASC) - Basics and Therapeutic Approaches in Otorhinolaryngology Mesenchymal stem cells from adipose tissue can be easily harvested with less discomfort, low donor-site morbidity and high amount compared to bone marrow-derived stem cells. Due to their multilineage differentiation potential in various cell types, immunmodulatory properties and their capability to enhance wound healing, ASC are a promising cell source for tissue engineering approaches and regenerative medicine. They are characterized by the expression of specific surface marker proteins and their differentiation potential into the mesenchymal lineages. Whereas only preclinical studies are published for otorhinolaryngology-related therapeutic options using ASC, various diseases, for instance graft-versus-host disease, have already been treated with ASC in single cases or clinical trials. Safety and genomic stability of ASC as well as the risk of spontaneous malignant transformation are still disputed. This review summarizes the current literature on characterization and anatomic localization of ASC. In addition, beside the presentation of preclinical studies concerning therapeutic approaches in otorhinolaryngology as well as of current clinical applications, the issue of safety of ASC in human stem cell therapy is discussed.
    Laryngo-Rhino-Otologie 06/2014; 93(6):369-80.